B-2017-2030 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2030
10736 FARALLONE DR CUPERTINO,CA 95014-4453(369 34 010) PELLE HEATING&
AIR INC
SAN JOSE,CA 95111
OWNER'S NAME: MATHUR SUNILAND SUNITA TRUSTEE DATE ISSUED: 11/27/2017
OWNER'S PHONE:408-504-2082 PHONE NO:(408)978-7060
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING.VENTILATING AND AIR-CONDITIONING
Lic.#809887 X BLDG _ELECT _PLUMB
Contractor PELLE HEATING&AIR INC Date 10/31/2019 YX MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license is in full force and effect. REPLACE FURNACE(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
.erformance of the work for which this permit is issued.
/` ave and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$3600.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 369 34 010
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:Abby Ayende
"•natureaate 11/27/2017 Date: 11/27/2017
OWNER-BUILDER DECLARATION RE-ROOFS:
•
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofmg material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:11/27/2017
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaniinants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of Califomia. If,after making this certificate of the Health&Safety Code,Sectio s 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall 7 or authorized agen . .! ''
be deemed revoked. Date:11/27/2017 ��
APPLICANT CERTIFICATION CONSTRUCTIOIENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.l agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Professional
Signature Date 11/27/2017
CONSTRUCTION PERMIT ApPL'CATION
U DNG DIVISIONtS
\\,- 'I `' COMMUNITY DEVELOPMENT DEPARTMENT Z03�
10300 TORRE AVENUE •' CUPERTINO,CA 95014-3255 20'�
:V.::-• ertino.oT� PEMIT#B- " �—
(408)777-3228 0 build @cup .O DEF#
CUpEl�.T O
RE ROOF ❑SWIMMINGPOOLISPA.
0 NEW CONSTRUCTION ❑ADDITION ❑ALTERATION 0 T.I. A❑MEP 0 (( (�I
PROJECT ADDRESS /01n 10 ., n y ot I I T�e Dr I ci �"1 v L
OWNERNAM6 jao (J PHONE o
L` ��� IE"MPIL l
STREET ADDRESS a '
34 CONTRACTOR NAME ❑QWNER-BUILDER COMPANY NAME --- --- LI t.Mt NUMBt,K LICENSE TYPE
fte Iiect n far C2a
I STREET ADDRESS �. Cl STATE,Z /�^I�� I
SI ‘D ceer fold. C - V1 i�'e, CIS (/t s
E-MAIL PHONE BUS.LIC R
� 5i col. Ileh kerx,l,,;H Le; R-i? -lobo 2�
❑ARCHITECT ❑,OWNER ❑ CONTRACTOR AGENT❑ENGINEER❑DEVELOPER
�0TENAANT /� �Iry' /y
CONTACT NAMES IAV\. (�l(A E-MAILle&S'ica
' r 1.lI` hV1' ioix 1 e ne+
STREET ADDRESS QTJ{�) IW` CITY STE,ZIP ttt/// PHONE
,-iS1-I) C,l� -ter for I t c-F- �(Oir!i (7oS-e, (Pr C1S/ 3(,
DECRII'TON
,SINGLE-FAMILYiDUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL ' _ I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR • GARAGE 0 ATTACHED'
BATHROOM SF SF SF SF 0 DETACHED
EXLSING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: 0 NO S F
POOLS! 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED 0 YES 0 NO I TOTAL-SF
RECEIVED BY: / / T TALL�VA/L'I]MlTION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 2�fr�_� c _ _' � JIUU J
RE-ROOF I EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHIN ES❑TILE OTHER(SPECIFY)
REMOVE REPLACE❑NO IF NO PLYWOOD 01" ❑3/8" - PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #OF LAYERS THICKNESS❑S/8" OTHER ' ❑OSB 0 CDX OTHER .. ',2 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
By my signature below I certify to each of the following: I am the property'owner or authorized agent to act on the property owner's behalf. I
have read this application and the information I have provided is correct. I have read the Description of Work and verify itis accurate. I agree
to comply with all applicable local ordinances and state laws relatingto'bhilding construction. I authorize representatives of Cupertino to
enter the above-identified property for i. -Cyon purposes.4iack•.wldge and authorize all information contai ed on th• application form
to be made available for public record. " , 1/.....i /104,
. i
Signature of Applicant/Agent: / j l i
� � Date:
SUPPLEMENTAL INFORMATION REQUIRED 1
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition p'ermit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure;form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a Ietter of approval from the Home Owner's Association •
.I
i'; B1dgApp_2oJ7.doc revised 08/01/17
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CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
.. ,
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name:
, Mathur Sunil Date Prepared: 2017-11-27
A.General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,use one - - -
CF1R-ALT-02 document for each dwelling unit.
01 Project Name Mathur Sunil 02 Date Prepared 2017-11-27
03 Project,Location 10736 Farallone Dr. 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name• Sunil Mathur
-;-):.:..AIR, , •••••'.....
mfolls,„!%:),,, Dwelling Unit Conditioned
07 Zip Code 95014
62-N::-4w.t.Ati. . /421 1512
-mi,Ktmr ttvl::.Floor Area‘...
Number of Space
,40-iat Oil'.;:i•
09 Climate Zone 4 .--.,* is:,OPConditioning(SC)Systems in 1 ___
: -.'-g.P,1'i;:•i.:*?'_1
this Dv/ening Unit, - , - = _ -_-__.,-,_- ____ _- _ -
,
B.Space Conditioning(SC)System Information .
01 02 03 04 A:44 . 01 W 05 l;,,,, : U2,f;,,r1,. i tre‘ -.,p„,i 07 08 09 10
Is the Sc.„,v „,,:11mqlking,Ivi v,. ,,
SC System : $C System CFA served systerr'i•J'' '-rdiideririt ''lligielling'keWSC- Installing Installing Installing.
Identification
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
_
Sunil Mathur Whole House 1512 Yes No Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:417-A020130364A-000-000-0000000-0000 Registration Date/Time:201741-27 13:00:47 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-27 13:00:49 .
Schema Version:rev 10/16
J `
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CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) - (Page 2 of 3)
D.Altered Space Conditioning System (Sections 150.2(b)1E and F) -_- _- _--_ = = - _- - -
01 - 02 03 — 04 — 05 _ 06- 07 08 09— - -10 11 12 — --- Heating—Heating = Cooling-• -
System Heating Altered Heating, Minimum Altered Cooling Minimum Required New or
•Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
Central gas All new No cooling This field or This field or This field or This field or
Sunil Mathur heating AFUE 0.81 No cooling component section is not section is not Setback section is not section is not
furnace components altered applicable ' applicable applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems
-Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums R6,(CZ 1 1D 12 and 13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are i6stal1e 6ducted systems,or when more than 40 ft of duct length is replaced
-Leakage rate compliance:<=15%or<=10%leakage to outside,or seal all accessible leaks. 6.4 t
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required
Exceptions: •
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Toting requirements.
-Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
key ;;.,
E. Entirely New or Complete Replacement Duct System,with or"without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)1E, F)
'This'section.does'norapply to t tis project.
•
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)1C)
This section does not apply to this project.
•
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•
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Registration Number:417-A020130364A-000-000-0000000-0000 Registration Date/Time:2017-11-27 13:00:47 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-27 13:00:49
Schema Version:rev 10/16
•
•
•
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems.(formerly CF-1R-ALT-HVAC) (Page 3 of 3)
•
Documentation Author's Declaration Statement =
1. I certify that this Certificate of-Compliance documentation is accurate.and complete._ ___ - __-_ -
Documentation Author Name: : Documentation Author Signature:. - •
Jessica Valencia Jessu:wVa.lencur. _
Company: Signature Date:
Pelle Heating and Air,Inc. 2017-11-27
Address: CEA/HERS Certification Identification(if applicable):
3751-D Charter Park Court •
City/State/Zip: Phone•
San Jose CA 95136 '408978-7060 •
•
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California j}rli
1. The information provided on this Certificate of Compliance is true and correct
2. I am eligible under Division 3-of the Business and Professions Code to accept responsibility for�t)i wilding design or system design identified on this Certificate of Compliance(responsible•designer).
3. That the energy features and performance specifications,materials,components,and manufa ft�red devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement agency fort approval with this building permit application.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building'permits)issued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance is reyuired'to be iiiduded V(iith the dicumentation the builder provides to the building owner at occupancy.
Responsible Designer Name: • , Responsible Designer Signature:
urvirattnea
Jessica Valencia `' 5
Company: Date Signed:
Pelle Heating and Air,Inc. 2017-11-27
Address: License: •
3751-D Charter Park Court 809887
City/State/Zip: Phone:
San Jose CA 95136 • 408-978-7060
•
Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered
document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number:417-A020130364A-000-000-0000000-0000 Registration Date/Time:2017-11-27 13:00:47 • HERS Provider:CHEERS
CA Building Energy Efficiency Standards 2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-27 13:00:49
Schema Version:rev 10/16 •
SMOKE / CARBON MONOXIDE ALARMS
(7• OWNER CERTIFICATE OF COMPLIANCE
?.'.- COMMUNITY DEVELOPMENT DEPARTMENT• SUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE:.CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•bulldino cupertlno.oro
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PURPOSE
This affidavit is a.self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family:and multi-family dwellings shall be provided.with Smoke Alarms and Carbon
Monoxide alarms. W1.en the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC SectionR314.,R315, and CTC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
_bedroom(s)•-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X _
Carbon Monoxide,alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420:6 and shall be approved by the Office of the State Tire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarms)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarnn(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms specified below have been tested and are operational, as of the
date signed below. �y f
Address: 101 to I ID Q Dr � fig q - LI Permit No. 2 D)`F-2Qo
Specify Number of Alarms: #Sthoke Alarms: MI . #Carbon Monoxide Detectors: j
• !have read and agree to comply with the terms and conditions of this statement
Owner(or owner Agent's)NBme:
Signature Date:
Cnnrrv
arrnr'f Name:
f � � ;
y / '-'
1 tv� Signature..._..,,../ Licit.....,C...r� '.a.' c Date: � � �1
4 '
,Synokeand'COfor;n doc revised 01/10/2017