The URL can be used to link to this page

11110124 '' .- -1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10188 MYER PL CONTRACTOR:SERVICE PERMITNO: 11110124 CHAMPIONS OWNER'S NAME: EGAN WILLIAM F AND MARY A 7020 COMMERCE DR DATE ISSUED: 11/22/2011 G NER'S PHONE: PLEASANTON,CA 94588 PHONE.NO:(925)444-4444 lLT LICENSED CONTRACTOR'S DECLARATION r r r /1 BUILDING PERMIT INFO: uLDG ELECT PlItAllt License Class CZo Lick g1?ONO r r I- - qq// � � NIECII RESIDENTIAL COMMERCIAL Contractor .SQ.fU WPi LUA.1�101cS Date ��'ZZ-1� hereby affirm that 1 am licensed under the provisions of Chapter 9 •JOB DESCH IPTION: REPLACE FURNACE AT SAME LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of die Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4598 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31623049.00 Occupancy Type: permit is issued. APPI.ICAN'I'CI?R'I'IFICA'1'ION I certify that I have read this application and stale that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and slate laws relating WITHIN 180 DAYS OF PER ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property f'or inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the /� �� 2 Z--G7 granting of this permit. Additionally,the applicant understands and will comply Issued by:, ! Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ^ ( n /2..� II_��_I RN:ROOFS: Signature lT4'{� �l"�'D�7�' Date All roofs shall be inspected prior to any roofing material being installed If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 nm exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETFER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ileallh&Safety Code,Sections 25505,25533,and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarotions: Health&Safely Cade,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emir hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants its defined by the Boy Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safely Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Ma1 q^-x� Z� Owner or authorized ogen(•�•�1u7Datr.`I 1 permit is issued I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ CJ Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter o•n die above mentioned property for inspection purposes.(We)agree to save ARCH II'1'I?C'I"S DECLARATION unify,and keep harmless the City Of Cupertino against liabilities,judgments, I's,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO •6 ITEMS OF 6 ' PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31623049 . 00 DATE ISSUED. . . . . . . : 11/22/2011 RECEIPT # . . . . . . . . . : BS000015376 REFERENCE ID # . . . : 11110124 SITE ADDRESS . . . . . : 10188 MYER PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER EGAN WILLIAM F AND MARY A ADDRESS 10188 MYER PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2336 RECEIVED FROM . . . . : !E INC CONTRACTOR . . . . . . . : KEVIN COMERFORD LIC # 31833 COMPANY SERVICE CHAMPIONS ADDRESS . . . . . . . . . . : 7020 COMMERCE DR CITY/STATE/ZIP . . . : PLEASANTON, CA 94588 TELEPHONE . . . . . . . . : (925) 444-4444 • FEE ID .UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL --------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 4 , 598 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4 , 598 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1MFR= 100 UNITS 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260 . 50 0 .00 260 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 260 .50 11833 --------------- TOTAL RECEIPT 260 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 10188 miter pl. DATE: 11/22/2011 REVIEWED BY: bob s. PtAN "VALUATION: $4,598 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK a lace furnace at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Phnub. Nan Check E7ec.flan Chock Mech.Permit Fee: IMPERMIT Plun,h.Ponrir hce: P;/ac. Pernrir • Other Mech. Insp. 0.0 hrs $44.00 thlrer F'Iunur Gi,:p, OrGrr Fie.:. lush. E17- Hoh.Imp. Fee: Plund" Insp.Fe"; Etu.Inv,. Fee: NOTE:This estimate does not include fees due to other Departments(le. Planning,Public Works, Fire,Sanitary Sewer District,School District etc. . These fees are based on the prellmina in ormation available and are onb,an estimate. Contact the Dent for addn'!Info. FEE ITEMS Jee Resohdion 11-053 EtL 7IL U FEE QTY/FEE MISC ITEMS !'hrn C77te<rh h'em: .Suppl, l'C Fe,= PME Plan Check: $0.00 Permit Fee: SuppL Insp Pee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Consirnction '1 ix Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA PDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTALFEEaF $260.50 Revised: 10/01/2011 GENERAL PERMIT APPLICATION M E p COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 950143255 ml �1(408)777 777-3228• FAX(408) -3333•buildingAcuoertino.orn ■V_�UPERTINO l l l l PLUMBING MECHANICAL ELECTRICAL 1r MaU.ANEOUS / PROJECT ADORm r F�! AP1VI ` 3 OWNERNAME PHONE Z65,-�SI7 7 E•MAM D �U I��,ylQt WI C Q✓I t10`b S UXrADDRW-I6, J a 'SLATE,T/,Io ea 9676;11 FAX WNCACF NAME f PEONE E-MAIL SIREETADDRM ClSY,SFAs$ DP FAX ❑OWNER ❑ OWwmt W=ER ❑ OWNER AGENT '{0 CMrMACiTnR 13 CONTRALTORAGENT ❑ A Ooot= ❑h]tnDrEER ❑ DEvtTxm ❑TENAM cE u REuc0 mmrp- RUL p CO)CANYNAME E-MAIL FAX eA (iy538 yZ5 ARCHrOICTIENO W EE R NAME LICENSE NUMBEREUI IJC0 i COMPANY NAME' E-MAIL FAX STREETADORMS CRY.STATE.EP PHONE OF gD yr DONPX ❑ MULnFAND.Y PROrECTMWE�LND 13 YES 1'RnlECTIN ❑YES DTHE mJ10AN (3 YES hNr� U Wpu, UaE,W iNTERFA�ARG ❑JJO Preto zozm G No Eiavm hJOaO:Y ❑No UESCRIFnaN OF WORK l ru.rrla&ee Op, LklC cue—. Coe n. TOTAL VALUATION: y`7 q c) RECE VED BY: By my sipstom below,I certify to each of the fallowbeT I am the property corner ar o2wrimd agent to art on the property aWmer's babalt I]cave toad dva application and the mibrmadoa I have provided is tetrad]}have read the Deseiptim of Wart and verify it is acetate I agree to oomph/with all applicable local ordinances and state levo relating to ding constJDcdoa I embm=represeotativeT of.C%mtivo to inter the above4dwifsed prop"for inspection Parposes. Signature ofAppt=tf ear SUP PI EbtENTAL INFORMATION REQUIRED OmcE USE ONLY m E oVmTSz-covNrmt y6 t' S1a"m Y Y ❑ STANDARD u ❑ LARCE ❑ MAJOR MPPMacApp_2011.doe revised 06!11/11 ShnimUfled Prescriptive CertMeate of Compliance:2008 RaMendal RVACAIterarfonr CF-IR-ALT-HVAC Climate Zoo"10 to 15 • SYaAdeKul S 4V, a Err)hrposreraAgenw.-. Dale: Fe.mirtk Conditioned Floor Equipineat7Vlem' Litt Mn inuum E&ct Duct Insulation requireamant Area Thermostat O Pecimgod Una ,BFmnes AFUB W O COP_ Over40 8 ofdocts added or 0 Setback O Indoor Cog OSEER_ O HSPF mpiaod in®tamditianed apes Sewed by eytmm (Yat abed,& OC®douingUnit Offit_ 0Resisinbs OR6 (t'Z10-13) of pvenc Mw be O Other I ORS (=14,15) hwarto4l 1.&4+1Pmew f)pec Cheam rhe sgnipowt babgl brrealleA•Ua err than oaeayaleot,we weather CF-IR-ALT-HVAC)ereach rystem Z Mitalawm EponteatEBMencles 13 MMk 78%AFVA 7.7fi4PF)brolmla l residmNal systmsr. . HERS VERIFICA770N SUMMARY listed below art tbm HVAC alteretlon Options. The installer deddcs what work w being dote , pdcb one of the APPtoprlete Optima. Each Optim Spathe HBRS measures that most be unendorsed.A spy of the Sams shall be left on site impntim end a copygrveo to the bmeotmm. At final,Poe iospocaorverifies Poet the work Rated an this three was in sial the work compl• . imager. The inspeemr alcoveiittet that each appropriate CF-6R and n gMezed CF4R forms(no hand filled C F4 U allowed)are filled out and signed. Begivaling Ostoha'1.2010.areaktared copy of the CF-1R sod CF4R AM also be on else for final inspection. a�- 101.HVAC Chmumiletout nixed Forms: • All HVACF-0dpoentteplacod CF4R tbsme MECH-KMECH-21-HM and(fcrsplit aystems)MRCH-25-HERS - CF-4R forme MECH-21 and far split s MECH-25 • Camden=Wind for CF-6R� MSH-21-HERS and(forge sysmmt)MECH-25-HILLS a malar Call and/w CF4R forme MBCH-21 and(for split sypeme) UKH-25 LI L] �•; • Furnace For.SpBt Systems:Dict leakage<15 percent; RC,CCA?300 C Iewicp(Mmitrmm Air Flow Reiln6mnent),TMAH ( � For Packaged Units: Duct leakage<15 percent v®� Esmpled form duct leakap tepmg if! O 1.Doctaystm was doc®eated tohave been previcady se dal and om&mcd through HERS vedficatich,w .. .. O2.Dad systema wiPo less them 40 Sneer Sent in unconditioned space,or _ 03. duct amcamstructickinsulatodarsenled with asbestos O2.NewHVACS t® Required Forms; ^ • e Cot in arCbaogeoin with Fav . CIT-6R Gams: MHCH-04,MEM-20411ERS,mtd(farsplit sy terve)MECH-22-11ERS,and MECH-25-11FM ' duct u(a0 new dvctmglold aS CF4R g MECH 20•,and(fm split sysoeas)MEM-22,and MECH 25 . new For Spat Systemic.Duct leakage<6 perces RC,CCA>_350 CFWton,FWD,TMAH,9r?AS,and either HSPP or PSPP. For Packaged IIdts:Duet leabile<6 pm=t O 3.New Ducts with Iteplacesnew I Required Forms: • hreladeareplacmgorimteNogeHxwduetng CF-6Ritam: MECH-04,MECH-20-HWAnd(for split*Vcm)MECH-25-HERS and/or omdoor condensing unit md/m indoor CF-4R forms WCH-20 and(far split syetms)MBM25 call and/or f necace Not all equipment climgod. . For Split Systeme:Duct leakage<6 percent,RC,CCAs_300(FMAon,TMAH . For Packaged Units-Duct leaks a<6 percent —6-4.New Duetting over 40 feet Required Foran: • Includes adding orreplacing awe d m 40 CF-6R for= MECH-04,MECH.21-fDRS CF4R forms; MB(31-ZI Romer fiat of duct in meouditiood Far spilt"em orpaekaged mitts- Duet leakage<15 percem O EXCEPTION:Existing duct castes insulated a sealed with whestaL Contractor(Dowmeotatioo Aoth is/Responsible Datgoer's Declaration Statement) .a 1 certify do this awe"ofptmpasm 4oemoeoatim6 awash and complete. . ,• .l am efip3b a-dw.l)jviyf®j.ofax:Uifvnl4 Bus Vas adProferdam Code to accept respouni lity for Wededgo ldeodfled m dea Certiocam ofcompfumee lartity"energy wd.Pafammm rysi6eatim fortlo deigr identifld an this Catldcate ofCompSmm conform mala regalreoene efTwo 24, Paul l pd 6 of the Ca4e.otRegoktims... • 7Udealp haOooldmtigdmPou OadgamofOmOhmemaaaEtmtwhhdabdbrmdmdoeommmdwathasWic"c hmmf adoebtraim rmted' ft' nil®mhmdmd te dieeoorvmmtht WPo Oced �, • Mona: MAXINE BROOKS S�'°W COY' SERVICE CHAMPIONS Date: - adama "q 0"Z O C.t)Ym%Yl L/ 'e fJ/ Liacnw.1817040 aty/stawLfp eastan lan Get 9' � FhnaCgZ7 ilYy yyYy • 2008RealdmrfalCmrgdfmresForm March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 0199 44!qef Pi PERMIT# / 1- OWNER'S NAME: LA_rVjLjCjrA lqeA14PHONE# 04 3-/fr4/4/ GENERAL CONTRACTOR: ilei CkA4AAj>jZvS BUSINESS LICENSE# ADDRESS:'7020 (0tu0t.�&r 4_ 0,— CITY/ZIPCODE: p(acsanFon 9ysw *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. .��'�� I am not using any subcontractors: 4 f l'Z Z // " IL7.tsW" Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date