11110069 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8035 PUMPKIN DR CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 11 110069
MECHANICAL INC
OWNER'S NAME: TRUMBOWER ROYCE I AND LORETTA 1 TRU 6056 E BASELINE RD STE 155 DATE ISSUED: 11/14/2011
ER'S PHONE: 4082539142 MESA,AZ 85206 PHONE NO:(866)692-5273
LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C ' y Lie.# _fl/// y MECHr RESIDENTIAL COMMERCIAL r
Contractor e.;9 '--1.'a Date 131'11
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE&INSTALL NEW FURANCE;RECONNECT
(commencing with Section 7000)of Division 3 of the Business&Professions PLUMBING&
Code and that my license is in full force and effect. ELECTRICAL
1 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 the Labor Code,for the
performance of the work for which this permit is issued.
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 Sq.Ft Floor Area: Valuation:$3269
permit is issued.
APPLICANT CERTIFICATION APN Number:36202047.00 Occupancy Type:
I certify that I 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
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ Issued by: Date:
Signature Dale
OWNER-BUILDER DECLARATION
RF,-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,)shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Sorely Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner r u ized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING 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 of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
inWnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
L ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
• CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36202047.00
DATE ISSUED. . . . . . . : 11/14/2011
RECEIPT #. . . . . . . . . : BS000015297
REFERENCE ID # . . . : 11110069
SITE ADDRESS . . . . . : 8035 PUMPKIN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TRUMBOWER ROYCE J AND LORETTA
ADDRESS . . . . . . . . . . : 8035 PUMPKIN DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CALIFORNIA DELTA ME
CONTRACTOR . . . . . . . : TODOR KITCHUKOV LIC # 32375
COMPANY . . . . . . . . . . : CALIFORNIA DELTA MECHANICAL IN
ADDRESS . . . . . . . . . . : 6056 E BASELINE RD STE 155
CITY/STATE/ZIP . . . : MESA, AZ 85206
TELEPHONE . . . . . . . . : (866) 692-5273
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
lADMIN HOURS 1. 00 41 . 00 0. 00 41. 00 0. 00
1BCBSC VALUATION 3,269. 00 1. 00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 3 , 269.00 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 #1834
---------------
TOTAL RECEIPT 260. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
C I I I OL)
GENERAL PERMIT APPLICATION
.MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 � ' /�
•CUPERTINO (408)777-3228• FAX(408)777-3333• buildina(acuoertinc.ara r (v'
INO K&MCHANICAL ELECTRICAL MISCa LANEOUS
PROJECTADDRESS go APN q,,_5 Od OL/-7
OWNERNAME FHONE 2S YT H-MAIL
S REEPADDRESSCRY.STATE,ZSP FAX
O 'n D/
CONTACT NAME PHONE p.MAp,
STREETA➢DREA9 CITY,STATE. ZIP FAX
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WNER-EUDIIER ❑ OWNER ACENT =R. 17CDNTAACrtIR AGENT 13m
ARmECr El ENGINEER DEVELOPER TENANT
O AME NUMBERy uCHJS¢TYPE EUS,LIC a
COMP /, E / Ft ,
A➢➢ CITY.STAT$ZIP FROM
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ARCHITECTIENGDIEER NAME LICENSE NUMBER EUA TIC p
COMPANY NAME E-MAIL FAX
STR IEI'ADDRESS CRY,STATE,ZIP PHONE
OF ❑SFD) DOPIRX ❑ MULTI-FAMILY PROIECTIN WCDTAND [3 FS YPROIEC'rN ❑YES is THE RLDO AN [3 YES
ING: 13 COMMERCIAL URBANINTERFACE AREA [3 NO FLOOD ZONE [3 mo HCHIIR HONEf 0N
DFSCRIFTION OF WORK
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TOTAL VALUATION: 2 O RECEIVED BY:
By my signature be oW,I certify to each of the following I am the property owner or authorized agent to act ons the property owner's behalf I have read this
application and the information I have provided is cormot.,j have read the Description of Work aad verify it is accurate. I agree to comply with all applicable local
atdinances Red state laws Miatiog to buil ' as andtorize r rives of Cupertino to enter the above-iiddeentified property far inspection puf•Seaes.
Signature of App&candAgenu' Date:,l
LENMNTAL INFORMATION REQUIRED OFFICE U ONLY
Y 01;R-TFTE-COUNTER
6
❑ EXPRESS
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❑ LARGE
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❑ MAJOR
MEPMacApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
• ADDRESS: 8035 pumpkin dr. DATE: 11/14/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $3,269
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK re lace and install new furnace.
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 Ins $0.00 i'hnab. Flan Check E7ec.Plan Chec7,
Mech. Permit Fee: IMPERMIT 1'lmn1). Permit Fee: h3e'. Pern,ie Fee:
Other Mech.Insp. 0.0 hrs $44.00 00u,,-11hun6 b,.vp. ELI ofilo Elru' /ey,
;Veeh,Ince. Flee: I'luerl. ln..p.Fee: Liles Ines. Fee:
NOTE: This estimate does not includefees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prellidna in ormadon available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Pee Resolution 11-053 Eff 7/1,111) FEE QTY/FEE MISC ITEMS
Plan C/te<rh ('tee:
5upl,el. PC1"(!"
PME Plan Check: $0.00
Permit Fee.,
Sv ppl, he-p Fee
e
PME Unit Fee: $130.00
PME Permit Fee: $44.00
Constrnctiun 77ix
Administrative Fee: (ADMIN $41.00
Work Without Permit? O Yes 0 No $0.00
dvanaed Planning Fees:
Travel Documentation Fee: 1TRAVDOC $44.00
Stron, Motion Fee: IBSBISMICR $0,50 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:, $260.50 $0.001 TOTAL FEE: $260.50
Revised: 10/01/2011
........... ............. ..........
E C P,I v F n
NOV 14 2011
1 Simplified Prescriptive Certificate of Compliance;2008 ResideniWZWACAlteradons CF-IR-ALT-HVAC
1 Climate Zones 10 to 15
•
IAI 80?>b groemanlAge c Dotal tjI 1permit
P0MDY-jQ N- - I
v 1 Conditioned Flow
Equipment Type' List Minimum Efficiency Duct insulation requirement Am Thermostat
Wages ged Unit ==FffC' OCOI� Over 40 it of ducts added at Setback
door oil HSpF— faced in unconditioned space S ved by system Waki already
R 6 (CZ 10-13)
Conden5ftill Unit EER Resistance sf premm,man be
Other
FM ff"R, 8 (CZ 14-15) innalled)
1.Equipment 7)pe.,Choose the equipment being installed;Y'mora than one system,we another CF-WUr-HvAcja,each
system
2.Matimurn Equipment Efflolender:13 SEER.78%AFVE, 7 7HSPFfor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option fists the HERS measures that must be conducted.A copy of the finans shall be left on site for final
inspection and a copy given to the homeowner. At final,the inspector verifies that the work fisted on this fiann was in fiwl the work completed by the
installer. The inspector also verifies that each appropriate CF-611.and registered CF-4R forms(no hand filled CF4Rs allowed)are filled out and.
signed. Beginning October 1,2010, registered copy of the CF-1R and CF-6R shall also be on site for final inspection.
a
1.�EWAC Changeout Required Forms:
• All HVAC Equipment replaced CF-6R forms: MECH-04,NMCH-21-HERS and(for split systems)MECH-25-HERS
CF-4R forms: NECH-21 and(for split systems) MECH-25
• Condenser Coil and/or
Indoor Coil and/or CF-6R forms: NECH-21-HERS and(for split systems)MECH-25-HERS
• Furnace CF-4R forms: MECH-21 and(for split systems) MECH-25
•For Split Systems:Duct leakage<15 percent; RC,CCA 2:300 CFWon(Minimum Air Flow Requirement),TMAH
For Packaged Units: Duct leakage<15 percent
Exempted from duct leakage testing if.
1.Duct system was documented to have been previously seeded and confirmed through HERS verification,or ii
2.Duct system with law than 40 linear fact in unconditioned space,or
3.Existing duct systems we constructed,insulated a scaled with asbestos
Amill LJ 2.New HVAC System Required Forms:
• Cut in or Changcout with new CF- fonts: MECH-04,MECH-EO�HERS,and(far split systems)MECH�22-11ERS,and MECH-25-HM
saw,a
ducts:( .pment)all new clucting Md all CF4R forms: MECH-20,and(for split systems))
MECH-22,and MEC14-25
T5
For Split Systems:Duct leakage<6 percent;RC,CCA>350 CFM/ton,FWD,TMAH,STMS,and either HSPP or PSPP.
For Packaged Units:Duct leakage<6 percent
E33.Now Ducts with Replacement Required Forms:
0 Includes replacing or installing all new ducting CF-6R forms: MECH-04,MECH-20-HERS,and(for split systems)NECH-25-HERS
and/or outdoor condensing unit and/or indoor CF-411 forms:MECH-20 and(for split systems)MECH-25
coil and/or fiance. Not all equipment changed. I
For Split Systems:Duct leakage<6 percent,RC,CCA>_300 CFM/ton,TMAH
For Packaged Units;Duct leakage<6 percent
4.New Ducting over 40 feet I Required Forms:
• Includes adding or replacing more than 40 CF-6p.forms: MECH-04,MECH-21-HFRS CF-4R forms: MECH-21
linear fact of duct in unconditioned space. I
For spi packaged its: Duct leakage<15 percent
a ag mai
BIFXMCPON.E,!stuiji duct systems constructed,insulated or sealed with asbestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify this this Certificate arComplianciit documentation is accurate and complete.
• I am eligible under Division 3 ofthe California Business and Proftsialims Coda to accept responsibility fm the design identified an this Certificate of Compliance
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requiremems of Tide 24,
Peru I and 6 of ft California Code of Regulationo,
• The design ficatures identified an this Certificate of Compliance we consistent with the
information urnarded on nth applicable compliance forms,worksheets,
calcul tz plans; fications submitted in the enflucemarit agency for anwovW with=it
'O'cian
Name:
"ILAI
Sign
Company:
nAdd,ms's:
License: F)A 1114
itylSlatelLip: I Phone:PAO, �A. C)-j ()-I
2008 Residential Compliance Forms t. July 2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
SU P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: F0 /Cr 1.a PERMIT# JO 06'1-
OWNER'S NAME: O p o PHONE# Vo P- 2
GENERAL CONTRACTOR: QG/ BUSINESS LICENSE#
ADDRESS: 6 CITY/ZIPCODE:
*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.
1 am not using any subcontractors: 99�
Signature Date
Please check applicable subcontractors and complete the following information:
V 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