13010025CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21073 CHRISTENSEN DR
CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 13010025
OWNER'S NAME: TURNER ROBERT C AND MARY A TRU
7020 COMMERCE DR
DATE ISSUED: 01/03/2013
OWNER'S PHONE: 4089730626
PLEASANTON, CA 94588
PHONE NO: (925) 4444444
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL M COMMERCIAL
6-Z Lic. O g Z cf
License Class #
REPLACE (E) FURNACE & A/C UNITS & 13 AIR DUCTS & 2
nn --J n t� 3 '
RETURNS, SAME LOCATIONS
Contractor �L�`1h/Date 1
ILrPJ l
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 license is in full force and effect.
I 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
Sq. Ft Floor Area:
Valuation: $13592
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
APN Number: 32654006.00
Occupancy Type: "
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state:thatthe above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and.county, ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FRO T CALLED INSPECTION.
indemnify and keep harmess lthe City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the2
7
granting of this permit. Additionally, the applicant understands and will comply
Issu Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.. _
✓ JJ
RE -ROOFS:
Signatu 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:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, 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 emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, S t' as 25505, 25 33, and 25534. .
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age Date: 3
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, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisionsorthis permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
- - -. APPLICANT CERTIFICATION
Lender's Address
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 conswction, and heretiy authorize representatives of this city to enter
up" the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, 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
CUPERTINO
GENERAL PERMIT APPLICATION fc� MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DMSION 0
163M TORRE AVENUE - CUPE;rr NO, CA 95614-3255 �O ' S C
(408) 7773228 - FAX (408) 7773333 - bttiTClimC4cuperdno-om \/�V ■
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MEp,V&a4� 2011.doc mmised 06121111
CITY OF CUPERTINO
FF.F. FCTTMATOR — RITILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 21073 CHRISTENSEN DR
DATE: 01/03/2013
REVIEWED BY:
UNITS
APN: 326 54 006
BP#:
'VALUATION:
$13,592
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or: Duplex
$67
PENTAMATION
FURN/AC
USE:
1MFR=<100
PERMIT TYPE:
WORK
REPLACE E FURNACE & A/C UNITS & 13 AIR DUCTS & 2 RETURNS SAME LOCATIONS
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Mech. Plan. Check 0.0 . his $0.00
QTY
UNITS
BP FEES
Plumb. Pcrrnir Fee:
A/C Units (<=10K cfm)
1BREMAIR
Other Plumb Insp. L
1
#
$67
Eke, Insp. Fee:
Furnace, Forced -Air
1MFR=<100
Suppl. ln.sp Fee
1
#
$133
PME Unit Fee:
PME Permit Fee:
Construction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? Q Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$200.00
�s a
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public wares, Ptre, sanaary sewer trtstrtct scnooi
_ _ + TG...... !',... .... x......d .... iG.. .....J :...:....... :.. rn...,nrinx n n:JnhJo and oro nn/v nn astimnlo_ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7111121IFEEQTY/FEE
Mech. Plan. Check 0.0 . his $0.00
Pba+rb. Plan Check
Elec. Plan Check
-Meth. Permit Feer 1MPERMIT
Plumb. Pcrrnir Fee:
Elec. Permit Fee:
Other Mech. Insp. 1 0.0 1 hrs $45.00
Other Plumb Insp. L
Other Elec. Insp. Li
.Adech. Insp. Fee:
Plumb. htsp. Fee:
Eke, Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public wares, Ptre, sanaary sewer trtstrtct scnooi
_ _ + TG...... !',... .... x......d .... iG.. .....J :...:....... :.. rn...,nrinx n n:JnhJo and oro nn/v nn astimnlo_ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7111121IFEEQTY/FEE
MISC ITEMS
Phin.Check Fee:
SznpE)l: PCI'ee
PME Plan Check:
Pernit Feel
Suppl. ln.sp Fee
PME Unit Fee:
PME Permit Fee:
Construction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? Q Yes 0 No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$1.36
Select an Administrative Item
Bldg Stds Commission Fee: . 1RCESC
$1.00
dll�; siz
`}IE'°,
$334.36
$0.00
`l''� i rT;07 AL>FEE
$334.36
Revised: 10/01/2012
Sim lifer ' dveCertidieateofco Kamm:2ooSRedknazIHVACAIterado>rs CF -IR -ALT -HVAC
Climate Zones 10 to 15
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fWM VERMCATI NT SUABL4RY Listed hdowme faarHVAC a twatim Ophoae The mstallerdcddes what work n b=g d=wA
picksoneoftheappsaip lecoplias. Fads Opdmffawthe HEIRSmeasuresthat becooftted. A copy of the Isms stall be left on site for final
hupettionandacepygiveatotbeffiwarow. Atfool,theimpectorveti5es thattbe work listed cc Bib Sam was in factawwork compcW by the
inslaDer. The inspectorabovaifiea thateacbappmpdaw CF-Wandregistered CF41t fvms(ao hand filed CF4b allowed)mo filled oat and
Oaaber 1.201 a registered cojpy of the CF -IR and CF4R shall echo bema she for final invadon.
1. HVAC ClumMut
RegaW Forms:.
CF4Ra : AMM4)k NECH-21--HERS sad(fotapht systems) MECH- 25 -HERS
• AOHVAC F-0rdpurmtrgtlaed
CF4Rfm w MECH-21MFCH-25
• Condenser Coil and/or
CF -a firm~ MEC33-2I-HERS gad(forsplitgyncens)MEICH-25-111W
e ImlooromIand/or
CF4Rfnuc MSM- 21 and (for split systems) MECH-25
a Puma=
For.Split Systems: Dtta leakige < 15 percent; RC, CCA >300 CFWtw(Mioimtmm Air Flow Requirement), TMAH
For -Packaged Units. Duct leakage<15percent '
Exempted from duct lesUptestmgl8
O 1. Doamsteur was dommmted tobavebeeapaevicady scaled and confirmed through HERS vrmf®ti®, or
.. ..•
02.DuetsysWMwNthastbm401bmwiutinmmdmmed spaca,or
03. ' ' dent amikuceekkmlilcdersededwitbabcAos
❑ 2. New HVAC System 1te9ntred Farms:
CtdurarChangeoawIDtoear. CF4R foams:MECH-04,MBCH-204MX%md(forsoitsystems) MXH-22-HERS, and MBM-25-HERS
dautz-(all new dottmgmd ag CF4RG MECHNI-, md(forapiitsyssens)h(1 722. and MECH 25. ..
near
For ftM Systems: Dud Wasp <6peoccut; RC. CCA 2:350CFMADv6 FWD. TMA% STIS,andeilberHSPPorPSPP.
For Packaged IIdfxDuct kakftc, < 6psucut-
3.NewDadswilhReFLeemest I ReaphydFarms:
• Includes replaciogmiwmRhagaH newdaeffig CF-6R16nfs. hiBCH44. MECW20-13Msnd(for split systems) NEC1i-25-HETES
sod/or outdoor omdexmgmat malfar Wow CF4RI MECH-ZD and(flrTlitsyatems) M9CH-25
unit mcvwiirmece NaaHeyu*neutchangpd.
For Split Syst®s: Dna leakage <6purceok RC, CCA>_ 300 (FMhm, TMAH -
For Packaged U®fs:Dudl <6 Peaccalt
04.Newl/a over4Yteet -I Required Forms:
• includes adding arreplaemgmaethm 40 C F -M f,rms: MECH-04. MECI121 HSPS CF4R f crac MKH 21
linewf et of daam mtcamfffiaoed SPROL
Far split system orpackagedmifat Duct leakage<15percent
Q EXCl1 CN- 112isting ductiosaLtdorsealedwitbaslustos.
Contractor (Documentation Anthir's/RaapomsVe Desipees Declaration Stalemeht)'
u
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. Icatify t6athe soggy&4mswdFaEammcekpsi8ratiom fatla:d®ger idevtifudm the Cafifiuoe afCaoptlsnx emSoemmthemgo;naumR afTale 24,
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N.mc IMAXINEBROOKS Stpume
CO�9y'SERVICECHAMPIONS
Address:. '7 ()-Z O )ni �i/G t� pi 1'�' 8,7040
/
leasan �vr� Ga 9 ��� 9Zs yYy-yyyy
2008AWdM"dCowpllmwF6rmv March 2010
CUPERTINO
Building Department
City Of Cupertino
10300 Torre Avenue
ax: 408-777-3333
JOB ADDRESS: PERMIT #
OWNER'S NAM&
BUSINESS NAME
;, Tcj y PHONE # 49.q 913- Jb ZO
GENERAL CONTRACTORt". &P LZ�e, ta^& BUSINESS LICENSE #
ADDRESS:'I" pr I ICITY/ZIPCODE: f��ZJdi �l
*Our municipal code requirwall-businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR, F NAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRAOiOR"AND"ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE
I am not using any subcontractors:
Signature Date
Please check applicable'subcontractors:and complete the following information:
Date
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; .
Pavtng
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date