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11040037 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19680 DRAKE DR CONTRACTOR:SERVICE PERMIT NO: 11040037 CHAMPIONS OWNER'S NAME: MURALI KOTTE 7020 COMMERCE DR DATE ISSUED:04/06/2011 NER'S PHONE: 4088582050 PLEASANTON,CA 94588 PHONE NO:(925)4444444 16 LICENSED CONTRACTOR'S DECLARATION F I— / ' BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.#_'9' _(y V Yy MECH RESIDENTIAL COMMERCIAL Contractor S.(U1Lle,1 4,(x. PA605 Date rt &-I I JOB DESCRIPTION: REPLACE FURNACE 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. 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. Sq.Ft Floor Area: Valuation:$2900 I 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:31632023.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, `�2 ( costs,and expenses which may accrue against said City in consequence of the -11 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. -14RE-ROOFS: Signature Date LIQ �I All roofs shall be inspected prior to any roofing material being installed.If a roof is I installed without first obtaining an inspection,I agree to remove all new materials for inspection. t J OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 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. 1 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,Secti 7ns 2P5051 2W3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen . Date:t`/ 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 provisions or this 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 construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .sts,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 FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19680 drake dr. DATE: 04/06/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: 1$2,900 —� PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK replace furnace SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check F6.6 hrs $0.00 FMech.Permit Fee: IMPERMIT Other Mech.Insp. L.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 09-051 I f. b"10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom; Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.001 TOTAL FEE: $211.50 Revised: 01/15/2011 Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAIteratiom CF-IR-ALT-HVAC Cliutate Zones 10 to 15 Site AddressEVbrc-cut Agency 7� Permit#: !G lc v U 01.6 ace ` Conditioned Floor T ' List Mmimum EfficienCy2Duct insulation requirement Area Thermostat 0 Packaged Unit Over 40 ft of ducts added or l R1 Furnace ( IR AFUE� 0 COP S ❑Indoor Coil OSEFR ❑HSPF rapiaccd in aacmdiaonod space Savca ify system (ifbw ❑Condensing Unit O EER ❑Resistance ❑R 6 (CZ 10-13) sf prrs�vrc mast be O Other ❑R S (Q 14-15) irsrtattedJ I.Eq*mens Type_Choose the equipment being in wflad'if mare that one system tete atother CF-I R-ALT-HVAC far each system. 2.Mlrrintam Equipmeya Effsdenciea:13 SEER,78%AFUF., ULGFF for tlptcal residm iad ry mnis. HERS VERIFICATION SUMMARY listed below are:four HVAC alteration Options. The installer decides what work is being dome and picks one of the appropriate Options. Fath Option lists the HERS measures idsat must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspaxor verities that the work listed on this form was in tad the work completed by the instaver. The inspectir also verifies that each appropriate CF-6R and registered e:d CF-41Z forms(no hand filled CF-4Rs allowed)are;filled out and si ning October 1,2010,a r copy of the CF-111 and CF-6R tduH aloe be on rite for final hispecdoiL 1.HVAC Changeout Required Forms: CF-6R tiaras MECH-04,MECH-21-HERS and(for split systems)MECH-25-HERS • AD HVAC Equipment replaced CF4R forms: MECH-2I and for split WCH-25 • Condenser Coil and/or CF•SR Somas: MECH-2I-HERS and(for split syscaffi)MECH-25-HERS • Indoor Coil and/or CF-4R forms: MECH-21 and(for split systems) MECH-25 • Furnace For-Split Systems:Dud leakage<15 percent; RC,CCA>300 CFMAon(Minimum Air Flow Re4uirenent),TMAH For Packaged Units: Duct leakage<15 percent Exempted from dud leakage testing if 0 1.Dud sys6em was documented to have been previously salad and confirmed through HERS ve ficatich,or 0 2.Dad systems with loss than 40 linear feet m tmconditioned space,or ❑3.Existing ducts"sternsysterns areconstructed,insulated or scaled with siilxstos 0 2.New HVAC System Required Forms: • Cut in or Chaugeont with new CF-61Z farms: MECH-04,MECH 20-HERS,md(for split systems)M33CH-22-ITERS,and MTCH-25-HERS duds:(alt new ducting md all CF 4R forms. MECH 20-,and(for split systeua)MECH Z2,and MECH 25 - new For Split Systems:Dud leakage<6 percent;RC,CCA>_350 CFM/ton,FWD,TMAH,STAB S,and tither HSPP or PSPP. For Pac Units:Duct kakagc<6 per=t 0 3.New Ducts with Replacement Required Formas: • Includes replacing or idling all new dotting CF-6111bims MECH-04,NCBM20-HFRSrand(for split systc=)M .CH-25-HERS and/or outdoor condensing and and/or indoor CF-4R forms WCH-20 and(for split systems)WM25 crn7 and/or furnace. Not all equipment changed. For Split Systems:Duct leakage<6 percent;RC,CCA 2t 300 CFMAon,TMAH For Packaged Units:Dud IcaWe<6 percemt 0 4.New Du over 40 feet Required Forms: • Includes adding or replacing more 8isn 40 CF-6R forms: MECH-04,MECH-21 HERS CF-4R forms: MEGs-21 linear fed of duct in unconditioned For split system or packaged tamrits: Duct leakage<15 percent Q EXCEPTION Existing duct gaterns constructed,insaialed or sealed with asbestos. C xtractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Ce?ut'rcate of coup-imce.ocarnmit"is accumu sod compSete.. _• .1 ane eligible rude Divssiaa 3 ad6re Caiiformrt B and Professions Code to accept r egmustlnlity for the design ideatitrad art this Certificate of Compliance. 1 eatify that tht energy festmes and'perfiammm for the dcOq p identiSod an this Cet'r8amo ofCo Wliance conform to the requircrnents of rate 24, Porta 1 and 6 of the CWWmrnia Co0c.of.RcVi1*hocA&.. • The design feaa=ideatificd on&is CatiScete of Complisooe are consistent with Bre atforrnetim documented do other apptirable compliance forms,worksheets, piing and cations svhmittod lo the ca6 agency for approW w*lh fibe Name MAXINE BROOKS Stgnatrae SERVICE CHAMPIONS Date: Adam' -1;L,4 ch art,©r /+U-4p— ikenw.1817040 t q/statelZip: S syn JJ 5 l�v� g 5!3 l Pie q D 3 9 4 q - q 2008 Residential Compliance Forms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 ELI] Telephone: 408-777-3228 D U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1 g 0 4doak,Za f)/' PERMIT# OWNER'S NAME: aurcki , nte— PHONE# GENERAL CONTRACTOR: 6efUt�-u ekO >fOv4 S BUSINESS LICENSE# ADDRESS: -7,� /"CU 7- A L.-Q CITY/ZIPCODE: ,'-j'An -T0),L CO ' S-/3/ *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: o 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 - CUPERTiNO (408)777-3228 • FAX(408)777-3333•building(cDcupertino.org misc ❑PLUMBING C5 MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS A/0 -3 PROJECT ADDRESS r / 1 p �J D/ 7N, 3 32- 62_3 OWNER NAMEr t1 F PHONE J J Cl E-MAIL iA c'l l STREET ADDRESS;/� '6 l/) it CITY,STATE, 1�A r.- 9 S()I FAX CONTACT'NAME PHONE`7 V PHONE (�j E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER E3 {�❑ OWNER AGENT �� ❑ CONTRACTOR ❑CONTRACTOR AGENT 11 ARCHITECT El ENGINEER C3 DEVELOPER C3 TENANT CONTRACTOR NAMEtK�tJl/�/ W L✓/ �U` s LICENSE NUMBE§ 7 U C/0LICENSE E BUS.LIC N COMPANY NAME a^ 7 E-MAIL FAX U ��� �l�G�/"` �tU7/l STREET ADDRESS A CITY,ST HONE IP �—a �31 P�®� - -/ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 9 SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK a o,p l e4 c-ej ­r ,,(A a c ,/> c)In TOTAL VALUATION: a.q oo; Gl V RECElYE77BY 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 it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b it ing co truction. I auAorize representatives of Cupertino to enter the above-dentif//ie��d pro/p rty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED trslR o� _ M of =� y, -; - i''�'i-ter.. &s 1 . IEERGFr MEPMiscApp_2011.doc revised 03/16/11