The URL can be used to link to this page

11040005 CITY OF CUPERTINO BUILDING PERMIT BUILDING.ADDRESS: 10104 LIBERTY OAK LN CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 11040005 OWNER'S NAME: DANNY PU 7020 COMMERCE DR DATE ISSUED:04/01/2011 INER'S PHONE: 4087183069 PLEASANTON,CA 94588 PHONE NO:(925)4444444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class �/ 2 U Li,.# �J l 7 0 Y REMOVE AND REPLACE FURNACE 6 DUCTS Contractor ��✓J L —64V(PI ct2'Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7195 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 whichAPN Number:34232049.00 Occupancy Type: permit is issued. lug 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, costs,and expenses which may accrue against said Ci hin consequence of the Issue&F%�. -__�)" r� _ � Date• granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature �I Date 7 / !( 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(x)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,Sections 25505,25533,and 25534. ! Section 3700 of the Labor Code,for the performance of the work for which this � Date: Gl—)—// permit is issued. Owner or authorized agent: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ..nting 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 Simplified Prescriptive Certificate of Compliance:20M Reszdendd RVACAIteradons CF-IR-ALT-HVAC C9imate Zones 10 to 15 Site Addres:L � �� r l � � l � / Enf-mmew Age-7 .,- Dante-- Permit V if ln� ]- Conditioned Floor T ' List Mmimum Foci Duct insulation Area Thermostat Packaged Unit Over 40 g of ductor 1 Indoor 116 AF[JE I O OOP oy� (7 f�a1—dy ❑Indoor Coil OSEER O NSPF iaord in mrcamdiooncd Sa•vai O Coming Unit O EER ❑Reece OR 6 (CZ 1013) sf prrsen&must be O Other I 1 O R 8 (CZ 1445) hw-tw 1-Egaupmew Tjpe.Choose the equipment being ivWUed irmorr than onesysiM are acether CF-1R-ALT-HTUCforeach system 2-hfbr mwm Equipm w Effic lenciff, 13 SEER.78%AFIJA 7.7hGFFfor typkwl rrsidm6 d systems. HERS VERIFICATION SUNUWARY listed below am four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Fath Option lists the HERS measures that mast be conducted.A copy of the forms shall be Ia8 on site for final inspection and a copy given to the bone wner At final,the inspector veri5cs that the work fisted on this form was in fad the work completed by the installer_ The hzpecoor also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and signed, nun October 1,2010,a r . c of the CF-IR and CF-6R aha"also be an We for final inspection. 1.HVAC Changeont Forms: • All HVAC Equipment rep laced CF-W fauns: MEC H-04.MECFI-2I-HERS and(for split systems)MECH-25-HERS CF4R famns MECH-21 and for Eelit IAKH-25 • Condenser Coil and/or CF- forms: MECH-21-HERS and(for split systems)MEC H-25-HERS • Indoor Coil and/or CF 4R forms: MECH-21 and(for split systems) NEC H-25 • Furnace For.Spht Systema:Dud leakage<15 percent; RC,CCA>300 CFMAon(Minimum Air Flow Reiluirement),TMAH For Packaged UWU: Duct leakage<15 percent Exempted from dud leakage testing if! O 1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or 0 2.Duct systans with less than 40 linear Sect m unconditioned space,or O 3.Existing duct sWystc==sarc constructed,insulated or sealed with asbestos ❑2.New HVAC Systesn Required Forms: •. Curt in or Clumgcou t with new - CF-6R forms: MEM-04.MECH 20-HERS,and(for split systems)M9CH-22-1IERS,and N£ 1-25-HERS ducts:(all new ducting d all CF-4R fmnss MEM 20-,and(for split systems)MEC H-22,and MECH 25 . new For Split Systems:Dud leakage<6 percent;RC.CCA>_350 CFM/ton,FWD,TMAH,STNS,and either HSPP or PSPP. For Pac Uulfa:Duct Enka <6 t O 3.New Ducts with Replacement Rapired Forma: • Includes replacing or insta111ng all new ducting CF-6R iluuss MECH-04,1413CH-20-HER.S,md(for split systems)MECH-25-HERS and/or outdoor condensing trout and/ar indoor CF-411 farms:MECI.1-20 and(for split systems)?ABM25 coil and/or furnace. Not all equipment cbemgcd- For Split Systems:Duct leakage<6 percent,RC,CCA>300 CFM/ton.TMAH For Packaged Units:Dud I c<6 percent 4.New Duover 40 feet Reavired Forms: • Includes adding or replacing more than 40 CF-6R fort=. MECH-04,MECH 21 HERS CF-4R farms: MECH-21 linear Sed of duct in unconditioned For split system or packaged u=nits: Duct leakage<15 percent El EXCEMON:limsting duct system constructed,insulated or sealed with asbestos. Contractor(Documentation Aath4ei/Responsible Designer's Declaration Statement)' • 1 eat&y"this:certificate of omp1 tsuum a accraate and eomplet. .•_jam am cli&ic,nmdcrDivioi a3 of die C.atifomla Bnsnea and Profession;Code to occept responability for the design ideadfle d an"Certificate of Comptiaom • .I certify that the energy femurs and perSmusace qxxfficabons for the d®gn identified on this CatiScate of Coragr6ance conform to the requimuents of T-dk 24, Hrts l orad 6 of the 6111 rpis•Codc of Regnktioas.. • ne design tea4aes idenufed on this Certificate of Compliance are eoos'sttat with the information documented an other applicable compliance forms,worksheets, ms and specific4im submitted lathe eafewcemoat Ser with Nie: IMAXINE 13ROOKS Ste- COmpear SERVICE CHAMPIONS Address `10L4 ch c' r(,o r /+V-e- 1 81704= 0ty/Stttdz* S q rt. JC95 e. c,v, g 5 t 3 i Phos« 'log q 1N - q-;q Ct 2008 Residential Compliance Forms March 2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34232049. 00 DATE ISSUED. . . . . . . : 04/01/2011 RECEIPT #. . . . . . . . . : BS000013071 REFERENCE ID # . . . : 11040005 SITE ADDRESS . . . . . : 10104 LIBERTY OAK LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . DANNY PU ADDRESS . . . . . . . . . . : 10104 LIBERTY OAK LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 195 .00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 7, 195 . 00 0 .72 0 . 00 0 . 72 0 . 00 1MFR=<100 UNITS 1. 00 126 . 00 0 . 00 126 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0. 00 1MRRAA UNITS 1 . 00 63 . 00 0 .00 63 . 00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 274 . 72 0 .00 274 .72 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 . 72 7734 --------------- TOTAL RECEIPT 274 .72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10104 liberty oaks In. DATE: 04/01/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$7,195 -1 ';PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: 19 WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 Heating System 1MRR4A 1 # $63 TOTALS: $189.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 Li NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Pae.Resolution 09-051 I.'ff. T1 /O) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.72 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.72 $0.00 TOTAL FEE: $274.72 Revised: 01/15/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 - (408)777-3228 • FAX(408)777-3333 •building aacupertino.org MISC CUPERTINO ❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS j o V :�� 5 11 00 OWNER NAME L PHO E-MAIL D AwPHONE STREETADDRESSI TATE ZIPC7 / FAX U tlb�etjv ICS CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA E , `L U LICENSE NUMBI, 7 D U LICENSFs,T�E�..� BUS.LIC# ME COMPANY NAE-MAIL (/(�(� FAX STREET ADDRESS CITY,STATE ZIP PH ARCHrMCT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-IviAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF If SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK TOTAL VALUATION: � -=RECEIVED B1C r.,; 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 bu'Iding cqnstruction. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. SignatureofApplicandAgent: Date: SUPPLEMENTAL INFORMATION REQUIREDdi�&IUSEFIlY€ axe An ( � 5 I3Tl!IDPEF115t ,.�. wi W I �� L� LeLRGE" t % � z MEPMiscApp_2011.doc revised 03/16/11