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11060230CITY OF CUPERTINO BUILDING PERMIT J BUILDING ADDRESS: 10541 STOKES AVE I CONTRACMECHANTOR: L INC C LIFORNIA DELTA I PERMIT NO: 11060230 I OWNER'S NAME: HEMAN KUMAR 16056 E BASELINE RD STE 155 DATE ISSUED: 06/30/2011 I FR'S PHONE: 4082346317 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor DateeT I hereby affirm hat -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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source ions per the Cupertino Municipal Code, Section 9.18. Signature Date �� r L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 ira^mnify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the gi—ang of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date MESA, AZ 85206 PHONE NO: (866) 692-5273 BUILDING PERMIT INFO: BLDG 1— ELECT I— PLUMB f— MECH F RESIDENTIAL COMMERCIAL F JOB DESCRIPTION: REPLACE HVAC LIKE FOR LIKE(14 SEER,4 TON) Sq. Ft Floor Area: I Valuation: $5600 APN Number: 32648032.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner=d a int: Date: � t Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32648032.00 DATE ISSUED.......: 06/30/2011 RECEIPT #......... BS000013931 REFERENCE ID # ...: 11060230 SITE ADDRESS .....: 10541 STOKES AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. HEMAN KUMAR ADDRESS 10541 STOKES AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 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 ---------- ---------- -ADMIN ------------- HOURS ---------- 0.50 ---------- 39.00 ---------- 0.00 39.00 0.00 1BCBSC VALUATION 5,600.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 5,600.00 0.56 0.00 0.56 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 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 250.56 ---------- 0.00 250.56 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 250.56 --------------- 250.56 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #7415 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING �. CITY OF CUPERTINO FI F FQTTX4ATnR — RI TUBING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10541 stokes ave. DATE: 06/30/2011 REVIEWED BY: bobs. UNITS APN: BP#: "VALUATION: 1$5,600 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex # PENTAMATION FURN/AC PERMIT TYPE: USE: 19 WORK PME Unit Fee: SCOPE PME Permit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1 MFR=<100 1 # $126 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: A Travel Documentation Fee: 1 TRA VDOC $126.00 Strong Motion Fee: 1BSEISMICR Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 1 0.0 1 hrs 1 $42.00 - Cnntnrt tho Dont fn/ addn'l info. FEE ITEMS (PE e Resolution 09-051 tiff'.' 7;1;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 E) No $0.00 A Travel Documentation Fee: 1 TRA VDOC $42.00 Strong Motion Fee: 1BSEISMICR $0.56 0.5 hrs Admin./Clerical Fee $39.00 (ADMIN Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.561 $39.00 TOTAL FEE: $250.56 Revised: 04/29/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC CUPERTINOg I— INTI MT',r- �r,rFrueuT(-At MFTF.CTRICAT. nMISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 • building ,cupertino.or PROJECT ADDRESS ` Q� APN # ( 03), )_ OWNER NAME PHONF�` ,^� ��l E-MAIL STREET ADDRESS– � CITY, STATE, Z;P` � � � FAX y � c TAcr �C10 (t2X CwC P Z.rJ2� 3 E-MAIL STREET ADD S( ; \ S'� CI STATE, ZII' F ❑ OWNER ❑ OWNER -BUILDER ❑ OWN'ERAGEN'T ❑ CONTRACTOR ONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT NTRACTOR NAM LICENSE NUMBER y LICENSE TYPE E BUS. LIC # CO1v�P NAME.t l �� EMAIL Z�dc,�z. S2.�- 3 STREET `DDR) � T STATE, `Z3SL� PI}QNE � S ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD w DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO 1S THE BLDG AN ❑ YES EICHLER HOME? ❑ NO f DESCRIPTION OF WORK TOTAL VALUATION: �' RECEIVED BY: 6C16 f By my signature below, I certify toeachof the following: I am erty 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 ha/e read t e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construct ori ep esentatives of Cupertino to enter the above -identified property for inspection pulposes. Signature of Applicant/Agent: Date: 6-2-g l SUPPLEMENTA ORMAT ON REQUIRED OFFICE USE ONLY ❑ O\� ER -THE -COUNTER c Y ❑ EXPRESS U ❑ STANDARD U ❑ LARGE G ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC Alterations climate Zones 10 - 1S ite A dress: ' Enforcement Aqency: `�(�� Date: ++ 1 Perm #: S i 'Ni •Z3 Dud insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat L] Package Unit 0 Furnace 0 Indoor Coil 0 AFUE 0 SEER 0 COP 0 HSPFf (",;) R 6 (CZ 10-13) 0 R 8 Served by system p Setback Tf not Alread resent, Y R � Condensing Unit g rl EER C] Resistance (CL 14-15) -LO _ must be Installed) [] Other 1. Equipment Type: Choose the equipment being Installed; If more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efilclencles: 13 SeER, 78% AFUE, 7.7HSPF for 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 forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR and CF -614 shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -411 forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Indoor Coil and /or CF -4. forms: MECH-21 and (for split systems) MECH-25 . Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leagage testing if. 0 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 0 2. Dud systems with leu than 40 linear feet in unconditioned space, or [] 3. Existing"ilt9 systems are CorstruGtpd,'lnsulated_: iseglrtl wittltigsl toy - 0 2. Ne1Al� 1�/AC Requirs .0 -_ x System _ _ Cut irT hangeout _ ��CH-04, MEO f�ERS, aid tic split systetj MECH-22 tl, atl,d with ri>iducts at new d�IFr"�LfJ/iS r E04, i�s Q�ns Cn"�p�N3h•.R?� '-^+�, I �2, �+7 new equfiii>ent) , For Split Systems: Duct leakage <t6 percent; RC, CCA z 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged • Units: Duct leakage;< 6 percent L 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS condensing unit and/or indoor coil CF -4R forms: MECH-20 and (for split systems) MECH-25 and/or furnace. No or some equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA k 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent [14. New Ducting over 40 feet Required Forms: . Includes adding or replacing more CF -6R forms: MECH-04, MECH-2I-HERS than 40 linear feet of dud in CF -411 forms: MECH-21 unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation Is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on 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 requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Brian Cannon Signature: Brian Cannon Company: CALIFORNIA DELTA MECHANICAL INC Date: i -V Address: 1235 GRAND AVE License: 811114 City/State/Zip: SPRING VALLEY / CA / 91977 Phone: (480) 898-0007 Reg: 211-A0019108A-00000000-0000 Registration Date/Time: 2011/04/19 01:14:48 HERS Provider; Ca10ERTS, Inc. 2008 Residential Compliance Farms July 2010 7UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: \cs�'-k v PERMIT OWNER'S NAME: Qx-c<)'j k PHONE GENERAL CONTRACTORC�,�6vr,C-�, tNESS LICENSE # ADDRESS:bospE , OIX, 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 SUBCONT RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:©" -- Sign ure Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature 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 Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date