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11010014
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10809 BROOKWELL DR CONTRACTOR:SERVICE PERMIT NO: 11010014 CHAMPIONS OWNER'S NAME: ALAN WALKER 7020 COMMERCE DR DATE ISSUED:01/03/2011 !NER'S PHONE: 4084728201 PLEASANTON,CA 94588 PHONE NO:(925)4444444 LICENSED CONTRACTOR'S DECLARATION rIf r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Z D Lic.# 9-/ 7 O q MECH r- RESIDENTIAL r- COMMERCIAL Contractor i L� 6 aiVt°V Date /- 3 - // I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE FURNACE SAME LOCATION (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:$4248 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:36921018.00 Occupancy Type: permit is issued. flo 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 180DA ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the l 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. RE-ROOFS: Dtdo :,j All goofs 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. 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,Sections 25505,Z5,533,and 25534. Section 3700 of the Labor Code,for theerformance of the work for which this ` � permit is issued. p Owner or authorized aged ) Date: i 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 --non the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION emnify and keep harmless the City of Cupertino against liabilities,judgments, -osts,and expenses which may accrue against said City in consequence of the 1 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 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36921018 . 00 DATE ISSUED. . . . . . . : 01/03/2011 RECEIPT #. . . . . . . . . : BS000012376 REFERENCE ID # . . . : 11010014 SITE ADDRESS . . . . . : 10809 BROOKWELL DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . ALAN WALKER ADDRESS . . . . . . . . . . : 10809 BROOKWELL DR 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 4, 248 .00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 4, 248 .00 0 .50 0 . 00 0 .50 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 211 .50 0 .00 211 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 211.50 6244 --------------- TOTAL RECEIPT 211 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10809 Brookwell DATE: 01/03/2011 REVIEWED BY: RDW APN: BP#: *'VALUATION: 1$4,248 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex lex rt17AL PENTAMATION FURN/AC USE: 1,7,00RAREt. PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: 1 $126.00 Mech.Plan Check 0.0 hrs $0.00 Piwid,. Plan C'he'ck N"n, 1'1<m Ch (k Mech.Permit Fee: IMPERMIT Fhonh, f'crinit hair: F' r. P,rmh V.,"c Other Mech.Insp. 0.0 hrs L $42.00 0(iwr•Pj'twr,h fn"p Urh�°r hi<< Insf�. 1'tectr, Cast). Fcc: t',?rrruh, h sir. (i°e. Isier.hw7 , P'cc: NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-05/Eff. 7`1/10) FEE QTY/FEE MISC ITEMS Plan C;Ireck I.,ee: PME Plan Check: $0.00 Perinit Fcic.': suppl. Irr:sp Fee PME Unit Fee: $126.00 PME Permit Fee: $42.00 Consiniction Klx FA ,1couVical Rcvieiv I'FV. Work Without Permit? 0 Yes E) No $0.00 Plcrrirtin�F'e�c>s: Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SJBTOTALs $211.50 $0.00 TOTAL FEE: $211.50 Revised: 12/07/2010 Sim lifted Prescriptive Certificate of Com pfiance:2008 R�sideutru7al HVA CAherations CF-IR-ALT-HVAC ©inaete 7-am 10 to 15 Site"d—Ar--,`b 8 6 a L3/b al —nent lam:. permit it �jZ"Z9-lU Conditioned Floor T ` List Wminim Effici Dud insulation requirement Area Thermostat O Packaged Unit Over Cf Furnace AFM9 ❑COP 40$of ducts added cr OSetback By 0 Indoor Coil OSEER O HSPF Rta6 replaced 10 I3 in unconditioned� � �ow afro 0 Condensing Unit 0 EER 0 Resistaiice O R 6 ((Z 14-13) �be 0 Other 1.Equoment Type:Choose the equipment being bntalleod if more that one sxtteM use ataodher CF-IR-ALT-HYAC`for each system 2.A Wamm Egtr*weat Effu3eachm 13 SEEK 7896 AFLIF 7.7HSPFfor o plad►rsidentid s}tstems. HERS VERIFICATION SUMMARY Listed below ars four HVAC alteration Options. The installer decides what work is being done and picks one of the approptiate Options. Each Option lists the HERS measures @kat mast be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the bormeowncr. At final,the inspector verifies that the work listed on this form was in fad the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R Erma(no hand filled CF4Rs allowed)are filled out and si Beginning October 1,2010,:reciatered copy of the CF-IR and CF-6R shall oke be on site for final inspecdoiL 1.HVAC Chan at Farms: Isood CF-6R frons MEM-K MECH-2I-HERS and(for split systems)NW-CH-25-HERS • All HVAC Equipment CF4R forma✓ MECH-21 and for split MF.CH-25 • Condenser Coiland/or • Indoor Coil and/or CF-6R fxws: MECH-2I-HERS and(for>pht sysoerns)MECfi-25-HERS • 1 CF4R fiestas: MECH-21 and(fa split systems) N ECH-25 For.SpIlt Systema:Duct leakage<15 percant; RC,CCA:!300 CFMhan(Minimum Air Flow Requirement),TMAH For Packaged Unfts: Duct leakage<15 permt Exempted frau duct leakage testing it: 0 1.Duct system was documented to bavc bast previously sealed and confirmed duoagli HERS veificatich,or 0 2.Dad systans with less d w 40 Hoar feet in unconditioned space,or O 3. ducttemsare cmwvctod,asNatod or sealed with asbestos 0 2.New HVAC Systen Required Forms: e. Cut in or Changeod with new CF-6R foimr. WM-04,MECH 20-HERS,aad(for split systems)?,MR-22-HERS,and UTCH-25-HERS ducts:(all new ducting and all CF-4R farms: MECH 20-,and ht and MECH 25 DOW me (for aP )MECN-22. For Split Systems:Dud leakage<6 percent;RC,CCA>_350(FMlton,FWD,TMAH,S ?4S,and citha HSPP or PSPP. For Packaged Units:Duct leakage<6 pownt 0 3.New Ducts with Replacement Required Formas: • Ltchides replacing or insfaliing all new ducting CF-61t f6rras KWH-04,MEGH-20-HERS,smd(for split systems)MECH-25-HERS and/or outdoor condensing nail and/or indoor CF-4R farms:MECH-20 and(for split systenns)MBCA-25 coil and/or furnace. Not all equipment changed. For Split Systems:Duct leakage<6 perces RC,CCA>300(FMAon,TMAH For Packaged Units:Dud leakage<6 0 4.New Dn over 40 feet Reavired Forms: • Includes adding or replacing more disn 40 CF-6R farms: MECH-04,MEM-21-IUS CF-4R farms: MECH-21 linear fed of duct in unconditioned For split system or packaged tmmfts: Duct leakage<15 pemend 0.EXCEPTION Exisigg duct wstems constructed,insulated err sealed with asbestos. Contractor(Documentation AatHer't/Responsible Designer's Declaration Statement) • 1 cooly that this Certif+ate of Compliance documentation is accurate sod complete. • .I am elig1le under Division 3 of the California Bmsinas and Pnofesnors Code to accept msponat'bilky for the desdgn Wer dW mm this Certiftcate of Comphianec. • .I eatify that the energy€e#m a and_ for the dcdp identified on this CertiScaoe of Compliance conibnm to the roqui ranents of Tldc 24, Pinta 1 and 6 of the California•Co&of lteantatiots • The design fawns denti5ed on this Certificate of Compliance we eoeskteat with the hmformation documented an other applicable complianceforms, worksheets, roc and _ cations smhmifted to the enforcement agmu for WMW with the Names MARINE BROOKS I Sigt,adoat: Com' SERVICE CHAMPIONS ]fie: l2 -Zq — cO Address: j ot.4 ch arc v it /4 u-e- Lieer>se si7o4o f ty/S>ahlLip SAfq J�5 e C.utr ! 3 i k D 3 91t�-! - 3'q Ct 2008 Residential Compliance Forms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10f309 j3f0,-k Lj)a 0 PERMIT# OWNER'S NAME: (Rn PHONE# ` 0l '00 - 67- 01 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: "l t)Zo C'ow m 4 r`t--2 D1' CITY/ZIPCODE: *t ,a 'L zuo qq!` ,g e *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: ) - 3 - 0 J " I �1 Signature Date Please check applicable subcontractors and complete the following information: s/ 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