10110009 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7680 NORMANDY WAY CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 10110009
OWNER'S NAME: JEI WEI CHANG 7020 COMMERCE DR DATE ISSUED: 11/01/2010
WNER'S PHONE: 4082532403 PLEASANTON,CA 94588 PHONE NO:(925)4444444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class l.) Li,. REPLACE FURNACE ADD A/C
Contracts Ui �ka MPec ►'1 5 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:$9229
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:36617053.00 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,
costs,and expenses which may accrue against said City in consequence of the
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.
�,��p RE-ROOFS:
Signatu Date !L ( 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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,Sections 25505,25533,,,and
d225534. /( /
Section 3700 of the Labor Code,for the performance of the work for which this C/GVW v !1 [ -li
permit is issued. Owner or authorized age l Date:
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
'-,Iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
,,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
6.anting 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: 7680 normandy DATE: 11/01/2010 REVIEWED BY: larrys
i9l APN: BP#: -VALUATION: 1$9,229
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARYSFD or Duplex '�11. i, PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Gravity-Type 1MFR=<100 1 # $126
A/C Units (<=10K cfm) 1BREMAIR 1 # $63
TOTALS: $189.00
Mech.Plan Check0.0 hrs $0.00
F
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. 0.0 hrs „,,r. EJ
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 Elf'. 7,1,10) FEE QTY/FEE MISC ITEMS
Plan CjTlfr'cA
>lIpp/ il
. l.,Fee
PME Plan Check: $0.00
M:'P'll'll(Fc(':
.�tppl, 11111p1-' -'
PME Unit Fee: $189.00
PME Permit Fee: $42.00
Coras11'11(Iict7 Tax
,lcousti,,,al Rcviciv 1=c:c,
Work Without Permit? 0 Yes Q No $0.00
I'Icatrrrrlrr7 f-��c.>.
Travel Documentation Fee: ITRA VDOC $42.00 _T
I
Strong?Motion Fee: IBSEISMICR $0.92 Select an Administrative Item
Bldm Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.92 $0.00 TOTAL FEE: $274.92
Revised: 10/17/2010
Sim )ified Presc ' tive Certificate of Co fiance:2008 Residential HVAC,411eradoru
(3L!te Zones 10 to 15 CF-JR-ALT-HVA R-ALT-HVA C
S&eAddh=/^ f"mment Agency: m
W�U fi C),( n W Date-. Permit#:
T t List M'irrirmon F.tfici Conditioned Floor
Duct insulation tArT'a
Thermopstat
(] �gr,1 T Fnit
IdFtanace l9 AFUE 9sEE Over 40 ft of ducts added or �Saba�lt
❑Indoor Cot? 61SEQt� rzplaad in tmaroditioacd space Served by sysfrar (lfnat abadyLZ
Co�ingunit O E R OR 6 (CZ 10-13) sf ,r nrxst be
Other OR 8 (Q 14-15) suTalle�
Egsipmew Type-Choose the equipmon being—Wad ffmure tlron one system use another CF-JR-ALTHYACforeach system
Mbulmm EpVmew E�13 SEE!>:78%AFVF,77HSPFfor typical resfdordarsystems.
ERS VERIFICATION SUMMARY listed below anti farce•HVAC alteration Options The installer decides what work is being done and
picks one of the appropriate Options. Foch Option lists the HERS measures&at mast be conducted.A Copy of the Sarins shall be 1cft on site for final
inspection and a copy given to the homeowner. At fiaA the inspector verifies that the work fisted oa this fxm was in fact the work completed by the
-6R and registered CF-4R.forms(no hand filled CF-4Rs allowed)are filled out and
si ed BeginningOctaber 1,2010,a r e of the CF-1R and CF-6R shall also be on site for final inspection.
installer. The inspector also verifies that each apptoptiate CF
.HVAC Changeout ired Forms:
• All HVAC Equipment replaced CF-Q2 farms` 1 1-04,MECK-21-HERS and(for split systems)MECH-25-HERS
CF4R farms ]�1EC11-21 and Ser lit s MECH-25
• Condenser
a• r Coil and/or CIndoor Coil and/a ~-6R farms MECH-2I-HERS and(for
Split System)MEd-25-HR
Furnace CF-4R forns: MECH-21 and(for Split
EYMM) MECU 25
For,Split Systems:Dud leakage<15 percent; RC,CCA>300 C FMA-on(Minimum Air Flow Regtiir«nent),TMAH
For Packaged Units: Duct leakage<15 percent
Exempted from duct leakage testing if!
Q 1.Aact-system was documented to have been previously treated and confirmed through HERS verification,or
Q 2.Dud systema with less than 40 Icrar Sect in unconditioned qxic-,or
Q 3.Exisft ductsystemsare ctmstc»dod,insulated or sealed with asbestos
O 2.New HVAC System Required Forms:
! Cut is or Changoont with new .
ducts:(all new ducting all CF-6R fusmx MECJi-04,M£�1i-20 IiERS,aad(for split s3'stems)MDCH-22-1ff1' and MI3CH-25-HERS
new Pgoprocut) CF-4R.forme: MEM 20-,and(for split systems)MECH-22,and NECH 25
For SpNt Systems:Dud leakage<6 percent;RC,CCA>_350 CFM/h j,FWD,TMAH,STAS,and either HSPP or P.
For Packaged Units:Duct leaknE<6 percent
❑3.New Ducts with Replacement Required Forms:
• Includes replacing or im-taning all new ducting CF4R.ftmr HXH-04,MSCI-1-20-HER-SAnd((w split systems)MEM-25-HERS
and/or outdoor condensing molt mWor indoor CF-4R forms MECH-20 and(for split systems)MEM25
cag and/or furnace, Not all equipment cbmp
For Split Systema:Dud leakage<6percen4 RC,CCA>300 CFMfton,TMAH
For Paeka ed Units:Did leakage<6 percent
Q 4.New DuFftg over 40 feet Required Forms:
• Incllinear f6 adding t replacing more than e. Cjt.�for= MECH-04,MECH_21-HERS CF-4R foams: MECH-21
linear fed of duct in unconditioned aa.
For split system or packaged units: Duct leakage<15 percent
Q.EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I cm*that ft Certificate cfCorrrimte documentrticu is accumte and compluc
•_ I am eli&le.updergvisign 3.of the Califotaia Business and Profesiens Code to accept rcspousibility for the design identified oa this Certificate of Compliance
• ;I eutifY the the eaergp fertuues sad pafiotm1W-Specifications for the design identified on this CatiScme of Coragance can to the rogei rernerita of Tide 24,
Partr I sad cif the Catffemia C*.of ltegnlatiaes.,
• caldetion features identified on this Certificate of Complitmee are coas'stait with the information documented m other applicable compliance forms,worksheets,
cxarlationa Cas stud ' ixtiow suhmitred to the cn&mcmmt gecy for XMOW wilb the 't lica6oa
]vsm� MARINE BROOKS Sigoatm�e:
CO0° `u SERVICE CHAMPIONS
Address: .t)L Z O comm ely;e- 817040
City/StaterLipr 7-74
�
2008 Residential Compliance Fars March 2010
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36617053 . 00
DATE ISSUED. . . . . . . : 11/01/2010
RECEIPT #. . . . . . . . . : BS000011889
REFERENCE ID # . . . : 10110009
SITE ADDRESS . . . . . : 7680 NORMANDY WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JEI WEI CHANG
ADDRESS . . . . . . . . . . : 7680 NORMANDY WAY
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 9, 229. 00 1. 00 0 .00 1 . 00 0. 00
1BSEISMICR VALUATION 9, 229. 00 0. 92 0 .00 0 . 92 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 . 92 0 .00 274 . 92 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 274 . 92 5384
---------------
TOTAL RECEIPT 274 . 92
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
aclorCUkTINO PERMIT APPLICATION FORM
Date:
Building Address:
Rv�o
Owner's Name: Phon #:
-Te, t
Contractor: - Phone#: qzS- yL/y 1IV,11
P/074
'701-0 I�)/"
PL-e,0 5u v Fax#:
Contractor License#: Cupertino Business License#:
9i70yU
Contact: a ,f Phone#:
Fax #:
Building Permit Info:
Elect'so Plumb ❑ Mech
Residential Commercial
Job Description:
For Residential Installations:
Attic ❑ 1"floor E] 2°d floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
gzzI,Ue,
Strapped On Platform Bonded New Location Replacement
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Valuation:
QZZ-
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09