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14020080 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10565 BEARDON DR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14020080 OWNER'S NAME: GAIL BIRGERS 7020 COMMERCE DR DATE ISSUED:02/13/2014 OWNER'S PHONE: 4082574849 PLEASANTON,CA 94588 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATIONl r— BUILDING PERMIT INFO• BLDG ELECT PLUMB License Class �,Z 6 Lic.# MECH r— RESIDENTIAL COMMERCIAL ContractorDate I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION. Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(E)FURNACE AND SUPPLY DUCTS,SAME i 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 LOCATION 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. APPLICANT CERTIFICATION [certify that I have read this application and state that the above information is Sq.Ft Floor Area: Valuation:$10546 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 APN Number:32609001 00 Occupancy Type: 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-pMtsrce regulati s per he upertino Municipal Code,Section 918. PERMIT EXPIRES IF WORK IS NOT STARTED signatuDatWITHIN ERMIT ISSUANCE OR AYS + CALLED INSPECTION. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of by' Date: 2 3 the following two reasons: 1 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 RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is installed 2. I,as owner of the property,am exclusively contracting with licensed contractors Without first obtaining an inspection,I agree to remove all new materials for inspection. to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 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. HAZARDOUS MATERIALS DISCLOSURE 2 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 I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with permit is issued. the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section s. I certify that in the performance of the work for which this permit is issued,I shall 25532(a)should I store or handle hazardous material. Additionally,should I use not employ any person in any manner so as to become subject to the Worker's equipment or devices which emit hazardous air contaminants as defined by the Bay Area Compensation laws of California. If,after making this certificate of exemption,I Air Quality Management District I will maintain compliance with the Cupertino become subject to the Worker's Compensation provisions of the Labor Code,I Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and must forthwith comply with such provisions or this permit shall be deemed 25534. / revoked. Owner or authorized ager Date:,9�3 (� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's for to building construction,and hereby authorize representatives of this city to enter which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address 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. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional GENPERMIT APPUCA I'IO �lcb . _ COMMUMM OV I'i3QQTMEt-t_UF-CLW=_=RTaIC}:Grc 432= j40S)77T-3=`FR X jA-08)r s - I misc cuQFJMxa \A� ICt . � 'a�-ica:_ �rs�t'�n•rrnT QgriS�Ta�� tt�s�s r�ea.fddr� Dr ll x7-fv/q - � Lf EAz CMTrACr NAUS . ....... .... a II ami a • MUOAMczm�ear{rrw� �"s" - NUAItO WAX MAX r, Q 1 " UAM rm I-I= � IIII- = Q am II man 13. mon aae Ii �r� cd�,i�aQ�c£nc� Ia�athaa�ras �mas7g�neaw�Cs�€Y�r�� S��'La�3�0�� F ��o�•.� � Q IV z • 3�3�scf�rrr_ZQd T-dx revrred Qd!?I/fl CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10565 BEARDON DR DATE: 02/13/2014 REVIEWED BY: MELISSA APN: 326 09 001 BP#: 'EVALUATION: 1$10,546 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK I REPLACE E FURNACE AND SUPPLY DUCTS SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 TOTALS: 1 $139.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $47.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (l<'ee Resolution 11-053 F. . 7/11113 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $139.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $47.00 Strong;Motion Fee: 1BSEISMIC,R $1.05 Select an Administrative Item Bldg Suds Commission Fee: IBCBSC $1.00 SUBTOTALS $279.05 $0.00 TOTAL FEE: $279.05 Revised: 01/15/2014 Sim &frescriptive Certificate of Co Diane:2008 Resjdf n ajREAC,41terataons CF-IR-ALT-MVAC Climate Zona 10 to I5 S&&.(ddrers: J6r�sortAgency. BaIC 1 ns 6s '6ea�coA �� - a-r3-�� Perms#_ Conditioned Floor Type' Inst Mnnm�Fffici Duct ituala6on t Area Thermostat -PwIngest Lin it Furnace E3SM�� O COP Ove•40It of du added cc ptSe back Indoor Coil OSEER O MPF replaced in unconditioned space Served by system pf—ob—d, O Cotrdeasntg Unit O EER 0 Resistance OR 6 (CZ 1 6-13) sf proses;mrest be O Other O R 8 (CZ 14-15) iutvltedJ 1_Egz*mew T1Pe-C7roare the eguipmert bang-1alFed if more Ams one system use menthe-CF=1R ALT-HYACforearh sysrenc 12.MbrPmara EquT-ene Eflkfnrcfea 13 SEEK 78%AFErg 7.77WFfor typfcdl residentfa{systerru HERS VERIFICATION SUMMARY I steel bekov ate fan HVAC alteration Opti.L The wstallcr decides what work is being dome and picks one of the app ap do Options: Foch Option lists the HERS nx&s,=that mast be conducted-A copy of the foams sbalI be left on site fur final inspection and a copy given to the homeowner. At final,the iospec for verifies that the work listed on this fzm was in fact the work completed by the hastaller- The inspector also verifies that each appropriate CF-6R and MVistered CF-4p'hams(no hand filled CF4Rs allowed)are filled oat and !j&2ed. 2!g!!LnjOt abear 1,2010,a registered copy of the CF-1R and CP-6R shall also be on site for final inspection. I.HVAC Chan tutI Required Forms: • All HVAC Egmipn=t replaced CF-6R harms:MFM-04,MECfI:21-HERS and(for split system)MEM-25-IMM CF4R 11, MECH-2I and floe SPlit s MECH-25 • Condenser Coil and/or CF-6R Eerie: M EM21-HERS and for a IndoorCoilsad/a ( bPlit systcuts)MECH-25-HERS • Furnace CF-4R€acme: MEM-21 and(for split systems) M K H--25 For.S�tlit Systema:Dud Ieakage<15 percent; RC,CCA>_300 CFM/tcn(Minim=Air Flow Rogaireruent),TMAH For Packaged Units:- Duct leakage<15percent F cnpbed fi=n dad leakage testing ifs O 1.Dod-aystem was docvmeand to have beta previously sealed and confirmed through HERS verification,or 13 Z Dun systems wi&,Icss thea 40 linear*ctin tmcanditioned space,or t 133- duct Ustem are covslroct4 inwW ed arsealed with asbestos 132.New HVAC Sy3tam Required Forms: ! MEM-04 Cut in m Cbsng mcti wide new CF-W frnm , CH-20- for ducts:(alt atw dtrcting�all MEHM.8°d( split system)MDCH-22-HERS.and MFCIi-25-FIEit� - nm eat) CF4R flans: MECH 20-.and(for split systems)MECH-22,and MECH 25 For Split Systems:Duct leakage<6 Percent;RG CCA>_350 CFM/ttm,FWD;TMAH,SrAV,and either HSPP or PSPP. For Pac ed Units:Duct leakage<6 percent [ 3.New Dads with Replacement Required Forms: • Includes replacing or installing all new .ducting CF-6R Inw. MECH-04 M I-20-HERSdwd(for split systems)MECEI 25-HERS and/or ootdoar ccnd=mg unit mWer indoor CF-4R flans MECH-2O and(for split system)?AWH-25 coil and/or furnace. Not all egaipment ehnagrd For Spft Systems:Dud leakage<6percentr RC,CCA 2t 300 C3:M/wn,TMAH F or Packaged Units:Duct k!ca e e<6 ersent 4.New Da over 40 feet aired Forms: Inchrdes adding orreplacingmare 9=40 CF-6R form` NECH-04M SCH 21 MMS CF-4Rfoas MBM-21 linear fixe of dart in woondifieaed ace. r split system orpackaged units; Duct leakage<15 percent Q EXCEPTION Eason dad coaster insulated c r scaled with asbestm Contractor(Documentation Aathbei/Responsible Designer's Dedarition Statement)" • I eettify that this certificate of CotrVr--aoc®e Wao is accurate sad complaG • .I am e5gsbk,rmdal}ivisioa 3.ofthe Caiiforaia Bacsmas wdPmfessions Code to acceptrespo=-Wfity for the:demga ideaffed on this Certificate ofcomplimm � I fy that the energy fepnms and fat o�mce alraificatmts farft design idmtifW ou this Cereate of CznWHance con&m to rhe regai=awts of Tnie 24, • Parts l sad 6of'tbe California•Co�te•of;Regalatieus... • The design fr+dures identified oa 6rie Cad$eate of Compliaoee ace Coas'stmtwith the imfocmatim doemneuted on other appliabk couplianm fomes,woAahxts, calmU inaa eras noel ' ai3oasonh�tted to the ea`NM-=at fir oval with the 't 6i LAd:. eel�^ /� Signature:Corapany- Jei ul(✓ ar'Vt Q)5re�Lip �f'QSQUI to C,A 99 Pt�a(�a� .qqq - qkqq 2008 Residential Compliance Forms March 2010