14020140 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10180 BONNY DR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14020140
OWNER'S NAME: RIFFE RONALD W AND JOAN 7020 COMMERCE DR DATE ISSUED:02/24/2014
OWNER'S PHONE: 4082537932 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
ip LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
/+ 7 /l �j r, REMOVE AND REPLACE FURNACE, 10 SUPPLY DUCTS
License Class C Z v Lica# lS 1 logo AND 1
Contractor
� Lel" p� O-A s Date 'y� RETURN
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12655
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:35911047 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 F 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 FR LAST CALLED INSPE TI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the j
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:
Signatu wkkQ_1 Date�'0?`f'/
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(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,Se ti ns 2 505,25 3,an 25534. � [�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. Date:1)'�'L/� l
permit is issued.
I certify that in the performance of the workfor 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I 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
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
91 ADDRESS: 10180 bonny dr DATE: REVIEWED BY: Mendez
APN: BP#: I *VALUATION: 1$12,655
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE:
WORK remove and replace furnace 10 supply ducts and 1 return
SCOPE
Mp
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Mech.Plan Check 0.0 hrs $0.00 I'hiwb,Plan Check
Mech.Permit Fee: IMPERMIT 1111"m! Fermi/I E e: (:ie;c. '<aom , 'c
Other Mech.Insp. 0.0hrs $47.00 011wr PlUmb Ins,,. Lj
Elthes tsCrc.? s,J.
Pluutb. hap. Fee. i Iec.lnst� f°:e
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimmina information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.000 # Mechanical
Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $139.00 ,MFR=<100 Furnace,Forced-Air
PME Plan Check: $0.001 # Mechanical
Permit Fee: $0.00 $70.001BAPPLOT Other Appliance/Equip
Suppl. Insp. Feer Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
G,m"�o-110ifm 7'a,C r— L——
Administrative Fee: IADMIN $44.00 E)
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Travel Documentation Fee: I TRAVDOC $47.00 A
Strong Motion Fee: 1BSEISMICR $1.27 Select an Administrative Item
Bld�T Stds Commission Fee: IBCBSC $1.00
® $140.27E$209.±00 TOTAL FEE: $349.27
Revised: 01/15/2014
Sim fified Press ' tive Certi iicate of Compliance:2005 Resdden al RVA CAItera erns CF-IR-ALT-HVAC
Climate Zona 10 to 15
SSYe Ad�cr� �rfor canesrt Agency: Bate
cal v 3e�wn r �-l9-i� Pernik#.
Typel List&fMjMUZM EfEci Coadmoaed Floor
0��" Unit Duct insulation t Area Thu mastat
J§Furnace A JE�s O COP Over 40$ofducts added or JW Setback
O Indoor Cori OSEER 13 HSPF
replaced m unconditioned slrace Savcd by system arr,V d.-,
O Condensing Unit O EER 13 Resistance O R 6 (CZ 1013} of preren;must be
O Other ORS (Q I4-1.f} iarta[[edJ
I_E4agpnwwType:(aware the equipment bang—Wtid ifrravre thmr mrerystar;core msvther CF Ile ALT-HY4Cfor"earh system
2.14Mbdvmm Equipment Erack rcim-13 SEED,78%AFUP 7.MVFforWcal rendentid systevM
HERS VERIFICATION SUMMARY listed below am flay HVAC alteration Options. The installer decides what work is being done artd
Picks one of the appropriate Options. Each Option fiats the HERS measures that must be caadnctcd.A copy of the foams shall be left on site for final
inspection and a copy givee to the homeowner_ At final the inspector verifies diet the work listed on tib foam was in tact the work completed by the
insuDer. The inspecinc also verifies dw each appropriate CF-6R and reg axed CF-4R forma(no band filled CF-4Rs allowed)are filled eat and
signed. October 1,20110,a registered copyof the CF-IR and CF-6R shall also bean site for final hupecdon.
1ir1.HVAC Chan est Requked Forma:
• AH HVAC Equipment replaced CF-6R fonrms:MECH-04,MECFI-21-HERS and(for split systems)MSCI-25-DERS
CF4R f nuc MECH-21 andfico split r
fstems) MECH-25
• Condenser Coil and/or .CF 6R forms: MEM21-HERS d
a Indoor Coil and!err and split
systems)MECH-25-HERS
• Furnace
CF4R forms: MECH-21 and(for split systema) MECH 25
For.Split Systems:Dud leakage<I5 P=cnt; RC,CCA>300 CFMAmi(Minittrum Air Flow Requirement),TMAH
For-Packaged Units: Duct leakage<15percent
Exempted from dad leakage testing it:
O 1.Datet-systcm was documents!to have been previously treated and confirmed through HERS voYifica&cm,or
132_Dud systems wiHt less thea 40 linear fretio ummditioaed space,or t
O 3.Exu6mg duct systems are conskucfiod,in sniatad orseded with asbestos
O 1 Nein HVAC System Required Forms:
Cut in orChangerut with new . CF,W forms MECH-04,ME 204MRS for
duel(all new ducting s!1 .smd( split systems)MECH 22 IUM,and MFM-25-HER9
new
CF4R forms; MECH 20-,and(for split systems)MECH 27,and MECH 25 -
For Split Systems:Dud leakage c 6 p RC,CCA>_350 GFM/tuns FWD.TMAH,SMI1 S,and either HSPP or PVP.
For Packaged Units:Duct leaks <6 pcx=t
3.New Dmcts�riW Replacement Required Forma:
• Includes replacing or installing all new ducting CF-6R tbams MECH-K MEM20-HERS,and(for split systans)MECH-25-HF-RS
sodlor outdoor emrdensing and tmd/or indoor CF4R fmtms MECM20 cad(for split system)MEM25
ccr7 andlor furnace. Not all equipment clmngod.
For Split Systems:Dud leakage<6percent,RC,CCA 300 C FMAon,TMAH
Forpacks ed Unfta:Dactleaks c<6 tcst,w t
0 4,New Du aver 40 feet Reauired Forms:
• Includes adding or replacing more than 40 CF-6R fossas:MECH 04,MECH 21 F>II2S (74R frame MEM-21linear feet of duet m unconditioned ace.
F.or split system orpackaged units: Duet leakage<15 percent
Q EXCEP710N Exigft dud systems con*udcd,inaulatod or scaled with asbestos.
Contractor(Documentxtfon Auther's/Responsible Designer's Declarition Statemehl)•
• f testify that this Certificate OfCompinaee docmaeatatiaa is neonate and complete.
• -I am eSgn6k amderlJjvnaaga;3.oftbe Caiifomii Business and professions Code to accept respoosability for the design identified can this Catificnte afComplianee
:I certify that the eaeW le"=and.�afu�aa specHicatiatn for the design identified on this Certificate ofCcatgJiaaa eemfanor to the ra�taas nof Tide 24,
ili to 1 gad 6 cif the&ifomia,Ca*0e 0f Regataticas..
• the design featz;nsldentified an He's l wdoem ofCompliaox'are eontikfttw6h the iaformatia n doc®eated oa otherapplicable compliance forms,workshe etsy
cakatlafionaulna aid 'eatiars snlrmitted t the eafbrremat for WOW wi&the t liami
Noma ,` Signatare:
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2008 Residential Compliance Forms March 2010