14040037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10412 SCENIC CIR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14040037
OWNER'S NAME: NITTA DANIEL H AND KAREN S TRU 7020 COMMERCE DR DATE ISSUED:04/07/2014
OWNER'S PHONE: 4082552047 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0
REPLACE 2 SUPPLY DUCTS&2 RETURNS
License Classy�� Lic.# �7 �y
Contractor Serb1C-P� C°tag.p6AS Date q
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:$5526
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:35707021 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 D RMIT 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 ROM L 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 e Y Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature 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
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,Sections 25505, 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized ager Date:
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 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
918.
Signature Date
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CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10412 SCENIC CIR DATE: 04/07/2014 REVIEWED BY: MELISSA
APN: 357 07 021 BP#: *VALUATION: 1$5,526
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RMAP1
USE: PERMIT TYPE:
WORK REPLACE 2 SUPPLY DUCTS &2 RETURNS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Other Appliance/Equip 16APPLOT 1 # $70
TOTALS: $70.00
Mech.Plan F 0.0 hrs $0.00 phlon!). '/car?(M'e'ek
.Permit Fee: 1MPERMIT 1'r'€s r>3. ' rnaiz h;€;:
Other Mech.Insp. 0.0 hrs $47.00 Oin,r 1'irr nb Vin,=>. Li I
i','rtnb.lnsoz
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelhWdna information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution.1.1-053.F,ff. 7/1/13,2 FEE QTY/FEE MISC ITEMS
Pf""n Cheek bee:
SuIppl, T-1
PME Plan Check: $0.00
Jg —171
PME Unit Fee: $70.00
PME Permit Fee: $47.00
ssl
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes No $0.00
Travel Documentation Fee: ITRA VDOC $47.00
Strong-Motion Fee: IBSEISMICR $0.55 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.00
:.
UBTOa �••• $209.55 $0.00 TOTAL FEE: $209.55
Revised: 04/01/2014
SimplifiedonPres ' five Certificate of Co
Climate Zona 10 to 15 fiance:2008llesrderzi6alHVA CA/2era¢rorrs CF-IR-ALT-HVAC
She Adders:
IN t 7, SGehcG qtr ����e�: Hatt ` Permit#:
-7—ft1
T r List Wmi Foci Conditioned Floor
Dntx intvlation t
0 Pacl apd Unit Area Thermostat
❑Furnace Q ARM ❑COP Over 40$ofducts added tr p Stxback
❑Indoor Cbt7 OSEQ2 Q mpg replaced in tmcoaditiomed space Served by system �,
•Comdencin Unit 3 Q EER O Resistance IJ R 6 (CZ 10-13) sf pre-4 meat be
1 Other 1 a1 Q R 8 (CZ 14-15) vuraltrdJ
1_Egaipmew Tipe:Choose the equipment hang butalled•if more Am one systems nae menthe r CF-IR-AIT-HY for earn system
L2- fbrfmam Equipments Ef keen iea 13 SEER;,78%AF'UP 7.7HSPFforRS VERIFICATION SUMMARY listed below axe RmrHVAC altea$on Option The installer decides what work is lung done and
s one of the appropriate Options. Each Option luta the HERS me�aautes that must be cmdac,-led.A copy of the farms shall be Ieft on site for final
ection andacopygiventotheho meowner. At final,the nxspoctorvari5es that the wane listed an this foam was m factthe work completedbythe
De�The inspector also veufies that each appropriate CF-6R and registered CF-4R fmras(no hand filled CF-4Rs allowed)ase filled oat and
d October 1,2010,a registered cgy of the CF-IR and CP-6R shag also be on ske for fdaal h2specdon.
131.HVAC Changeout F
ed Forms:
All HVAC Equipment replaced , -- and(for spilt systears)M BM-25-HERS
oams MECIi-ZI a� Son lit s MECH 25
• Condenses Coli and/or CF-6R forms: MECFI 2I-IR.S and for Split
e IndoorCoiland/or CF-4R forms MECH-21 and for rt }MECH-25 HF3iS
. Furnace ( ) MECH 25
For.Split Systems:Duct leakage<I5 percent; RC,CCA?300 CFMAcn(Minitntra Air Flow Reiluixzsaent),TMAH
For Packaged Units-- Duct leakage<15 peicwt
Exempted from duet leakage testing if!
O 1.Duct ayst m was documented to have been previously sealed amd confirmed
17 Z Duct systems with less thaw 40 linear fed In Unconditioned spacq,or through HERS vcri6t ticrit,or
O 3. duct systisax are cod,insulated or sealed with asbestos 4RE'[For
2.New HVAC System Re gnhvd Forms.
Cat in m Chsageout with new - CF-6R forms:.MECH 04,ducts(all new doctiog�all CFVR forms: MECFI 20-,an 2 h4l tMMd(for�rt Systems)M OCH-22-PIERS,andMECI
new ext ( sp. � 1�.and MECH 25
Split Systems:Duct leakage<6p�t R�CCA>350 CFMkon,FWD;TN IAH,STIv�S,and either HSPP orPSPP.r Pac ed puffs:Duct leaks S 6 pexcent
❑3.New Ducts with Replacement r(C-F-4R
ired Forms:
• Includes replacing or i�lKag al!new ducting ftttmr MECH-04,M 50--20-HERS,and(for split systc=)MECH 25-HERS
and/or outdoor ruing wait and/or hrdoor Saxm�MECH-20 mrd(for split systems)MECI�?S
cog and/or fiance. Nd all equipmentchanged
For Split Systems:Duct leakage<6 perces RC,CCA>300 C3�M/tt>fl,TMAg
For Packaged Units:Duet leakage<6 p=cnt
13 4,New Duefing over 40 feetRequired Forms
• ine linear�liof dart is unconditioned s adding or replacing more than 40
lCF-6R forms: N ECH-44H
,MECH-2) ES CF-4R forms: MEM-2121
in
For split system or packaged units: Duct leakage<15 percent
Q EXCEPTION Ridstia duct canto insulated or sealed with asbestos_
[Ad
tractor(Dommentatian Anther's/Respeiusr'ble Designer`s Deciarition Statement)
ratifythatthsC.ertifcate afCnngrliance docmncnttdc a is amwatc and complete.
am eSgiftkrmda L}ivisinn 3af the Califwaia Btsiaeu and Profession$Code to accept rrspaasdxilitfor the design idemWcd on chic Catificatc ofCompliance;LC=tvy that the energy f4,—, aut.Ferfummee cation for the dmgn identified on this Cakfr�ofCampHance cosstordr M the ragairsornta of7 etre 24,
Parts Isad 6dthe CitHforuiaCo¢aepalafioas...The design futures idwdfied tin this'pe"' cuteofCompli&6=arc coasatmtwith the imfarmadon doenmented an other applicable compliance forte,wor{zirects,
rilionisnhmiftcd to the:crosrcamt fm oval w the t IicadT Yll O ' /`"ss: 0Z) &)Ai4��C� J� License: 7oWa
arra qt 98 Phaae�a� _qqq - ijggq
2008Residentia1 Compliance Forms March 2010