14010059CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19967 PEAR TREE CT CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 14010059
OWNER'S NAME: MOORE RONALD 7020 COMMERCE DR
DATE ISSUED: 01/08/2014
OWNER'S PHONE: 4082531197 PLEASANTON, CA 94588
PHONE NO: (925) 444-4444
46 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REPLACE 13 SUPPLY DUCTS
(�
License Class �� Lic. # �,����
,� `
Contractor � ?1 U lL P l Date 1-914
1 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: $5785
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: 31630085 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 -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 FRO LAST ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
which may accrue against said City in consequence of the
costs, and expenses
Issued by Date: '
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
RE -ROOFS:
Signatur� Date 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 & SaCode, Sections 25505, 2 33, and 25534.
���. f
.fety
Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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 cityand 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
GENPRAL PERMIT APPLICATION
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(�� �,�y�07� CITY OF CUPERTINO
FOR - TFT IP QTTM A TnU — RI TII ,DING DIVISION
LaADDRESS:
19967 PEARTREE CT
DATE: 01/08/2014
REVIEWED BY: Mendez
APN:
BP#:
"VALUATION:
1$5,785
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
hrs
PENTAMATION 1 RMAP7
USE:
PERMIT TYPE: i
WORK
REPLACE 13 SUPPLY DUCTS
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
SCOPE
$0.00
Mech. Plan Check 1 0.0 1 hrs: $0.00 Plumb. Plan Check Elec. Plan (.:heck
Mech. Permit Fee: 11 PERMIT Plumb. Permit Fee:laec. Permit T ee:
Other Mech. Insp. 1 0.0 1 hrs 1. $47.001 OXlier Plumb Insp. I I I Chher Elec. Insp.
dlech. Insp. Fee. I Plumb. Insp. Fee: I Elec- Insp. Fisc:
NnTF. T/,:. ncdm"to door nnt:ittrludo foav due to other Departments (Le. Plannine. Public Works, Fire, Sanitary Sewer District, School
rnntart the Dent for addn'l into.
Loud o..y « Z.:..w.. ...,.. ». .. ..»...... .,._ _.._ .-'------___---
FEE ITEMS (Fee Resolution 11-053 E . 711/132
----__----
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 # Mechanical
$104.00 IBREMVENS Ventilation System
Suppl. PC Fee: (F) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
E."onstruction .Ta.v.
Administrative Fee: /ADMIN
$44.00
G
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Feer
$0.00
Select a Non -Residential
Building or Structure
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Travel Documentation Fee: ITRAVDOC
$47.00
Strong; Motion. Fee: IBSEISMICR
$0.58
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$139.58
011
$104.00, §Qu
$243.58
Revised: 01/01/2014
Simplified Prescriptive Certircate of Compliance: 2005 ResadenjW RyAC,4lterapions CF -JR -ALT -HVAC
Qrmate Zones 10 to 15
SNe Ad&ers:
om : _ _ 8 _l Perna
Fgaipmertt TYPer List M -minium EfFicirnrV2 n --r-4— Conditioned Floor
1 � _ L•ave,i IFnit 1 -
- - - - ---
lndTllog(3L
Q Furnace Q A�
Q COP � 40 f1 of ducts added or
0 Setback
Q Indoor Cbt7 l]SEER
Q HSPF repiatxd in tmcoaditioaed space Saved by system
�, d,��,
0 Condensing Unit Q EER
Q Resistance Q R 6 (t210-13) sf
Pr—c must be
O Other
Q R 8 (Q 14-15)
i,rsWr.7
L E'4z*-eW T}Fe: Chaore the eguipmeW beong butallad f more rlroa acre syttor, rcre another CF -IR- fLT-HVAC foreach systenc
Z- baa Eq -,p --W Er -&,=m 13 SFEX 78%AFUB, 7.7ZM-Ffor typical rrsidoitiad syJtentt
HERS VERIFICATION SUMMARY listed below nus fanrHVAC alteraticm Optioaa. Tb: installer decides what work is being done and
Picks one of the appropriate Options` Each Option Bats the HERS measmts that mast be coaductcd- A copy of the farms shall be left on site for final
inspection rad a copy given to the homoownca. At final, the inspaxor verities that the work listed on finis farm was in fad the work completed try the
installer. The trip-oor also veafks that each aPluvpriete CF -6R and regist-md CF -4R forms (no hand filled CF-4Rs allowed) ars filled out and
signed. >�»mg 0dober 1, 2010, a registered copy of the CF -1R and CP R shad[ also 6e on site for final Inspection.
Q 1 HVAC Changeoot I RRequimd Forms_
! All HVAC Fquilmment replaced " % r"`mic `vLrJ-n'U'k, Z4tLJJ-2l-Ht:ttS and (for split systems) M1 CH7S-);�,g
CF4Rforma: MECH-21 and for lit s MECH-25
• Condenser Coil and/or f CF -W fora» MHCM21-HERS rad
a Indoor Coil and/or CFVR frarns: MECH- Z1 and (� �� ins) MECH- 25 -HERS
• FFurnacefor ( split systems) MECH-25
For Wt Systems: Duct leakage < 15 percent; RC, CCA> 300 CFMAo t(Minimum Air Flow Reifuirrrnent), TMAH
ForPackaged Units: Duct leakage < 15 percent
Exempted firm dad leakage testing it:
Q L Daa-syst= war document Tato have bemprsrioudy seated and confirmed
tbrvugh HERS verificaticm, ar
Q Z Duct systems with less than 40 li near ted in unconditioned sgacc ; or
03. Existing duct EM= we Camlftvd0d. kwuldod orsealed with asbestos 1
rCL3
(F-6R faarms: i►gQ%04, New HVAC System Req" Fors:
utinorChangeoutwithnesedr (all new dactiag� all MEM 204MRSand (farsplit systems)MEM-22-HERS; and MSM2H5-ERiw eat CF4R fm M' MEC[i 20-, and (Ser split systems)MECH-27, and MECH 25
For Split Systems: Duct leakage <6percent; RG CCA >_350 CFM! FWD;
For Packaged pelts Duct leakagec 6 �' TM'° � ST > and -either HSPP or PSPP.
0 3. NewDucts with Replacement LRN=Ired Forms:
• Includes replacing or installing all newdactiag CF -6R hums_ MECH-04, MEC -20•HERS,and (for split syst=) MECH 25 -HERS
and/or outdoor mg unit =&or indoor CF -4R forms MEC -20 and (for split systems) pABM25
coffand/orfurnam Notallequipmentcbseged.
For Split Systems: Dad leakage < 6 per+ce4 RC, CCA,!300 CBVWD, TMAH
For packs ed Ueiis: Duct `l e < 6 percent
10 4, New Ducthg over 40 feetReauired Forms
Inclu• linear es adding or tin unconditioned
tbaa 40 CF -6R farms: MECH-04, MEGii 21 HERS CF -4R forms: MECH-ZI
linear feet of deet m fficoaditialued -roe.
For split system orpaekaged Writs: Duct leakage < 15 percent
Q EXC EP iON F.usfindrat MM conshn ith insulated or sealed wasbestos.
Foutractor (Docurnentatlon Authbei /Iiespdesiblte Deaiguer's Declaration Statement)
I =tiny that this Ceatificate GCoit>pTimee docmgeaWar is agate and eomplaa
• . - I am eSgrbk;uader iJjvisoa_3.ad t5e Catifomir<Busmeu and Pfafesoo»< Code to accept respoosiMiity for the design ideatifkd on this Certificate of Compiimx
• :1 cerfify that the energy fe¢ques -d petSo>mmce Vecifiiayom for the deQgn idea65od oa thin Certffiate ofCartrptirmx canfartii to the rogaitarKrita afTitle 24,
Perfa k sad 6 of rhe Catffaraia (`ode of Regoiatious
•
The desien fahinrs idenii d ea H.re f`wr:Fr.r....sr•........r• .
cakuhtims, Plana and V90iaiianicchmitted to tb
Nu= 41 Q. •► TIc
se, 01b PIA
Address: 1 0 Z o �f7YLtWl �I�G
L easy v1�
2008 Reside rd Compliance Foran
-xe are coassteatwith the information docamcnted on other applicable coWliancc forms, workshecta,
t agency fm avtaovak with the aemrit.amt!i Wi—
8 C 7040
s .WN -W
March 2010