14050091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 810 CANDLEWOOD DR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14050091
OWNER'S NAME: BLACK THOMAS L AND JEAN A 7020 COMMERCE DR DATE ISSUED:05/14/2014
OWNER'S PHONE: 4082522019 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
/1 ,/R,/ EPLACE 7 SUPPLY DUCTS
License Class C Z10 Lie.# '8 l-1 o"bo
Contractor'Y'[61�J l�►1ClW�( S 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:$8747
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:36919032.00 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 1 D S 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' AYSLAST 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 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
9 18.
S1q-1L any
roofing
_
Signaturl)�&ALT_)J 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&Safety Code,Sec ions 25505 25533,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 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 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
ADDRESS: 810 candlewood dr DATE: 05114/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $8,747
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION 1 RMAP 1
USE: SFD or Duplex PERMIT TYPE: A
WORK �re lace 7 supply ducts
SCOPE
Mech.Plan Check 0.0 hrs $0.00 I'h( .i).Pla",Che',V, L luc. t n t� ick
Mech.Permit Fee: 1MPERMIT I't r f�. T't t�� �`t'i't::
rer Mech.Insp. 0.0 hrs $47.00 Doll�r P114nib Inv)
a_. PhI1111) h7sp.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 fa.' 7/f 1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 �_J # Mechanical
Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $70.00 IBAPPLOT Other Appliance/Equip
PME Plan Check: $0.00
Permit Fee: $0.00
Supp/. Insp. Fee:Q Reg. Q OT O,Q hrs $0.00 T=
PME Unit Fee: $0.00
PME Permit Fee: $47.00
t.ons",'11c lorr Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure ,
Strong Motion Fee: IBSEISMICR $0.87 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
10° $139.87 $70.00 TOTAL FEE: $209.87
Revised: 04/01/2014
simplified-p-rescriptive Certificate of Compliance:2008 Resideatial HV.4CAUeratiostrs CF-IR-ALT-HVAC
Climate Zona 10 to 15
Safe AdT O l-G-AJ"'`--L/WQd DI EnforrnneM.4gexryt Dam--
TO
slt Pernod t.
Fquiprnlent T ' List&f timnm Elfici Comiitiancd Floor
0 Ptti�tit Lin;3 Duct insulation c Arca Thamostai
0 Fwvace ❑AFUE ❑COP Over 40 ft of ducts added or L��
D Indoor Cot? OSEER ❑HSPF
replaced in unconditioned space, Served by system ,0 Condensing Unit DEER 0 Resisuhce 0 R 6 (CZ 10-13) sf0 Other OR 8 (Q 14-15)
1_Fgnxrjpmerrt Type Cfwase the equ4-art bebWimtalled ifmare lhmr onesyst-em rrse mmther CF-IR-ALT-HYACjoremh system
2.Afbrimam P947me>g E arciea 13 SEEk 78%AF(lP..,7.7HSPFfor typical rmndmtttd systems.
HERS VERIFICATION SUMMARY listed below am RW HVAC alteration Options. Tie installer decides what work is being dove and
picks one of the approp;ate Options. Each Option lists the HERS measures that must be conducted.A copy of the firms shall be left on site for final
inspcctian and a copy given to the homeowner. At final,tate inspector verifies that the work listed on this foam was in fact the work campleted by the
installer- IIx iospecWr also verifies that each appropriate CF-6R and registered CF-4R foams(no hand filled CF-4Rs allowed)are filled cut and
signed. October 1,2010,a registered copy of the CF-IR and CF-0R scull also be on site for final Inspection.
D I.HVAC Changeout Ittguired Forms:
!All HVAC Egrrip ru=t repisacd CF-6R fur � MECl�21--HERS and(for split aystanrs)MECI;-ZS-HI tS
CF-4R fames: MECH-2I and lice in s MCH-25
Inndoor
• door Coil
Coil and loot CF-6R fo mtc M SM21-HERS and for M
a l and/or CF-4R fatmr. MEM-21 and(for split systema Systems)
CH-25 I�I2.S
•Furnace CH-25
For.SpHt Systems:Dail leakage<15 percent; RC,CCA>300 CFM/tcn(Mini mut Air Flow Reiluimnent),TMAH
For-Packaged Units: Duct leakage<15 perernt
F-x=q ted fiom duct leakage testing if!
0 1.duct-system vas documented to have bees previously sealed and confirmed through HERS verification,or
D 2 Dict systema witb less than 40 liocar feet in unconditioned spam or t
0 3. ' ' duct are emstructo8,insulated or sealed with asbestos
❑2.New HVAC Syd= Required Forms:
Cut is or c hangeoat with ensu iiotms MEQi-04,MECH--ZO KERS for
ducts(all new dueting�all .and( spirt systems)M WH-22-H W sad MEM 25-11ER�
new eatC7-4R forms: MEM 10-,and(for split systems)MEM 22,and MECH 25 .
For Split Systems:Duct leakage<6 pew RC,CCA>350 CFI1d/tion�FWD,TMAH,ST11 5,and either HSPP or PVP.
For Packaged Unfts:Duct leaks <6 Percent
0 3.New Ducts with Replacement fired Forms:
• Includes replacing or fintafling all new ducting CF-6R hums: MECH-04,MECH-20-HERS,and(for split systems)MEDT 25-HERS
and/or outdoor condensing unit and/or indoor CF-4R fiamc MECH-20 and(for split systems)MECH-25
owland/orfurnace. Notallequipmentehanged.
For Split Systems:Did leakage<6 perce4 RC,CCA>_300 CFM/ton,TMAH
For Packaged Units:Duct leaUge<6 Percent
4.New Ducdng over 40 feet udrted Forms:
• Includes adding or replacing move than 40 CF,W foams: MECH-04,MECH 21 HERS CF-4R ftsms MEM-21
linear feet of duct in unconditioned yam
F-or split system orpackaged nuns: Duct leakage<I5 percent
0.EXCEPTION F-Wing duct systerns com*uebcd,insulated or scaled with asbestos.
Cpratractor(Documentation Aothor's/Responsable Desfgner's Dedarition StatemcbQ'
• I certify that this Certificate ofCompdimx docmnoatation is sccu;ate and completes
•--I am cEgibk.tmda,Diviogn_3-ef tke Cslifonu I; and Profcs ions Code to aaxptresponsibility for the design idcatUled on this Certificate ofCampiiance.
;I cuafy that the energy fora acct q(RW j eons for the design identified on this Certificate afCcmpHxnce confocal to the rogmtsacnts of Tide 24,
• Pada I sad 6 of'dre Catfforaia,Code ofRegaktioos... ,
• The design fraetrrru.ideutified ot[Hta Cer"We ofCompliaaee see coniktmtwith themformatim docamcuted as otherappdicabie compliance fonts,workshxts,
calculdioaa taaw a id- 'iatiaani cnhmitted m the eaforamat agcocT fez approval win the pqpi3itaMfi=WoW
I '�11. Sigmtrae:
Dew
r Se u►c, �IldWl td�s
Ad !�!
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Ozo O'Dfa -errc� iJ�
dress: 1�r e Rt7O4o
Ct9 q--�;98 Pbonegas .qyq - Tiggy
2008 Residential Compliance Forms March 2010