14050128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10345 DEMPSTER AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14050128
OWNER'S NAME: YASAKI EDWARD K AND RUTH M TRU 7020 COMMERCE DR DATE ISSUED:05/21/2014
OWNER'S PHONE: 4082575570 PLEASANTON,CA 94588 PHONE NO:(925)4444444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPLACE(E)A/C UNIT,COIL,9 SUPPLY DUCTS&2
License Class C/LO Li,.# ';6-1 OLQ RETRUNS
Contractor U (1(tS 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:$12715
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:32647079 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 DAYS 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 DAYS F 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 compl a Date:
with all non-p int source regulations per the Cupertino Municipal Code,S on
9 18.
�riorto
-ROOFS:
Signatu Date S�Za All roofs shall be in oofing material being installed.If a roof is
installed withou 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, 5533 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen : Date:S"?-
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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: 10345 DEMPSTER AVE DATE: 05/21/2014 REVIEWED BY: MELISSA
APN: 326 47 079 BP#: *VALUATION: 1$12,715
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E A/C UNIT COIL 9 SUPPLY DUCTS & 2 RETRUNS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
TOTALS: $70.00
Mech.Plan Check "00 $0.00 1,11w1b. Plan Che(;4c
Mech.Permit Fee: IMPERMIT F lump. Permit 1'ce: i>i�c'- Perr i'
Lter Mech.Insp. 0.0 hrs $47.00 Othei,Plumb IniT). Li I
other t:=&-.c Ir=sty.
1'C': Plumb. hisp. Fie: 1_iac 1, _
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the relimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff.7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Pee:
.S1,1f)/1l. l'('1'`:c
PME Plan Check: $0.00
Peranil 1'ee:
;Sr Ppl. 111'/s�Fe
PME Unit Fee: $70.00
PME Permit Fee: $47.00
Cousn';tction TUX.-
Administrative Fee: (ADMIN $44.00
Work Without Permit? 0 Yes ja No $0.00
Travel Documentation Fee: ITRA VDOC $47.00
Strong Motion Fee: IBSEISMICR $1.27 Select an Administrative Item
Blda Stds Commission.Fee: 1BCBSC $1.00
... LS $210.27 $0.00 = TOTAL FEE: $210.27
_ . e, .,.
Revised: 04/01/2014
SimplifieO-Prescriptive,Certificate of Co Mance:2005 Resadermal Hv.4C,4Itera&,s CF-IR-ALT-HVAC
Climate Zones 10 to 15
to31s sfe�' A�2 F✓rfor,-t -4gertcy: �l-f Pemrii `:
T ' List Mannon Eflici Conditioned Floor
juipanent0 Pprtraved r_Ink Duct insolation t Area Thermostat
Over 40 8 of ducts added ertt
O Furnace O A.FUE O COP 1�Setback
laced m unconditioned
{�Indoor Cot? L�SEIIt� 13 HSPF O R 6 (CZ 1013) �by ssfystrm
PfCo�nrg Unit 0M. O Resistance P' 4 mast be
0 Other OR 8 (CZ 1445) tle�
L Egz*men i Type:a0aw the e9uipmew baarg mstallad f more fh4 W one rptev;ure weMher CF IR-ALT-HyACforeach sys[em
2-Afhumam Eg ip-e t Ef kfm==13 MEk 78%AFET,7.71MOFfor optcdl msid=ad system,
HERS VERIFICATION SUMMARY listed below are fiwHVAC alteration Optioffi. Tlzc installer decides what work is being dune and
picks one of the appropriate Options_ Fath Option fiats the HERS measures that must be conducted.A copy of the forms sball be lett oa site for final
inspection and a copy given to the homeowner. At$nal,the bspa for verifies that the work listed on this from was in fact the work completed by the
installer_ The iaspecWc also vedfies that each appropriate CF. R sad registered CF-4R films(no head filled CF-4Rs allowed)are filled out and
sf ed Begirming Ottober 1,2010,a regbtered copy of the CF-1R and CF-6R shall also be on site for final hupecdoL
L HVAC Changeout I Required Forms:.
• AllHVAC Eguipmentreplaced CF4R flacon`MECH4K MEC -21--HERS and(for split systems)MECii-7S-HTRS
CF4R forms: MECH-21 and Sur lit s MECH-25
• Condenser Colt and/or CF-6R fits-= IMM21-HERS sad for lit
systems)I�MCH-s Indoor Coil and/err CF-4R farms. MECH-21 and(for split system)mEECK 25 25 HERS
•Furnace
For.Split Systems:Dud Ieakage<15 perc=t; RC,CCA>300 CFMAon(Minimum As Flaw Rcquimnent),TMAH
For-Packaged Units: Duct leakage<l5 percent
Exempted fiam dad leakage testing if!
O 1.Daa'gstan wss docomertod to have bcrapreviously seated and confrtmed though HERS verification,or
f3 2.Deet systems wM Jess thea 401hwu faun tmoonditiored space,or I
❑3.Existing durst are ca ushvdod,insulated orsesled with asbestos
O 2.New HVAC Systems Required Forms-.
! Cat in or Chamgcout with roar - CF-6R foQms MECH-04,MECH-204iERS for
dads-(all new ducting and ail .�( sort s3rsterns)MEM 22-HERS,sod?ABM-25-HERs
new
CF4R Rams MECfi 20-,and(for split systeaa)MEC;22,mad MEQi 25 .
For Sp>lt Systems:Duct leakage<6 percent;RC,CCA>350(FM/bn,FWD.-TMAIL SI S.and either HSPP or POP.
For Pac ed Unfts:Duct kala[ <{Pement
3.NewDntds with Replacement Required Fonio:
• Include,replacing or in-11 ng ail new dating CF-6R foams: MECH-04,M1CII20-HERS,aad(for split systems)MECH 25-HERS
and/or outdoor cmdensutg uma mWor f xfoor CF-4R forms:MECIi-20 and(for split systems)MEM25
cor7 and/or f¢mact Not all egaipme s changed.
For Split Systems:Dud leakage<6percenk RC,CCA>_300 CFMAtan.TMAH
For Packer ed Unita:Duct 1 e<6 erscnt
0 4.New Da over 40 feet Required Forms:
• Includes adding or replacing more&=40 CF-6R fperos; MECH-04,MSM-21 HERS CF-4R farms:MEQi-21
linear fed of duct in unconditioned ace.
For split system orpaekaged units; Duct leakage<-15 Percent
Q i53CCEP7IOlY duct aortshru hudatetl or scaled with asbestos.
Contractor(Documentatfou Auther's/Responsible Designer's Dedarition Statement)•
• I cetify[bat this Cwificate ofComprasce docmoeobtiou is nocraate and wmpkta
•_.I am t5gibk,rmder Djvisiaa 3•ofthx Giifotaia Basinas rad Professions Code to accept rrspo=--tritity for the design ideatittad on floc CettiSJXW,
;I certify that tfre CW fc�tmerandPerfu�moe Vecafirxtimn for the design idmtifed on this Catiocate ofComptlanoc confotur,to the r0g ,
• Parts 1 rad 6a the Catftartia,C*of Re�aletioar,
• ILedesignfeaturesidea6fiedmthisCotigcateofCumpliacceatecon,ictmtwiththe iniorma oodocomestedonotherapplicableconplianc ,
ealmtatians im and" 'ntiors i6finkod m the eaforoemeat fm coral with the t licati
I3sma S1''�� � � Signaaas:
' � iJ l l✓ �a� [0>7S
Address: �~�1✓/0zo C '-AYU9 42,rcitS, ttix �eaSQtn � CSA �
2008 Residential Compliance Forms March 2010