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14060156 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22229 HAMMOND WAY CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14060156 OWNER'S NAME: FRANCOIS&KELLY DELEPINE 7020 COMMERCE DR DATE ISSUED:06/25/2014 OWNER'S PHONE: 6509688846 PLEASANTON,CA 94588 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ 14 REPLACE 2(E)FURNACES& 1 (E)A/C UNITS,SAME License Class—(k�,,,� G� Lic.# ��t'(0 LOCATIONS Contractor,gas()ice/ UkkDt0A'- 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:$15823 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:34258007.00 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 AS LLED 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 Z� granting of this permit. Additionally,the applicant understands and will comply by with all non-point source regula'ons per the Cupertino Municipal Code 9 18. RE-ROOFS: ,Section d1� Signature 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 i ns 25 O5,2 33, 25534. 'Z:7 71 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 GENERAL PERMIT APPLICATION �0 �� MEP - _.0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION11 �� 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 O (408) 777-3228.FAX(408)777-3333-buildino(a.cuoertino.org \\k M I S C eUp'>rEtT1hCO ❑PLUMBIINTG MECIiAMCAL ❑ELECTRICAL ❑MISCELLANTEOUS PROTECT ADDRESS 9 a a a q �aMVA OAd A)aq Z 00 OWNTERN.a.ME STREETADD Sa.a�-'1 (L CITY, ST Z `.h!•�� gsol q I FAX NT COITACT NAhS (I C[(il PHOS R(P�/Z>� Yy/ E-IJ�AII STREET ADDRESS �i1 11 CITY,STATE,ZIP FAX ORTrTTt ❑ ORfi�R-BUII DER ❑ OVMTR AGEAT ❑ COTTRACTOR ❑CONTRACTOR AGENT ❑ ARCEUIECT ❑ENGINEER ❑ DEVELOPER ❑TEIQANT CONTP.ACTO TAKE i' n S LICENSE NUMBER (7 1�Or Lv LICENSE'12 p BUS-LICn COMPANY NAME I�v E-IvLAIL a "[ FAX STREET ARCHITBCTIENGINTEER NAME LICENSE NUMBER I BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SM or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL I URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOIJIE? El No DESCRIPTION OF WORK TOTAL VALUATION: S Y7 a 3 AN 12 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o a I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bildljig construction. I thorize representatives of Cupertino to enter the abo�n identified prope for inspection purposes. Signature ofApplicanUAgent: Date: V J �� l SUPPLEMENTAL INFORMATION REQUIRED r Q • � �C� OL'-ER��CiO�TER �.. �e ��_.ExTI2ESS��` ' - - - - V1fPA4isc.4pp_201 J.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ADDRESS: 22229 HAMMOND WAY DATE: 06/25/2014 REVIEWED BY: MELISSA APN: 342 58 007 1 BP#: EVALUATION: 1$15,823 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK REPLACE 2 E FURNACES & 1 E A/C UNITS SAME LOCATIONS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 2 # $278 A/C Units (<=10K cfm) 113REMAIR 1 # $70 TOTALS: $348.00 a Mech.Plan Check 0.0 hrs $0.00 !'tFrt.rh. 1'lara£tte c� �-cMech.Permit Fee: IMPERMITFIE 1;:EOther Mech.Insp. 0.0 hrs $47.00 (hr'r�G�P F'/vrnT7lrts,a. s�. Lje: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These _f fiees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'l info. FEE ITEMS (Tee Resolution 11-.053 Eff. 7i1/13Z FEE QTY/FEE MISC ITEMS Plan (.'heck 1,'ee: Suppl, PC P'ee PME Plan Check: $0.00 PME Unit Fee: $348.00 PME Permit Fee: $47.00 C'c}n:irvction Tax: Administrative Fee: ]ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 A Strong Motion Fee: IBSEISMICR $1.58 Select an Administrative Item Bldy,Stds Commission.Fee: IBCBSC $1.00 o $488.58 $0.00 *, TOTAL FEE.: $488.58 Revised: 04/01/2014 Sim lino rescriptive Certificate of Co Climate Zones 10 to IS lienee:2008 Resdderuial RVACAIperations CF-IR-AL.T-HVAC S&e Addrr u mut#: FAuip�T I3st1�MM Effici Conditioned Floor Q ave,Mont r_r,+_a Duct insolation t Area nermostat �Furttaoe '� AFUE$0 9� ❑COP Over 40$ofducts added er ' Setback W indoor Cott ®SE[1t Q HSPF replaced in unconditioned space Saved by system gf,� � IffCo�surgUnit O EER 0 Rhee R 6 (CZ7013} sf preset;must be 13 Other EJ R 8 (CZ 14-15) urreite� 1.E4wpmewTjpe.Chowethe egrcipmeitbeing hnfaue4 fmorethmrone systor xcrewwtherCF-IRALT-BV4Cforearhsystenc 2.hfbrk—EquTwentEf�uFeaciea;13 SEEk 78%AFV 771MFforOpkd rendrntfd systencx HERS VERIFICATTON SUMMARY listed below am fora HVAC alteration Options. T- h installer decides what work is being dricre and picks one of the appropriate Options Fath Option lists the HERS measures that must be cmdaca d.A copy of the forms shall be Ieft em site for final inspection and a copy even to the homeowner. At fiaat the inspector,verifies that the work fisted on tris fexm wan in fact the weak completed by�e installer- The inspector also v fees that each apguvpitete CF r$d registered CF R fcama(no hand 511x1 CF-4Rs�IIowod)are 6Iled ant and !! ed Octabcr 1,;2010,a registered e of the CF-1R and CF-6R shad also he on site for final ecdon. I.HVAC Changeout Required Forms:. ! AU HVAC Equipment replaced. CF-%fees:MEC H4K ME01-2I--HERS and(for split systems)MEC-25-JIM CF4RR Am= MECH-21 and Sou split s AECH-25 • Condenser Coif and/or C2<-6R forms: MECfi-21-HERS and for • IndoorCoiland/a ( split systems)MECH-25-HERS Furnace CF-4R fww. MECH-21 and(for split systems) MEcFf 25 • For Wt Systems:Dud leakage<I5 percent; RC,CCA>300 t FMAon(Mininxmn As Flaw Rogairerne t),TMAH For-Packaged Units.- Duct leakage<15 parent Ezcmpted fian duct leakage testing if! O 1.Duct-Ustem was doc®eated to have been previously sealed and confirmed through HERS verification,or 132-Dad systems wig less than 40 linear feetin unconditioned apace,or 13 3.Exisft duct sysums are caaisttud4 insulated or sealed with asbestos 132.New RVAC System Regahvd Forms. Curt in orChangeout with vow - CF-6R formes MEM-04,MBM-204MS for . ducts:(all new ducting a�al! .eud( spirt systems)lv¢7CH 22-HERS,and MECH-25-HER9 -. mew eat) CF4R.farms:MECH2Q-,and(for split systeua)MEM 22,smd MECH 25quipp . For Split Systems:Dud leakage<6percent;RC,CCA>_350.CFWton,FWD,TMAH,SIIV S,and either HSPP or MP. For Packaged Units:Duct t!a! <6 percent ❑3.New Ducts with Replacement !red Forma: • I�ludes replacing or installing all new ducting CF-6R items: MECH-04,MEC H-20-HERS,and(for Wit systems)MECH-93-HERS and/or outdoor cor>d�ing®rt mWac f xfoor C11 4R.fiomnc MEM20 and(for split systems)MHC11-2s coil and/or fianax Net allequipment dramgm& rF pUt Systems:Duct leakage<6 pereeat,RC,CCA>_300 CFMAcn,TMAH Packaged Units:Dud leaks e<6 percent ew Dn over 40 feet oired Forms: ludes adding orreplacing mora then 40 CF-6R furl MECH-04,MEC-2l fiER.S CF-4R fas:MKH-21 ar fixt of duct in unconditioned ane. lit system orpackaged wits: Duct leakage<15 percent 12 EXCEMON Eidsim duct 292s fi=hted or sealed with asbesw& ctor(Documentation Aathbei/RespOnSibleDafgaer's Declaration Statement)' tify that this C=Ofic m esf,Cors4riimoe documentation is secvrate and exmpk tc crigibk.rmdesl}ivisoa3-gribe Csiirwak Bwiw"and Professions Cade to accept rapoasiWffty fa the design idenri icd an this Certificate ofComplianceY the �B!feytamand rpea6ratimtsfathedeasgmidmti5ed ons this Certificate oECompAaaa contrta m the rogmretnertta of Tinier 24, ts 1 sad 6'of rhe CiJffornia Cei4eof Regaiatioo�.,design featrrssfdeati.. a¢this Catifieate ofCamplOnce are eoosictmtavidrthe information�emtcd oa other applicable conipliana fmms,workshects, rtatinea tea aha - eatios iotimitted to the eaforoement f� Huai wi@r the t 6csmi N. il'l Q 1: 5 Signature: AA I Diam Address: -7 o Z U WAM l (,,e, N' vt e te0.s0-rn iD In eA q- :98 2008 Residential ComplianceFornu March 2010