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14060133CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10555 METEOR PL CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 14060133 OWNER'S NAME: MACINTOSH JOHN A AND FAY A TRU 7020 COMMERCE DR DATE ISSUED: 06/19/2014 OWNER'S PHONE: 4082457445 PLEASANTON, CA 94588 PHONE NO: (925) 4444444 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] n1)q (� REPLACE 13 (E) HVAC DUCTS License Classy_ C2Q Li.. # b -' 1S �1 Date Contractor CGQ� �•�( 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 Sq. Ft Floor Area: Valuation: $5033 performance of the work for which this permit is issued. 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: 32644008.00 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 QLRERMIT 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_U0MTASED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the6 ed b • a e. �/ // y 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. RE -ROOFS: Signatur Date l d 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 1, 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) 1, 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,;Veios 25505, 25 33, and 25534. Q� K_ 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 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 �ga:asss: s GENERAL PERMIT APPLICATION �0 MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O\ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildino(Mcuoeriino.org MnT T rn n.T/7 146kAMr T-TA"rA7 7'PT .Fr ?T( -A T . 7 MISCELLANEOUS m I S (Clk PROJECT ADDRESS n S s '� n � � li /y p I I APN # -3 rJ (./ l D �� /' OWNER&TAME F (' L�CIi I i GV 1 E MAII PHONEg0s STREET S S ADDRESS b 5 C STATEi� i' 7 S CSI I FAX V CONTACT NA ,NE /2 PHONE E 1vL^ II STREET ADDRESS CITY, STATE, ZIP FAX ❑ ORTM ❑ OV7QER-BUILDER. ❑ OVRERAGII,'rCONTRACTOR ❑CON' ACTOR AGENT ❑ ARCHrIECT ❑ ENGIN R ❑ DEVELOPER ❑ TENAN'T CONTP.ACTORNAMEr' n � N/Ci LIi(i W LICENSENUMBER QQr-7/V)t�� I LICENSETYPE A l -U/ C BUS.LIC# I Z / COMPANE-MAILN.A vM E-MAIL FAX STREET ADDRESSTATE, ZIP �� P ARCHrrECT/ENGINEERLAAME LICENSE NUMBER I BUS. LIC # COMPANY NAME B -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MUI.TL•FAMI Y PROJECT IN=LAND ❑ YES BL=ING: ❑ COMMERCIAL URBAN ]M=ACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO I IS THE BLDG AN ❑ ITS EICHLER HOIJIE7 ❑ NO DESCRIPTION OF WORK lUc,cJ Slit oV ctas TOTAL VALUATION: `%3 t 00 By my signature below, I certify to each of the following: I am the property o-%Nmer or authorized agent to act on the ovmer' alf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accura o comply v�th all applicable local ordinances and state laNvs relating to ildina ecpstruction. II� thor' representatives of Cupertino to enter the above-iden(tiifiedCpr -rtp for inspection purposes. S i mature of Applicant/Agent: J'LDate: SUPPLEMEI9T'TAL INFORAIATION REQ=D . W M. i Ng BOB `JYE2ESS TA�Z3tiTLD - MEPldisa4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF F.CTTMATnR — RTTILDING DIVISION kaADDRESS: 10555 METEOR PL DATE: 06/19/2014 REVIEWED BY: MELISSA p t hvt , Che 'k APN: 326 44 008 1 BP#: *VALUATION: 1$5,033 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PME Plan Check: PENTAMATION 1 RMAP1 USE: PERMIT TYPE: WORK REPLACE 13 E HVAC DUCTS SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1 BAPPLOT 1 # $70 TOTALS: $70.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Pire, sanitary sewer vistrict, acnooi - L-4 __ sG .... ..I -0a,..-0. --- is.%r nfin.: n ni/n Rln ".d ara n/ h) nn actimata_ rantart tho Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1113) FEE QTY/FEE MISC ITEMS p t hvt , Che 'k PC Fee PME Plan Check: $0.00 PME Unit Fee: $70.00 PME Permit Fee: $47.00 {_,OT2:1t wclion Tux: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 F'(crrrrttrtg Fees: A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 L , FEE: $0.00 $209.50 Revised: 04/01/2014 Simplified Prescriptive Certificate of Compliance: 2008 Rea4rentkjfIVAC,4&era&ns CF -IR -ALT -HVAC Climate Zona SFte Add s Jr' UeLecv C Frfor—nud ,4genry, Permit, A T ' Q pechagm r r -k QFtrnace ❑ indoor Cot? Q Comir�sing Unit Q Other List Matmn Q AFUE QSE[?t 3 Q TER Effci 13 COP (3 HSPF Q Reaist�ce DuctinsulatitArea Over 40 8 of duals added m laced in unconditioned Q R 6 (CZ It? -13) � Q R 6 (CZ 14-13) CanmamcdFloar - �� 8�� Tbermostat Q Setback (7f, w dd, I�c trust to -0 1- E9uipated Tjpe Choose the egugmmt being 5utalled- f mare Jrmr one ryste� use mmiher CF -IR. 4LT-HVilCfareaCh sysrem Z. Afbiime;m Eqw p-eW Effrdnrr&a; 13 SEED 78%AFVP, 7.7HSPFfor typical Mr1dendd sysfenu ITERS VERIFICATION SUMMARY listed below ars foot HVAC alteration Options. The installer decides what work is being dance and picks one of the appropriate Options- Fach OPtim fiats the HERS measures that must be conducted. A copy of the farms shall be left on site for final impection and a copy given to the bomeowner. At final, the inspector verifies &st the work listed on trig firm was in fad the work completed by the installer- Ile iuspeebor also verifies that each appropriate CF -6R and registcted CF -4R forms (no band filled CF4Rs allowed) ars filled out and steed. l3egbanimg October 1, 2010, a registered copy of the CF -IR and CF -6R stall also be on site for Snal 6rsnerttod El 1. HVAC Changeout Required Forms: • All HVAC Fquipmeat replaced CF4R fams: AfECH-04 MEC[I•21--HERS and (far split cyst evu) MECH- 25 -HERS CF -4R forms: MBCH-21 and Sot split a• Coil and/or s MECH-25 Indoor Coil and /or CF -6R fon~ MSM21-HERS Bud far split }MEC H- 25 -HERS •Furnace CF -4R fnaMFCH- Zi and (farsplit st=) MECff25 For.Wt Systems: Dud leakage < 15 percent; RC, CCAs 300 CFMAm(Minini= Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 jiereeat Exempted from dad leafage Testing it Q 1. Dol system war doearmeaW to have been previously stated and confirmed through HERS verificatic% or 13 Z_ Dad systema with less then 40 linear fed in tmcanditiomed space, or l Q 3_ Existing duct system are canttac 4 msalated or scaled with asbestos 132. New HVAC SysUm t(=74R'fbrms:- red Forms: ! Cert in all n n3r good with new -� �� MECH-204MRS for rt stems MDCH 22-H M, and M ECH-25-HEPi duces (alt new etaz�g� ail •� ( �system) new ezrt MMN 20-, and (forsplit syst=)UBCH 22, and MECH 25 , For Split Systems: Duct leakage <6 percent; RC, CCA >_ 350 CFMltun, FWD. TMAH, SF11�S, and either HSPP or MP. For Packaged Units: Duct leaks 46 PeMcnt Q 3. New Ducts with Replacement fired Forms: • Includes replacing or installing all newdudiag CF-6R,g M WH -04, NECH-20-HERSAnd (for split systc=) MEM -25 -HERS and/or outdoor conderuuug mit and/or indoor CF -4R I MEC11-20 and (for split systetus)1AECII.25 coiland/orfroam Not allcut changed. For Split Systems: Duct leakage <6 percent, RC, CCAs_ 300 CFM/wn, TMAH For Packs ed Units: Duet Ieakaua < 6 aerccut • Includes adding or replacing mare don 40 CF -6R fort= MECH-04, MECH 21 HERS CF -4R farms: MEC H-21 linear feet of duet innncoaditioned ace. For split system orpackaged miftw Duct leakage < 15 percent 11 EXCEP71ON ExistwS dud ristem 29FAM04 insulated of scaled with asbestos. Contractor (Documentatfou Anther's /Responsible Designer's Declaration Statement) • I ccr* tbat this Certificate of Coulrluaoe docmneotatiaa is aoemate and complete- -lam omplete•Iam eBgibk.uadeTDivisiaa:3.ofSte Glifomis Ilnshgess andPtnfessions Code to acceptrcspoasr"6iiity for the de dgn ideatVlcd on this Certificate ofcomplimm I certifY that the eaeW. fe-tures and �etSozmmce specifications for the design. ide nti5ed on this Ccrtificaoo ofCarapflance canfata in to the rcgmnenta efTtde 24, • Parts I rad 6'of the Ca$tmaia•Cti�le.of Regnlatiou:.,, • Tba design femora derrtified to Slit CatiState ofCompliaoee ars eaat"sbeat wilt the info,am cn doc®wted on other applicable complianoe forms, woriahe cts, caladatims plimsz6d c' eatiotsi66mittcdtothiocult tncat NPCXT fm twatwi&the i b: Flame: .-9!1 n .: t - 1 _ . i . , e:.._. _-. ---�---�- S 2 U ► c/,� ` .awl t 0►� s � � > �� _ � � Address: - 7 O z li�:�llM �i�C. {� 'J P Lic—Mr 0 8l -1U4a l✓A q'�98 > c as .qqq - q qqq 2008 Residential Compliance Farms Mardi 2010