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14080013Ll CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10123 AMADOR OAK CT CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 14080013 OWNER'S NAME: HOOD SARAH S AND WEST ROBERT A 7020 COMMERCE DR DATE ISSUED: 08/04/2014 OWNER'S PHONE: 9259848580 PLEASANTON, CA 94588 PHONE NO: (925) 4444444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ REPLACE (E) FURNACE, SAME LOCATION �I► License Class � 2(] ic. # ZS nn Contractor G/vu-e m&te 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $3496 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34232023 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 DAYSO RMIT 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 DAY L ALLED 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 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 �J ` ` 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, Sections 2�55�05,, 25 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this t Owner or authorized agent: permit is issued. —Date: 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 90300 TORRE AVENUE • CUPERTINO, CA 95014-3255 408 ra-3228 • FAX 4W) ra-3333 • In cu �+ • ( ) ( ) build a� pertul4.otQ i cup��cxyyo ❑ NEW mNBTRucnoN ❑ ADDmm IbLTERAMON / U ❑ RFVW0N / DEFEUM ORIGMAL PE RMT # 1 I — I --- I 1 USE I '[M I OW. I SQXT. I VAIUAMON(S) 1 =TONE RAM Dmw TOTAL ARS& ARBA ARRA NffARSA Ancm OTHM RPAIODffi AREA I smlonRl mu RUNME .AM ,0*4pp 2011.doc revised 06/21/11 R-10-, . ARRA Jl / I 1 �Eiu.J. 11i�� •it ••I„1• 0111191,111111111C F/:I� �J •%JM�. A-., sI A / /I ♦ 111' 'J NI 1=1 �' I' rA';:I' I:.:' 1 I — I --- I 1 USE I '[M I OW. I SQXT. I VAIUAMON(S) 1 =TONE RAM Dmw TOTAL ARS& ARBA ARRA NffARSA Ancm OTHM RPAIODffi AREA I smlonRl mu RUNME .AM ,0*4pp 2011.doc revised 06/21/11 CITY OF CUPERTINO RUIN TTT Tncirr7r,r A Tl113 WITTY nll%I `_ TITV1CT(I1N 1' iJiJ JJ1✓ 1 FEE ID »••» »•- QTY/FEE ADDRESS: 10123 AMADOR OAK CT DATE: 08/04/2014 REVIEWED BY: MELISSA APN: 342 32 023 BP#: *VALUATION: 1$3,496 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex $143 PENTAMATION FURN/AC PERMIT TYPE: USE: WORK REPLACE E FURNACE SAME LOCATION SCOPE $143.00 APPLIANCE / EQUIP TYPE FEE ID »••» »•- QTY/FEE QTY UNITS BP FEES op0 Furnace, Forced -Air MFR=<100 1 # $143 ( .i9 ; PME Unit Fee: $143.00 PME Permit Fee: $48.00 �t}i c� Ft i'C'itLJrZ " �7.Y. Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $143.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check 0.0 hrs $0.00 Ptruttb. I'Lan Check � `e:r, t'''<'�� `�e("I Mech. Permit Fee: IMPERMIT fther Mech. Insp. 0.0 �rs$48.00 C dwir P' vmb Ins�rl =ra.a . P- f1hu'll'), hup. Fee- /:"ret ins.. NOTE: This estimate does not include jees aue to otner vepartments < __-, _ ._z. ,. ,...f;.......f., /'..... fonf thv Ttont fpr addn'] in%. E District, etc). /hese fees are nasea on me reunuf4ur FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/132 to �...u«�•...�••w.. FEE »••» »•- QTY/FEE -- -- MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $143.00 PME Permit Fee: $48.00 �t}i c� Ft i'C'itLJrZ " �7.Y. Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 �'�tib`t7atL't'G; I'll ?r7'kT7fk' `e'PS: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 r ® 5 w..- $285.50 $0.001TOTAL FEE: $285.50 r1UVIJCU. vil lulw �-r OF CAUFORNIA ERATIONS - HVAC KATE OF MMPUANCE MR -ALT -03-E AI ons - HVAC CZ 1, 3 to 7 and 16 (formerly CF -2 -ALT HVAQ ( Page i of 1) bar 11 ar quaiffam - I- I j tba KnM SouwIand; eatrI I tete line W Hdiina at 1.800.772 -MM A,In' Oa '",; " Perrnlifr;� D / v New: DucgnB, Planwns► onager Required RJMalue ndd can tooThenrlostat Floor Area ft E4 pmeM Type- Equipment Effidency 4 D Evaporator Cush E COP D R-6 (CZ LR) Ducks Served b system Setback 9yscern 13 Cagdansles Unit SEER DRO (Q 16) �` -4,-"% sq $ Rf not oire!ady theca OU ngs of ER �ISPF 0 R 6 (dl W4 Plenums p R,S or R75 Unesett' be lnSWIed) H VERIFlCKT10N bWAMA1tY Instslier determines workto be completed and mooches to one of the optSoers below. At permk applkatfon this Isnowed to be Aped tui Frond. farflnal letapactlort all iormdarc m be red m bond filled forms allowed and a left on site. MiAC QierwouR/Raprr buyude 0101i ducli'm Regttbed CanplhnceDoaiments tube (oft as alta fur Final: Equlpmen� CPiR-ALTS Unci, Svaporator toll, CF2R: M101-01, ME04-20-HERS AllAI Handler CF3k MEO 20 -HERS RoatlFiaenaettt Oust leakilge (S25% or, 5096 to 9MIde, or seal all accessible Inks) ed front duet Inkap Ust ing N: ragatered whit HERS provider as pnrwlously sealed, or O 2. There Is less than 40 Ifnear feet of duct In uneondidoeed eta . Insulated or sealed whit asbestos manufacture date of buildingw ;__w AC %stent Required Compliance Doeuprmos to be Idt on site for 4tidtd: eequiprnent and A0 New poets' CFIR ALT -02-E CF2RAWN- 1, MM -20 -HERS, MECF-22-HERS, MECWJ23 or 24}HERS CFSR-MF-04. HERS, MECH 22 -HERS ME 23 or ]A) -HEW In Reqak4nent: Oust leakb® S 6%, Fan Efficacy (.SOW/CFM). Air Flow t 350 U M/ton (or Standards Table 350.0-C / 0 alternative) . AN Now f eft allN nggseeenaatt Required COPPO rete Documents to be left an Otefor Final: udes +ns or IttaWkg AD New �C U ALT -02-E Ei acrd one or mora of the fiollawurs: Mit-MECH-01, MECH-20-HERS, MECH423 or 24)-HERS East UnIt BiwoonmrCall. Furnace OSP MECH-20-HERS, MM1423 or Z4 RS RegWranones Ocie! leakage A 6%, Air Flaw a 950 CFM/ton (or Standards Table 150.O -C/ D akernstivs) C Earn from dud 1 exist!gg duct M=2 are Canstructed, Insulated or snled with asbestos. 4. !caro aMer 40100Cam laweD sun- w rto, to be left an df'4�for Find: repfadngductsinunconditioned MR -ALT -124 CF2R: MECW20-HERS P;leesthen AN New Ducts° CF3L MECH.2O.HERS I or Req" toe Duce leehase 15.3996 Ot, 00961A CUM*, or seal SU aooeasibte leekOl D from duet {eels testln f existiftAuct systerns are corotsue =Insulated or sealed with asbestos now duding XS readnd when mora then 40 ft Installed and R-6 when less than 40ft lnrWtsd. This Includes In %oafs, between floors etc. = Now Oust oyMn Is when the duct system Is constructed of at least 75 partent new duct material, and up to 25 percent may Comm of reused from the dwel&ts unles etdurting duct system (a.g., registers, gAIM boots, air handler, plenums, duct material. • h (i" ttrtdd Irisulattlon) for Ilnez4ts 1" and less. R-7.5 (3.V thick insulation) for Nnesets ower 1 inch. Most mfg will require Suetlon Una Diameter InVJh0 n as tha foil 3.54T -2W 2.5-3T2W95 to4T23E"' ST- " C r (powmeneadon Attsfror'a JRdpetsteg t oerslpmem Dechiaton Statmaint) 1 the folWMnS under penalty of perjury; undarthm hes of the Stena of CalNomia: 1. The lntemation pravfded on this Cer.uftri a of Compliance Is true and cm7ftL lam ell&We under Dwon 9 of the Caffornia Business and Professions Wet* accept responsiblltty forthe information on this document Thatthe energyfieaturw and perlbrmance specifiea ions forthe design klentMed on this CerOflate of compliance conform to the reeptiraments of Title 24 Rama 1 and 6 of the California Coda of Regulations (CCR). Thatthe anergyfenture and perfmmwm speciflcofto, ntatlrialk components, and manufactured devices forthe building design or system design identIftW on tits teWf a to of Compliance canb" bo the requirements of Tlda 24, Part 1 and Part 6 of the CCR. 5 The buMns desion faeum or system design features ldenftd on this Certificate of Compliance are consistent with the Infonnetfon provided on other applimWe compliance doom , caleulmons, plans and speelAcations subn*d to the enforcement aserw 11braporml wkhtftis bulldog terror `r , x Addrew MP: /I ohm U I s bar 11 ar quaiffam - I- I j tba KnM SouwIand; eatrI I tete line W Hdiina at 1.800.772 -MM