15120017CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 21930 OAKNOLL CT
CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 15120017
OWNER'S NAME: CIARDELLA CHRIS AND DEBORAH TRUSTEE
7020 COMMERCE DR DATE ISSUED: 12/03/2015
OWNER'S PHONE: 4083903100
PLEASANTON, CA 94588 PHONE NO: (925) 4444444
1�3� LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
ij ��
License Clas� �� Lic. # 0 1 � U (( `'I'
DUCT REPLACEMENT IN CRAWL SPACE
Contractor gujcl u(i!�/l� a e)4 J 15- D
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: $4805
performance of the work for which this permit is issued.
JIiave 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: 32639013.00
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 I8 IT 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
I EWNSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date: Z ��
granting of this permit. Additionally, the applicant understands and will
Issuy:
wi all non -point source regulations per the Cupertino Municipal Code, ection
9.18.
,;•
— �J
RE -ROOFS:
Signature /X 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 bnsurance, as provided for by
the Health & SafetyCode, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this'
Owner or authorized agent 0K). at
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
9.18.
Signature Date
MSP
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO. CA 950143255 cuaerZ
U1P�Ei INti (408) 7711-3228 - FAX (408) 777 3333 • buildinc tino.L)m �I V 10
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BU&4pp 4ll doc revised 06/21/11
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CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
APPLIANCE / EQUIP TYPE
21930 OAKNOLL CT
DATE: 12/03/2015
REVIEWED BY: MELISSA
liaADDRESS:
APN: 326 39 013
BP#:
*VALUATION: 1$4,805
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 RMAP
WORK
DUCT REPLACEMENT IN CRAWL SPACE
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Phatrh. Plan Check
QTY
UNITS
BP FEES
Elec. Pertnit Fee:
Other Appliance/Equip
1BAPPLOT
Other Elec. Insp.
1
#
$72
Perin it Fee:
Suppl. Insp Fee
1
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Conswixtion Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (•) No
$0.00
TOTALS:
TravelDocumentation Fee: ITRAVDOC
$72.00
Strong Motion Fee: IBSEISMICR
NOTE. This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelindnai in orntation available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13)
Mech. Plan Check 0.0 ht's $0.00
Phatrh. Plan Check
Elec. Plan Clieck
Fmech. Permit Fee: 1MPERMIT
Elec. Pertnit Fee:
LOther Mech. Insp. 0.0 hrs $48.00
Other Plwnh Insp.
Other Elec. Insp.
lush.Fee:
Plattnh. Insp. Fee
Elec. lash. Fee:
NOTE. This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelindnai in orntation available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek Fee:
Suppl. PC.Fee
PME Plan Check:
$0.00
Perin it Fee:
Suppl. Insp Fee
1
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Conswixtion Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (•) No
$0.00
Acivanced Planning Fees.-
ees:Travel
TravelDocumentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.62
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$214.62
$0.00 TOTAL FEE:
T77$214.621
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
CHRIS CIARDELLA I Date Prepared:
CFiR-ALT-02-E
(Page 1 of 3 )
2015.12-02 I
A. General Information
CFIR-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
--use-one-CF-1R AL -T 02 -document for-each-dwelling-unite-----..---------..------------.--.--------•---------•--- _.__._._. .
01
Project Name
CHRIS CIARDELLA
02
Date Prepared
2015-12-02
03
Project Location
21930 OAKNOLL CT
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
CHRIS CIARDELLA
System
SCS stem
Identification or
SCS m
y
Location or Area
served
by this SC
Dwelling Unit Conditioned
0
07
Zip Code
95014
O8
Floor Area (f :2)
Name -
Served
System (ft2)
system?
component?
Number of space conditioning
feet of ducts?
09
Climate Zone
4 z,
10
(SC) systems in this dwelling
1
unit.
'V .
B. Space Conditioning (SC) System Iformationtfi'" r
h.
01
02
a Q3
04
09
10
CFA
Is the SC '
stem a
n alien a
rr ige t
nstalli ` g "'
1 sta ' g
; n Irl,
�'
nstalling
System
SCS stem
Identification or
SCS m
y
Location or Area
served
by this SC
ducted
_.
containing
system
more than 40
entirely new
entirely new
Name -
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Extension of existing
System 1
Location 1
0
Yes
No
No
Yes
No
No
duct system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
01 02
System Identification or New Duct R -Value
Name
System 1 R-6
Required Documen
Registration Number: 215-A6425613A-000000000-0000 Registration Date/Time: 2015-12-0216:40:33
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2015-12-02 16:40:31
CFIR-ALT-02-E
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Dud insulation requirement for new plenums: R6.
CF2R & MR -MCH -20-H —Duct leakage Verification
- Leakage rate compliance: 515%, ons leakage to outside, or seal all accessible leaks
Exceptions:
Existing dud systems constructed, Insulated or sealed with asbestos are exempt from MCH -20 dud leakage testing requirements
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and,150.2(b)1E, F)
This section does not apply to this project.
F. Entirely New or CompleWit0i'9141ftint SpUc'*nC0'W* itionin} ,Y m; (Section 150.2(b)1C)
n
xa
sectlon o t
Registration Number: 215-A6425613A-000000000-0000 Registration Date/Time: 2016-12-0216:40:33 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-02 16:40:31
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111 ALT -02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: � �
ar ara (+a/'ar
Salazar, -Barbara---- --- _ ---- --- ------ --- - - ---
-- --- ----
Company:
Signature Date:
2015-12-0216:40:33
( PERMIT E RATERS
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213,
City/State/Zip:
Phone:
�
West Lake Village CA 91362 ;
818-735-7876
Responsible Person's Declaration statemeill>
,•5Yt
I certify the following under penalty of perjury, under thp.laws�Bf the State of California:
1. The Information provided oiC..ert[ .cate�ffCom ,(lanced true and correct.
2. I elfglble under Division 3 oii(,.isiness and Proi?ess%ns Code tp aQptesponsidllriy for the building design or system design identified on tfiis Certificate of Compliance (responsible designer).
am �y w, ^i �'t::. "
3. That the energy features and perfbPtr(ce specifications,., co . - vents, and nufa ed de lc fo . build d. sign. system des n Identified on this Certificate of Campltance conform to the
,.,G.. ,,;.M
requirements of Title 24, Part i and PattOof the CalifrnlaLode of . a ns.
building design features or system d sign feairbsrl ntified o is Certt f ante ar he rm rovfded o t p lance documents, worksheets,
4. The
calculations, plans and specifications s�utiml duos the rceme envy f v; this buil g pe a Icat '.
5. I will ensure that a registered copy of hl °h� .• . forcement agency for all applicable
S e ifl pliance s i i# le ' p it Isstl for4 Ig an a . a b g cY PP
inspections. I understand that a registered copy of th tate of Cop1 nc� (, req d to included th come fo the. t er p ides t .tbe bull Ing owner at occupancy.
Responsible Designer Name:
Resp, a De 'g r S 'n re:
�aqra oatazar
Salazar, Barbara
Company:
Date Signed:
ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS
2015-12-02 16:40:33
Address:
License:
7020 COMMERCE DR
817040
City/State/Zip:
Phone: .
PLEASANTON CA 94588
925-598-1911
Digitally signed by CaiCEM This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A6425613A-000000000.0000 Registration Date/Time: 2015-12-0216:40:33 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-02 16:40:31
Schema Version: 0.S55SDD