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10100052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11139 SUTHERLAND AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 10100052 OWNER'S NAME: VENKATA UPPULURI 7020 COMMERCE DR DATE ISSUED: 10/06/2010 iER'S PHONE: 4087188325 PLEA SANTON,CA 94588 PHONE NO:(925)4444444 LICENSED CONTRACTOR'S DECLA/R'ATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB F License Class C 2 V L".4 l7 U q v � ` - u_ MECH RESIDENTIAL COMMERCIAL� Contractor CkWO;Z-6 (J' Ao� OX 5 Date 1 tO JOB DESCRIPTION:REPLACE FURNACE-A/C SPLIT SYSTEM 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.F;Floor Area: Valuation:$8407 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:35617064.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save `JVITHIN 1 AYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 80 DA M LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: 0 — __ Date: 9.18. Signature Date t/ l/ - RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All n)ofs shall be inspected prior to any roofing material being installed.If a roof is insta led without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspc ction. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Sign.Kure of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I ha,,e read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Cali'ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the com)liance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance.of the work for which this cont aminants as defined by the Bay Area Air Quality Management District I will mail stain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Hea th&Safety Code,Sections 25505,25533,and 25534. 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 Owli�pr lrorize ent: ��"" Compensation laws of California. If,after making this certificate of exemption,I l� Dater become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hei eby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address unon the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I un derstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. � ^ Lia:nsed Professional Signatur ll !/�:�_9 /R-YG10Z� Date 10'10 � G) CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35617064 .00 DATE ISSUED. . . . . . . : 10/06/2010 RECEIPT #. . . . . . . . . BSOOOC11662 REFERENCE ID # . . . : 10100052 SITE ADDRESS . . . . . : 11139 SUTHERLAND AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VENKA"A UPPULURI ADDRESS 11139 SUTHERLAND AVE CITY/STATE/ZIP . . . : CUPER-INO, CA 95014 RECEIVED FROM IE INC CONTRACTOR KEVIN COMERFORD LIC # 31833 COMPANY . . . . . . . . . . : SERVICE CHAMPIONS ADDRESS 7020 COMMERCE DR CITY/STATE/ZIP PLEAS.ANTON, CA 94588 TELEPHONE (925) 444-4444 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------------- ---------- ---- ------ -- 1BCBSC VALUATION 8, 407 . 00 1 .00 0 . 00 1.00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 63 .00 0 . 00 63 . 00 0 .00 1BSEISMICR VALUATION 8, 407 . 00 0 . 90 0 . 00 0 . 90 0 .00 1MFR=<100 UNITS 1 . 00 L26 .00 0 .00 126 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 274 . 90 0 . 00 274 . 90 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 .90 #5164 --------------- TOTAL RECEIPT 274 . 90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Sim li5ed presc • tive Certificate of Co Hance:ZOOS Residesttial HVACAUeratxonS Climate Zones 10 to is CF-1 R-ALT-HVA C Site Ad*=- l� 3 a ��✓1 a In G� a t aforcanent Agency:. Pernut T List Mimum FjEcl Condido d Floor O Packaged 13nk �j Duct insolation t Area Thermostat F'�0C AFUE `J O COP O mr 40$of ducts added or O boor Coil ISSEER 15 ❑NSPF zl Ylaaed in unconditioned space �,cd bl, setbecic 0Other irtgFJnit O EER OR he O R 6 (CZ 10-73) If System !7f� � O Other OR 8 (CZ 1445) prcs-;moat be I.Egan av Typc 00,"the unrolled) Z.Mbri,nwm Fq,ripasenr E stem S installed if-0-than one cyst OM rune weather CF-IR-ALT-t1YACfor"each aysrena �idenciaL 13 SEER 79%AFLp 7 f)WFJ��l nsidentlaisyrtans: HERS VERIFICATION SLTMMgRY Listed below astfourHVA,,altrratian picks one of the appropriate OPtioWL Each Option]iota the HERS moo T�iastaIIer decides what work is being donne and inspection and a copy given to the homeowner. At ��res that must �daexod.A xPY of the forms sball be lett on site for 8ffiJ imuner- The' ��the i6R an r vt ril5es&at the work listed®thin fo¢m was in fimt the uing 0 r also verifies that each appcopcja(e CF-6R and reg stored CF-4R fors(no hand filled CF-4Rr allowed)work comple0c the ed October 1,201Q a r c of the CF-IR and CF-6R strap also be on site for final art filled out and 1.HVAC Chan M mired Forms: ed0°' • AII HVAC Egnipneat replaced CF-6R farms ;' NEC and(for split systems) CF-41�(ECH ZS-HFiRS R farms MECti-2l and f u lit s MECH 25 • Condmaer Coit sad/or e Indoor Coil and/or CF-6R farm -21-1�and(for split systems)MECH-25-HERS •Fumace CP-4R farms; MECH-21 and(fir split systems) MECH-25 For.SpBt Systems:Dud leakage<15 peacoat; RC� 14I/tuCCA>300 Q m For Packaged Un : Dart le�B e<15 percent (Minimum Air Flow Requirement),TMAH Exempted hum duct leakage testing it O L Dtrct"systtun wu documented to have baa previously Bede I and confu mcd through 3 Du�rAtttExisting �with less then 40 lbaw feet}n�nditioned t pax;or Hl verification,car 13 oPackaged w HVAC System Req orw r or sealed svi tlr asbestos or Chsageaut with newductc(alt new ductmg�all CF-6R forms: MECH.{)a MECR-2041ERSad(far split systems)MBB-22-HERS,ad MrCH-2-',HEPSRSnew • CF-IR forme 1 120-,rmd 001 split systems;22.and RMCH 25 Systems.Duct leakage<6 perces RQ CCA>_350C .Unit&Duct leaks <6 t S%SIPIS,and either HSPP orPSPP. Dncb Replacement firs rePlacing car installing all new dactiag 04,1 �z0-Fl1R S datdocr ouniand/or indoor CF-4R farms:MEM 20 and(foe split (fur )MECN25-HERS /or furnace. Not all eguipmemt changed systeaas)PAWH-25 For Split Systems:Duct leakage<6 percea4 RC,CCA 2t 300 CFW m,TMAR For Packs ed Units:Duct leaks e<6 vercemt ❑4.New Do over 40 feet meed Foams- • Includes adding or replacing mare than 40 - linear fret of dart m> eandid ed ace. CF-6R*= MECH-1a,MECH 21-HERS CF-4R farm, MECH 21 split system or nnfts: Duct leakage<15 pemmt For Q EXCEPTION:Emsting duct qatem eonstra insulated or ser led with asbesssos Contractor(DOCnmentation Anther's/Respottar-bk Dea;gner's , 'I ttiott Statement)' • I car*that this Cutifuate of CO-pr-oce docmnmrs'bar is=mte,md complete • -I am eHgtbk;ander vrsian 3.of the Califamia Bncir>as sad Pr ofessiom Code to u exon rnpoambility far the dexi id �1 :. • 'Cole that fept md. apeci5catians for the d® ,dents find oa this ga �tltled at this CertiSeate of Compliaoca f'irtc 1 and 6 of the C;lffomia Co*.of R%nkti=x,.. �°• CatiSeatc of CompAaace conforut to the regmreramta of Title 24, • The design hr<trua identified at this Certificate of C 1• caltuhtiaoa, ms and i esba: omp ranee ate eoosseratwidt d ie information doermrcat,ed CoOther applicable compliance fotaa,worlalreres, lie: MAXINE BROOKS mr far c 41 w� t lieatioa °� Signa true: Company:SERVICE CHAMPIONS Date Address: _ : 111 7& `1 L z O r✓0m/Y) C'�/`G lJt^ License atyrs�tidZ;txQ 817040 I c� 5ctih. �v� P(rorne:q Z5 yY y--T/77 y 2008 Rw dentia!Compliance Forms March 2010 Simplified Prescriptive Certificate of Compliance:2008 ResiufenddRVACAJterations CF-IR-ALT-HVAC rCliutate Zones 10 to 15 Sire Ada3rss: 3 `� ! J, l a i/1(� a v'� En)6raa� t.tEtncy.. I1ot7 70-k k ,-) Pemut#.Conditioned/Floor T t List MnLmtun EtHci Duct it sulation requirernent Area T hermastad ❑ ed lha Over 40 f:of ducts added or �`•� ,Setback W Furnace 11 ARM ❑COP replaced in unconditioned space Served by system �„� „may ❑Indoor Coil WSEE3t� ❑HSPF ❑R 6 (C Z 10-13) —of pf nor aril be 0 Other tsingUnit O F.ER O Rice ❑R 8 (C Z 14615) s waled ❑Other ' 1.Eq&*mart Type:C hoate the equ4 nre w being bulalled-ifmore limn one rya tem,are another CF-IXALT-HV.lCfor"each sysrem *Mbrhmm Pgaiperent Ejjdarcim 13 SEER.78%AFUE,7.77MPFfor OVA al madmild slstems. HERS VERIFICATION SUMMARY listed below arse£ore•HVAC alter mon Options. The installer decides what work is being dome and picks one of the appropriate Options. Each Option lists the HERS measures tha t mast be conducted.A copy of the fame shall be lctt on site for final inspection snd a copy given to the homeowner. At final,the inspector verifies i hat the work fisted ore this foam was in fad the work completed by the installer. Tae inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and si ed_ October 1,2010,a rtgbftrW copy of the CF-IR and CF-SR shall also be on site for final Inspection. 1.HVAC Chan at Requbtd Forms: t laced CF-6R I MECH-04,MECH-21-1 MRS and(for split systems)MECH-25-HERS • All HVAC �ui�a �' CF4R far= MECH-21 and for lit s N ECH-25 • CondIndoor Cooser Coil and/or Indoo + CF-6R forms` MECH-21-HMS S and(i br split systems)MECH-25-HERS rCoilsad/or CF4R foams: MECH-21 and(for spli;systems) N ECH 25 • Furnace Fur.Split Systema:Dud leakage<15 percent; RC,CCA?300 CFM/tc tn(Minimum Air Flow Requirement),TMAH For Packaged Units: Dad leakage<15 percent Exempted from duct leakage testing if! O 1.Dod-system was dotmmented to have been previously sealed and confirmed thr ono HERS verification,or D 2.Dart systems with lea than 401crar feet in unconditioned space,or ❑3.Existing ductase coastrvctod,insulated or sealed withas restos ❑2.New HVAC System R"akvd Forms: Cut in or C6angtcont with new • CF-6R lianas MECH-04.MECH-20->•:ERS,and(for split systems)MDCH-22-HERS.and MIs A 25-HERS ducts:(all new dadingmd all CF4R farms MECH 20-,and for li t new ( sp systems�IF�i 2Z,and MECH ZS • For Split Systems:Dud leakage<6 percent;RC,CCA>_350 CFWtDA FWD,TMAK STNS,and either HSPP or PSPP. For Packaged Units;Duct leaks <6 percent ❑3.New Ducts with Replacement Required Forms: a Includes replacing or installing ail new ducting CF-6R forms: MUCH-04,MECH-20-HFR4,and(for split systerns)MECH-25-HERS and/or outdoor condensing unit and/or indoor CF-4R forme N ECH-20 i nd(for split systema)MECH-25 coir and/or furnace. Not all equipment cbangicd For Split Systems:Dud leakage<6 percent,RC,CCA>300 CFMAon,TMAH For Packaged Units:Duct leakage<6 Percent ❑4.New Do over 40 feet Reanimil Forms: a Includes adding or replacing more tEEJ CF-6R forms: NWH-04,MFECH 21-HERS CF-4R forms: MECH-21 Ifnear fed of duct in unconditioned For split system or packaged units: Duct leakage<15 percent 11 EXCEMON:E)datiag dad gstem construct4 insulated or scala l with asbestos. Contractor(Documentation Anther's/Responsible Designer's Declartition Statement) • I cati&that this Certificate ofCorpoisaoe docu moatation is accurate and complee. :0. 1 am cligsbk twouTjvogn 3.af the Califoroia B sato and Professions Code to acre s rssponsr'bility for the design ideatwied an this Certificate of Compliance. • .I catify that the eangy f tyres and perSrrrmance specifications for the d®ger identific d on Wis Certificate of Corogance conform to the reomroents of Tide 24, •Partr 1 and 6ofttr Celffaaia•Cade.ofRgGnlatioos... . • The design fgmura3dentrSed mthis Certificate of Compliaoee are coes'sabt with the information doc®cated on other applicable compliance forms,worlahects, am and . caliculi cuhmitted to the eaforcemmt for approwm with Qte Permit avolicadca. Nsma MARINE BROOKS Sigaatuce: Com SERVICE CHAMPIONS Date: Address: t,L Z O ( (O rhm �/`G t✓' fjt— licetL4e 817040 °'ty/stat iR 1 e ci �0") G�� 3`�`5 `Y «9 Z5 DIY 2008 Residential Cbmpliatce Forms March 2010 Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t 1f 3q '5L4-i P,f1j6t uCj 6tU °- PERMIT# C/ t V L v �1 OWNER'S NAME: Uejj)< �-r4 U fflUk4ri PHONE# y68 q - ` 2 GENERAL CONTRACTOR: cc ('�c La- t t644 > BUSINESS LICENSE# 311040 ADDRESS: "7y2U CITY/ZIPCODE: *Our municipal code requires all businesses working in the c ty to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. C � /&)-6 -(0 I am not using any subcontractors: LIN Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CL:PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: ;)ATE: REVIEWED BY: APN: BP#: *VALUATION: 1$8,407 xPERMIT TYPE: Mechanical Permit PLAN C HECK TYPE: Alteration /Addition / Repair PRIMARY ,?f Ji PENTAMATION FURN/AC USE: SFD or Duplex F°1 s/? F.°k1;,� PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check 0.0 hrs $0.00 '- �:r. FMech.Permit Fee: IMPERMITF7 Other Mech.Insp. 0.0 hrs $42.00 0' ��_ in'l,_ Li hop" fcc NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resohition 09-051 Ejf. ''170) FEE QTY/FEE MISC ITEMS slq)plP( kv F PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 CoItNlrlwfion Tax F Work Without Permit? Q Yes 0 No $0.00 I'lcrrftrl;t�r f�c<<.i: Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: $0.84 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $274.84 $0.00 TOTAL FEE: $274.84 Revised: 9/29/2010 CITY OF CITY OF CUPERTINO FURNACE/AC C U P E RT I N O PERMIT APPLICATION FORM APN 44 � � � ( - � Date: � 7'o Building Address: 11139 su*kff11CqPtd a("-e- Owner's Name: Phone#: Contractor: _ L 1, Phone#: Fax#: Contractor License#: Cupertino Business License#: F i 70 L/0 Contact: Phone#: Fax#: Building Permit Info: Elect Plumb Mech Residential 0 Commercial Job Description: For Residential Installations: Attic El 1�c floor ❑ 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Add 4ional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Constru,,tion(Usage Class): Strapped On Platform Bonded ET New Location Replacement Project Size: Express [✓Standard ❑ Lar e❑ Major❑ Valuation: SFY 0 7o 60 Green Building:Please complete relevant portion of W.-Green Building Checklist&attach it to the application or if applicable,include in plan set& the sheet index. Revised 01/07/09