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10090017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20030 FOREST AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 10090017 OWNER'S NAME: RAMOND CHIU 7020 COMMERCE DR DATE ISSUED:09/02/2010 'ER'S PHONE: 6509967822 PLEASANTON,CA 94588 1 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r License Class L Z Lic.# U V O MECH r RESIDENTIAL r— COMMERCIAL Contractor `V(a'ki► � Date -Z —1(/ —' f JOB DESCRIPTION:REPLACE FURNACE ONLY 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:$4259 1 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:31623107.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM 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�/�_ Date: 9.18. � / Signatur. �/(`1 134,tn�"��.Date � Z-J RE-ROOFS: L OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 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 have 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance 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 contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&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 Oar u rorized a nt R—--2 -11/� Compensation laws of California. If,after making this certificate of exemption,I Date: 6 become subject to the Worker's Compensation provisions of the Labor Code,I mus forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby 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 relatinj; to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ir-'-mnify 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 g.,...ang of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $4,259 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY 7t1'l.iL PENTAMATION 1RMAP6 USE: SFD or Duplex 1;10OR / k"'I PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT I'E„r:l>. Pt°rma Vc— 1;I'c_ f'i'r77ril 1'�'f Other Mech.Insp. 0.0 hrs $42.00 otr:c'r' Ort,c.r 1:r��c_Irrrp. NOTE: These fees are based on the relimina in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 09-051 Elf. 7/1,"I( FEE QTY/FEE MISC ITEMS Plail ChccA Fcc- S1fppl. PC Fcc F7 PME Plan Check: 10.00 Pt'rini1 Fc'c Sa�llpl. Irrsl�I'ce PME Unit Fee: $12:6.00 PME Permit Fee: $Z.2.00 C`onso-uczion Tax <f1<:oustical Rc viciv 1'FCc: Work Without Permit? 0 Yes G No 50.00 Plasmin” Fccs: Travel Documentation Fee: 1TRAVDOC $42.00 S`11-ong 11otion Fc". Select an Administrative Item Bldj Stds Commission Fee: 1BCBSC 61.00 SUBTOTALS:> $211.00 $0.00 TOTAL FEE- $211.00 Revised: 9/01/2010 CITY OF CUPERTINO 4 ITEMS OF 4 PERMI`C RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN . . . . . . . . : 31523107 .00 DATE ISSUED. . . . . . . : 09/02/2010 RECEIPT #. . . . . . . . . : BS300011371 REFERENCE ID # . . . : 1090017 SITE ADDRESS 20030 FOREST AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RAMOND CHIU ADDRESS 20030 FOREST AVE CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM . . . . : IE INC CONTRACTOR KEVIN COMERFORD LIC # 31833 COMPANY SERVICE CHAMPIONS ADDRESS . . . . . . . . . . : 7C20 COMMERCE DR CITY/STATE/ZIP PLEASANTON, CA 94588 TELEPHONE (S25) 444-4444 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- - --------- ------ 1BCBSC VALUATION 4, 259.00 1 .00 0 .00 1. 00 0 .00 1MFR=<100 UNITS 1. 00 126 . 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 211 .00 0 .00 211. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------- CHECK 211 .00 #4343 --------------- TOTAL RECEIPT 211.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- -- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Palet 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal as Exposed Particleboard or MDF 4 IAQ/Health.pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 ' 1 1 1 Total Points Available: 140 1301 57 Total Points Project Received: 0 0 0 G:data/progs/gi eenbuildngguidelines/remodelerstgreenpc intsfinal21264pro1eoted.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z 0 0 3 V FO S:� l4 V — PERMIT# OWNER'S NAME: o�� L LGt I to PHONE# z uy y - �yY� GENERAL CONTRACTOR 5�ro �L A iU6� s BUSINESS LICENSE# ADDRESS: .I Q Z J LU�m e/C -D In CITY/ZIPCODE: sC'A fon *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCYINSPECTION(S) WILL BE OBTAINED A CITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTRACTORS BUSINESS LICENSE. /9) ,V& > q - 7 - 1b I am not using any subcontractors: I 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 TEE Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Simplified Prescriptive Certificate of Co fiance:2008 Residendd RVACAJldons CF-IR-ALT-HVAC Climate Zona 10 to 15 Site AdAvm- Fxjbrconent AgenW-,, nom, Permit tR: Av 7.'L - 1© Condffioned Floor T i List Wmimunt rMci Dort insolation requirement Area Thermostat 0 Peciaged Unit Over 40 8 of darts added a s 3etbacic XFtaneoe dAF[IE 9� D COP replaced m unconditioned space Serval by systtm (if not otneedy • 0 Indoor Coil DSEFR D HSPF_ 0 R 6 (CZ 10-13) —if orwenc neat be O Condensing Unit D EER D Reaistabce 0 R g (CZ 14215) t rOs� 0 Other 1_Egafpamod Type:l.7roaee the equipment heft in uUad Vmwe 1)on one system,use mtotther CF-IR-ALT-HYACjoreach system Z N"a mea Epometat Ep dead 73 SLS)1;78%AFUE,7.77M Ffor O*W residential systema HERS VERIFICATION SUMMARY Listed below we four H VAC alteration Options. The installer decides what work is being dome and picks nae of the appropriate Options. Foch Option lists the HERS m attares drat must be conducted.A copy of the Rums sball be}eft on site for final impaction and a copy given to the bomeownar. At final,the inspax(r verifies that the work listed on this foam was in fact the work completed by the installer.The inspector also verifies that each appropriab CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)m filled oat and si Octobcr1.2014 a recbftrW copy of the CF I)t and CF4R shad also bean site for goat luspecdom I.HVAC Chan ut Forms:- • All HVAC Equipment rspiata�d CF44t a MECH-04)t MCH-2I-HERS and(fa split systcou)MECH-2S-HERS CF-4R forma: MECH-21 a for it MECH-25 • Condenser Coil and/or CF4R lural:: MEC-21-H ERS and(for split systema)MECH-25-HERS a Door Coil and/or CF-4R firmar. MECH-21 x d(for split sysh ms) MF.(HI 2S �Fttmsoa For.SpNt Systems:Drat leakage-<IS parent; RC,CCA>3110 CFMAon(Minitnum Air Flow Requireroent),TMAH For Packaged Units: Duct leakage<15 percent Exempted from dad leakage testing it D 1.Doct•syalem waa docgmented to bave ban previously sealed and confirmed through HERS ve ificatiem,or .. • D 2.Duct systema with teas thin�]hour Beet In tmcamditi owed space,or � . D 3. duct are conattceood,insolited or soled with sabestos O 2.New HVAC System Required Forms: a. Cut in or Cbaageout with nor . CF-6R farms: MECH-04,h WM-2041ERS,aod(for split systema)M13CH-22-ITERS,and MECH-25-BM duces(ail new ductingmd all CF-4R farms: MECH 20-t i ad(for split syscems)MEI-22,and MECH 25 . new ' For Split Systems:Dud leakage<6 paceu�RC,CCA>_350 CFWton,FWD;TMAH,ST?AS,and either 11SPP or P. For Packaged Units.-Duct leaks 4 5 percent O 3.New Daus with hhceme9t Reauked Fo rms: • Includes replacing or install g no new ducting CF-6R Rama: M WH-04.MECIi-20-HERS,nnd(for split systema)NECHI 25-HERS and/or outdoor condensing unit and/or indoor CF-4R forma;WECH-20 and(for split syscoma)M WH-25 coil ander Ramie. Not all equipment cbanv . For Split Systems:Dud leakage<6 ptncenk RC,CCA>_300 CFMhon,TMAH For Packaged Units:Dud Icabile<6 percent 0 4.New Do over 40 feet Reavired Fe nus: • Indicia adding a replacing more tbm 40 CF-6R forte MECH-W,MEC-21 HERS CF-4R form:: MK H-21 linear fed of duct in tmco�itioned ee. For split system or packaged mots: Duct leakage<15 pence at Q EXCEMOM Existing dnct system constructed,insula led or sealed with asbestos. Contractor(Documentation Anther's/Responsible Desipe)-'s Declaration Statement)' • I eettirfy that this Ceipfiate ofCompliance docmrreatwon is aoemata as i complete • .I am e6ok under Djvitita,3.od die California Btrs s and Profaaiom Code to W4=0 rsspooald ty for the dolga ideatitled an this Catiscate of Complisoee t ratify Wet the Baggy fpnun mod pofi xonence apetdSei6one for the di sign identified on this CaWcd c of Com itaax conform to the regainments of Tido 24, 'Pasta l orad 6'of the CiJ)lbrnia,Co¢e of Regolatioos.-. • The design features idealised m this t.atfsata of COVIisim ass cowl trot with the information doemneated an other applicable compliance forma,worksheets, ins mad iaiioo iAmiltod to the eaforeremmt r for with the it 6cstion. MAXINE BROOKS ISrga COQ'SERVICE CHAMPIONS l�. Address: ",(� z O dt mm el c t✓ Pt- Lim 817040 Phone:q Z Y q- 2008 Residlendd Compliance Farms March 2010 i009 00 i -7 CITY OF CUPERTINO FUF24ACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # j /D �J Date: z _e Building Address: 2vv o Owner's Name: Phone#: Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect Q- Plumb Mech Residential Vi Commercial Job Description: s � p Id C-e �1 , OC, For Residential Installations: Attic ❑ 1St floor 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: G� Type of Construction(Usage Class): Strapped On Platform Bonded . New Location El Replaceme._ Project Size: Ex ress ❑ Standazd ❑ Lar e ❑ Major❑ Valuation: Green Building: Please complete relevant portic n of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. ct— Revised 01/07/09