14040090 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10396 S STELLING RD CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14040090
OWNER'S NAME: DONALD ROSSI TRUSTEE 7020 COMMERCE DR DATE ISSUED:04/15/2014
OWNER'S PHONE: 4082536754 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
I LICENSED CONTRACTOR'S DECLARATIONF
BUILDING PERMIT INFO' BLDG ELECT PLUMB
License Class Li .it y �U `� r j
WAS.
M MECH RESIDENTIAL COMMERCIAL
Contractor ( S �� T
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION.REMOVE&REPLACE FURNACE SAME LOCATION
(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:$7298
ave 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
permit is issued. APN Number:35913124.00 Occupancy Type:
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
orrect.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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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 /V / 'C Date:
9 18.
Signature Date
RE-ROOFS:
❑ 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)
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 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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must IV 11
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 relating
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting 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
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10396 SOUTH SPELLING ROAD DATE: 04/15/2014 REVIEWED BY: SEAN
APN: BP#: -VALUATION: $7,298
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK REMOVE AND REPLACE FURNACE.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $139.00
Mech.Plan Check 0.0 hrs $0.00 Phunb. Plum(' e'c n'
Mech.Permit Fee: IMPERMIT Plum/p. Ptrrrsf
Other Mech.Insp. 0.0 hrs $47.00 Otiwr Pluinb Insp.
Phrwh. Ins p.Fee: Ekl ( Insl). 1ce:
NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate Contact the Dept./or addn'1 info.
FEE ITEMS aW Resolution 11-053 M.' 7/1/13 FEE QTY/FEE MISC ITEMS
Man C"h ecl: ["cep:
Slplpl, PC Fee
PME Plan Check: $0.00
PME Unit Fee: $139.00
PME Permit Fee: -FT $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (F) No $0.00
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.73 Select an Administrative Item
Bldg*Stds Commission Fee: IBCBSC $1.00
r
$278.73 $0.00 TOTAL FEE: $278.73
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
GUPERTtNO
(408)777-3228•FAX(408)777-3333•buildinae-cupertino.org
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction, reconstruction, installation,relocation, or alteration of any mechanical system, except as
permitted in Chapter 1,_Section 112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil,FAU or condenser ?
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE,SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners &heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2" of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Fornns.doc revised 04/10/12
Fr.
SimpMed Prescriptive Certificate of Compliance:2008 Res1deYi1W EVACAIferatinus.. CF-IR-ALT-HVAC
C#iniate Zona 1 and 3-7
She Addresa: � EiiforcesnersiAgency: 3Jure ".= Perrrrit:#
Conditioned Duct insulation
ent T m I3st°1.frnimuien" floor Aiea " ,-r
Over 40 of dans
Pac]zaged Ufut
Furnace AFLTE COP Serued by system added of replaced m + etback
Indoor Coll ( S IIt HSPF ofareadppre=9mustbe
sf' unconditioned spaces,- .
Condensing Unit E3 EER Resistance msttrltei�J` z
•-
®R 6 (CZ I,3-3)
Other
1.Equipment Type.Choose the equipment being installed;if mom than one_system,use another CF-IR-ALT-HVAC for each system.
2.Alinimum Equipment 1£ficiracies:13 SEER,78%AFUE,7.7HSPF for typical residential:systems.
Contractor(Documentation Author's/Responsible Designer's Dedaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and eons ilete.
• I am eligible under Un inion 3 of the California Business and Professions Code to accept responsibility for,the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance.specifications for the design identified on t3tis Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the orcement agency for approi:al with the peunit
application.
Name: IKO
S Sim:
Company ` ate
Address Lte: 91 7C��CJ
City/State)zip: fj Phone:
2008 Residential Compliance Forms.doc revised 04/10/12