14080012CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1118 NOVEMBER DR I CONTRACTOR: SERVICE CHAMPIONS
OWNER'S NAME: BIKASH KOLEY
OWNER'S PHONE: 4086670304
P LL�ICENSED CONTRACTOR'S 99DECLARATION
/License Class `� Lic. # `V
Contractor 'W-11 [�-Qi 6fif� Date
�t
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.
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
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and wil y
with all non -point source regulations per the Cupertino Municipal Cocle, Section
918.
Signature Date 13
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
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.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9 18.
Signature
Date
7020 COMMERCE DR
PLEASANTON, CA 94588
JOB DESCRIPTION: RESIDENTIAL ❑
REPLACE (E) A/C UNIT & COIL
Sq. Ft Floor Area:
APN Number: 36217056 00
PERMIT NO: 14080012
DATE ISSUED: 08/04/2014
PHONE NO: (925) 444-4444
COMMERCIAL ❑
Valuation: $7877
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WtF
180 r IT ISSUANCE OR
1 T CALLED INSPECTION.
EA //
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec 'ons 25 O5, 255 ,and 5 4.
Owner or authorized age Date: D
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION. PERMIT APPLICATION O`
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION t '
10300 TORRE AVENUE • CUPERTINO, CA 95014.3255
V P R`$.iMO (408) 7TT-=$ • FAX (408) 777-3333 • bulldIna0mmorthom
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owada bebe[E E have read this
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ed P1roiiYSo1 0th PSP•
B1dgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
Imum
TUU UQrlrlfl%4 A r1r"1D — 1111Tlr1.nTNP- nIV1qI0N
ialADDRESS: 1118 NOVEMBER DR
FEE ID
E: 08/0412014
REVIEWED BY: MELISSA
APN: 362 17 056
1 BP#:
*VALUATION: F$7,877
'PERMIT TYPE: Mechanical Permit
1BREMAIR
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
#
PENTAMATION FURN/AC
PERMIT TYPE:
USE:
WORK
REPLACE (E) A/C UNIT & COIL
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
SCOPE
-T-T
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=1 OK cfm)
1BREMAIR
1
#
$72
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
-T-T
Administrative Fee: JADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$72.00
1
Z
Mech. Plan CheckF001 hrs $0.00 11111wh. Plorl
Mech. Permit Fee: IMPERMIT
rtherMech. Insp. 1 0.0 F /71,W
Li
/I hmp- L -c 13, hisp. Fee.
NOTE: This estimate does not mcluaejees aue to orneruepurtmerm (tr. U tuftleM6,
I n"tart tho Hent fnraddn'l info.
'u1strict, etc.. .1 rfr3e ara urc puO GK— . V.
FEE ITEMS (Fee Resolution 11-053 E(f.. 711113)
FEE
QTY/FEE
MISC ITEMS
Plun 04ecii, J",(W:
PME Plan Check:
$0.00
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
-T-T
Administrative Fee: JADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.02
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
ILI,
--Y
$215.02
$0.0001 TOTAL FEE:
1 $215.02J
Revised: 07/10/2014
OFCAUMRMA
ERATIONS - HVAC
CEIMFICATE OF CDMPUANCE MR -ALT -03-E
16
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arrt
Date spared: i
PeraaPor:
6q 'patent raw.
Equipment Et deny
New: cling; Menruns, litre3et
dl0o d
IWMM
Regulmd. R -value
Floor Area ft)
0 Systsimr
rColl
_„�►FUE
Cop
D R-6 (Q1,3-7) Ducts
13 114 (Q16) Ducts
Served b NAM
k
(f(notaUeady
It9yaeept
ndensing Unit
aSEER
ft
�1 groes
D Unasat
EER
--MPP
O R-6 (dl tr'a) Plenums
present must
D R-5 or R7.5 Unset'
be Installed)
M vlRIFICATIDN ASAMW Installer daterminas vorlcto be eomplebd and rnaEGhes to one of the options below. At permit epplkation this
k allowed to be IIIW out by hand. Forfinal inspecdm ell forarhr: ara>n be 'ed no hand filled forms allowed and.a copyleft on site.
HVAC auarrgeeret/Repir
Rsqulnd CompRaarea Doeuansarb to be Nit eat shat for llnaW
arta naw duan
E9WP
MR-AL.TM-E
neer Unit, Evaporator Coll,
CF2R: MECH-03, MEQf-20-HERS
At Hendler/ArrnaCe
CF3lt: MEW0-HERS
Raqu>nernenC Dud 1011190 WSY, or, 110146 to 9"Cle, or seal all accessible leaks)
pttai from duet leakap t estfng If:
L Duct system M0212red *11th HERS provider as prev'ously sealed, or C 2. There k less than 40 linear feet of duct in unconditioned
or JK& edxft dmt ars oonattudad. inwMted or soled with asbesoos Mawowlacture dace of building -
0 2. Now HVAC Sptam Req*ed COmpllaaos Domna is to be left on site for MW:
AJ new equipment and All New Duns= MWALT-02-E
CF2R-ME04-01, MIEGR.0-HERS, MECH-22-HERS, MECP,(29 or 2 Y14ERS
CF311-ME04-20-H MECH-224MM, MIC 140 or $)—HEW
ln#ABw Regvireneenk Duct laeWP 16%, Fan Efficacy (-%W/CFM), AIr Row z 350 CFM/ton (or Standards Table 150.0-C/ 0 alternative)
L All Naw Ducts wK% Raplaeenuent Requited Cw*llaaeea Doeumenb to be left an *& for Final:
J#cludaz replacing or Installing AD New CF1R-ALT-02 f
W and one or mato of the fcIW*vug: CF2R-MEOf•03, ME01?0-HERS, MECK423 or 24) -HERS
ser Unit rColl. Furnace CP3R-MECW20.HERS, ME04423 or24 HERS
RegWnNaaaht: Duet leakgp < 6%. Air Flow a 350 CFM/ton (or Standards Table 15W. C 0 aftmative)
D Eumm ftm duct feakel tesdin z I erdsti duct are constructed, inrufated Or sealed with acbeatas.
4. NeWDUCO2~40fiat a 0ooana a is t o be (cit on sift for Real:
ding err replacing dress In uneoMltbned MR-ALT-02-11
CFM ME04-20-HERS
but less than All Naw Duds:
MR. MEC 4 -20 -HERS
I er Reofte t—M Duct lealuege 015% or, &,1096 m awtslde, or sae) all accessible leaks)
0 from ductleab Vit 1 duet systems are eonstrucbad, Insulated or sealed with ad*ftL
140 new ducting R41 reafulred when more than 40 ft Installed and R4 when less then 40 ft Installed. THa Indudas In %wHs, bstween floors ea.
w Duct eystem is when the duet system k construcmd of at least73 parent new dud material, and up to 25 percent may consist of reused
fttlm the dwel ft UWS eldsting duct system (P-& moon, grilles, boots, air handler, plenums, duct material.
tft,ulftion
W thickinsutedon) fvrllnasetsY and (ass.R.7S(L5"tNckinsulation)forIhkseteaverllneh Mose mfgwtH require Suctlon ane Diameter
as the fbDowing 1.5-2- 2W2,S-3T 2W. 33 to 4T -W, ST -4)"
r MOCYrrlYrrlidW Authoes /Re M le B Dedaragon 210ment)
I I OrWthe following under penalty of perjury, underthe laws of the Sthaee of Cohlbrnla:
The hftme11ion provided on thk.COUBcate of Compliance k true and correm
l am eligible under Division 9 of the CWHbn a Business and Profesatons; Code to acoept rewondbility.forthe Inf netlon on this document
Thatthe anergy fractures and perFormwuce Wedficatbns for the design identified on this Cadfle M of Compliance conform to the
requhasmants OfTWe 24, party land SaFtfre California Code of Regulations (CCR).
4 TlhattM enargyfeetures and performance specifications, nu terials, cornponenrs, and manufactured devices forthe building design or
system design idantlW on thts CerMicate o(Compllance conform to the requirements of T4de 24, Part l and Part 6 of the CCR.
S' The building design faeetures or system design features identified on this Certificate of Compliance are consistent with the Information
provided on other apokable compliance doeum wo , eakuhmom, plans and speetfkaelons subm ttad to the enfOra emant
e for t wide thk bulk 1n on.
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For aswtarres ser quai11lame rperdrra due Energy Smudwd6 remise[ the Enarty 61otRoe at: >reotTv772-a3oo