11020087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20083 WHEATON DR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 11020087
OWNER'S NAME: HINMERS KENNETH J AND RAE M TR 7020 COMMERCE DR DATE ISSUED:02/23/2011
" VNER'S PHONE: 4082535012 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
q LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class- C Z Lic.# 1' 0 q o REMOVE&REPLACE FURNACE AND 10 SUPPLY DUCTS
Contractor ss�k rj)U—Q, L k CkN.t P l 0 A 5 Date a `,�3 i'
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:$9180
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:31623056.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION 1/
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 180 DAYS OF PERMIT 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 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�� alt,,-�-e- S:
Signatur. Date All roofs shall be inspect or to any roofing ma rial being installed.If a roof is
installed without first obt 'ng an ins ection,I agre to remove all w in erials for
inspection.
OWNER-BUILDER DECLARATION J
Signature of Applicant: Date: l
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)
1,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 Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this nn�''
permit is issued. Owner or authorized agen (�/1/� Dater
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
`s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
.sting 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
Sim lified Presc ' Rive Certificate of Compliance:2008 Rmiderrtial HV.4CAheradioxs CF-IR-ALT-HVAC
Qiaa:te Zones 10 to 15
SYte.11ds�,rssU� 3 �1 J�( CJ �✓ ERforees+eht't8e+ky: Da ^23,( ► Permit#:
Conditiaeed Floor
Ekluipment Type' List Mmi atim 1$ci Duct insulation requirement Area Thermostat
O Packaged Unit Over 40 ft of ducts added or
1 19 Furnace '4 AFUE 9� O COP t�Setback
O Indoor Coil OSEER O HSPF mPlsOCd in macondinonod space Served by system (1f„W a&early
O C odensing Unit O EER O Resistance O R 6 (CZ 10-13) ttf premum;now be
O Other O R 8 (CZ 1445) butdte 0
I-Egrci -est Type_Chorea the equipment being installed if more than one s}crtem,use another CF-IR-ALT-HVAC for each system.
2.MW&wm Equipmev E,ftdowie:13 SEER,78%AFVE,7.711SPFfortyphurl re sidenda!slataw-
HERS VERIFICATION SUM%L4RY listed below ane far HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options- Earp Option lists the HERS measuics that must be conducted.A copy of the foams shall be left on site for final
inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the
inctancr. The Qupector also verifies that each appropriate CF-6R and registered CF-4R forms(no band filled CF4Rs allowed)are filled out and
signecL BeginningOctober 1,2010,a registered copy of the CF-1R and CF-6R shall also be an tdte for final hupecdoiL
1.HVAC Changeout Required Farms:
• CF-611 forms MEM-04,MECH-2l HERS and(for split systems)MECH-25-HERS
All HVAC
Equipment rephxxd CF4R farina: MECH-21 and for split MECH-25
• Condenser Coil and/or CF-6R firms: MECH-2I-HERS and(for split systems)MEM-25-HERS
• Indoor Coil and/or CF-41Z hassles KWH-21 and(for split systems) MECH-25
• Fumare
For.SpBt Systema:Duct leakage<15 percent; RC,CCA 2:300 CFMAcn(Miinituwrt Air Flow Re4uirement),TMAH
For Packaged Units: Duct leakage<15 percent
Exempted from duct leakage testing it r�
O 1.Duct-system was documented to have been previously scaled and confirmed through HERS verffeatich,or
0 2.Dad systems with less than 40[fix=Sed in unconditioned space,or
O 3. duct arc cansuvetA hwal iced or sealed with sabestos
17 2.New HVAC Systt'aut Required Forms.
• Cat in or Changeout with new - CF-6R fame. MECH-04,MECH2O4MS,aod(for split systems)1413CH-22-HERS,and MBC'.H-25-HERS
dads:(all new ducting—anj an CF4R foetus: MEQi 20-.rad(for spfit syaxeam)NE01-22,and MECH 25 .
new
For Split Systems:Duct leakage<6 pacent',RC.CCA>_350 CFM/ton,FWD,TMAH,Sims,and either HSPP or PSPP.
For Pac Units:Duct kAmgc<6 Perccut
O 3.New Ducts with Replacement Required d Forms:
a Includes replacing or insmIflmg all new ducting CF-61Ribrras MECH-04,MBCH-20-HERS,snd(far split systems)MEQi-25-HE3RS
and/or outdoor condensing nail and/or i door CF-411 forte MECH-20 and(for split systems)MMI-25
carr and/or furnace. Not all equipmerrt changed.
For Split Systems:Dud leakage<6 percent;RC,CCA>_300 CFMhon,TMAH
For Packaged Units:Duct leakage<6 percemt
4.New DuEgn aver 40 feet Reavdred Forms:
• Includes adding or replacing more than 40 CF-6R f. MECH-04.MECH-21 HERS CF-4R forms: MECH-21
linear feet of duct in mconditioned
For split system or packaged units: Duct leakage<15 percent
t
Q EXCEPTION Firisting duct quems oonswmted,insulated or scaled with asbestos.
Contractor(Documentation Author'=/Responsible Designer's Dedaratioo Statement)"
• I artify dwt this C"f este of Courplianoe docmnesubaa is awwate sod complete:
• .I am 3_of bre Califarnk Busi ma sod Pralemioos Code to accept responsibility for the design identified an this Certificate of Comptianee.
• .I and pafiozmrooe for the desegn identified on thio CeriifiCaoc ofCompliance aaconform to the rogairanrnts of True 24,
eertify that the energy 4-M,
Puts 1 and 6 of the cilli ga Code ofRegnlatioos.:
• The design haw=ids an this Cmdoate of Cow0i=.a are eonsiamt with the information dowmeated ern other aitptinble compliance forms,worimbecu,
ins and . esbani so6mitted to the tPoraemast wax.7 for soprovA-ft&a Penni amficatilm
Nam MARINE BROOKS
SERVICE CHAMPIONS Date'
`7�4 e.h of t:.®?' l+u-e— l s,7o4o
Art JJ S t:i� g 5! 3 1 Phos& it D 3 9 4 ti 93'`{q
2008 Residential Cm plia nce 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: ;;7008;3 Ct�ot') ]-)f' #
OWNER'S NAME: o N mn eo s PHONE # qO?
GENERAL CONTRACTOR: 52,'U is--e-., ClQ ,c-zn S BUSINESS LICENSE#
ADDRESS: "l L2U 4fow Y1 r&-e- 17i^ CITY/ZIPCODE: La"45ca(p hoyl qqs:& 3
*Our municipal code requires all businesses working in the city 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.
I am not using any subcontractors: �/��',�� o� "o? 3 -1�
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 CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31623056 . 00
DATE ISSUED. . . . . . . : 02/23/2011
RECEIPT #. . . . . . . . . : BS000012758
REFERENCE ID # . . . : 11020087
SITE ADDRESS . . . . . : 20083 WHEATON DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HINMERS KENNETH J AND RAE M TR
ADDRESS . 20083 WHEATON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2339
RECEIVED FROM . . . . : !E INC
CONTRACTOR . . . . . . . : KEVIN COMERFORD LIC # 31833
COMPANY . . . . . . . . . . : SERVICE CHAMPIONS
ADDRESS : 7020 COMMERCE DR
CITY/STATE/ZIP . . . : PLEASANTON, CA 94588
TELEPHONE . . . . . . . . : (925) 444-4444
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9, 180 .00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 9, 180 . 00 0 . 92 0 . 00 0 . 92 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
1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 274 . 92 0 . 00 274 . 92 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 274 . 92 6914
---------------
TOTAL RECEIPT 274 . 92
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF
CITY OF CUPERTINO
FURNACE/AC
L U P E RT t f O PERMIT APPLICATION FORM 1102,
APN# �I� Z 3 ��,� Date:
Building Address:
C)D3 f0n D/`
Owner's Name: Phone#:
� �►n � e�5 �v� a s3- 5v► z.
- Phone#:
Contractor:
S-e�l'v i� ��G�►"'� ��u►n s qU y
Fax#:
Contractor License#: Cupertino Business License#:
9 ) q0
Contact: G� Phone#:
Fax#:
Building Permit Info:
Elect�� Plumb Mech 91
Residential Commercial El
Job Description: yl Flo 3 et
i ur✓a ar�� o s�ppr �u�fs
For Residential Installations:
Attic ❑ 1 `floor [� 2ndfloor F-1
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: Type of Construction(Usage Class):
Q1,30 . cc)
Strapped On Platform Bonded New Location Replacement
Pro'ect Size: Ex ress❑ Standard® Lar e❑ Ma'or❑
Valuation: q100 , U0
Green Building:Please complete relevant portion of the Green Building Checklist&attach it to the
application or if applicable,include in plan set&the sheet index.
Revised 01/07/09