14080085 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10180 BONNY DR CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 14080085
OWNER'S NAME: RIFFE JOAN D TRUSTEE 7020 COMMERCE DR DATE ISSUED:08/12/2014
OWNER'S PHONE: 4082337932 PLEASANTON,CA 94588 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
�7 n /� REPLACE(E)A/C UNIT& COIL ONLY(SAME LOCATION)
License Class w I Lie.# 'b t Q C�
Contractor Ui L{l�iAtip��1t Date
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:$10464
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:35911047 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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 RMIT 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 18 TSTROM L ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theZ /
granting of this permit. Additionally,the applicant understands and will co Issued Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
(� /a_Ir� RE-ROOFS:
Signature Date ` 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
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)
I,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,Secti ns 25505,255 R,and 25534. "�
permit is issued.
Section 3700 of the Labor Code,for the performance of the work for which this 'Owner or authorized agent )• � Date: 12
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting 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
GENERAL PERMIT APPLICATION O�
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �b
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
Is (408)777-3228 FAX(408)777-3333•building ancupertino.org MISC
CUPERTINO
PLUMBINGlKWCHANICAL ELECTRICAL? WSCELLANEOUSS
PROJECT ADDRESS }D I (O D go� AM# /
,J 19 — ( — V Y
OWNER NAME 3-Dk ,Z5 `'n �.J Q PHONE_ �2�� �Ip? E-MAIL
STREET ADDRESS I O (C G ,1� CITY>STATE J q)ao FAX
CONTACT NAMEaGrjUkJ , E-MAIL
O7. y &yy
STREET ADDRESS CTIYSTATE,ZIP
FAX
❑OwNER ❑ OwNER-BunDER ❑ oWNERACdNT CONTRACTOR ❑CONTRACTORACENT ❑ ARCHITECT ❑ENGINEER - ❑ DEVELOPER ❑TENANT
CO OR NAIvtE < LICENSE NUMBER Q)-7 n Il0 LICENSE TYPE /1�o BUS.LIC#
COMPANY NAME E-MAIL 11,J !l z V (� FAX
STREE i�[, 17` ct �'& `�Ys'g y- /5�V
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME B-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF m DUPLEX ❑ MULTI-FAMILY PROJECC INWIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUIIAINCr ❑COMMERCIAL URBANINTSRFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
lacy �- Coc OA lbc�4o�
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to n e property owner' �.Iflve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatmqp buildmaconstructi I representatives of Cupertino to enter the above-identified prCoprty for inspection purposes.
0 Signature of Applicant/Agent: Date: l� _1L
SUPP MENTAL INFORMATION REQUIRED OFFICE USE ONLY
prw VEP, COUNTER
�" ❑ EXPRESS
STANDARD
LARGE
a
MAJOR
MEPM1scApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10180 BONNY DR DATE: 08/12/2014 REVIEWED BY: MELISSA
APN: 359 11 047 BP#: *VALUATION: 1$10,464
xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E A/C UNIT& COIL ONLY SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 113REMAiR 1 # $72
TOTALS: $72.00
777
� .
Mech.Plan Check 0.0 hr's $0.00 Plyw7b. Plan ChecI /Cc. Pian Check
Mech.Permit Fee: 1MPERMIT Pt,mb. Pt mrr 1''ec.
Other Mech.Insp. Fo.0 hrs $48.00 C1r1 e,: Ph.onh Irsn. Li Ofhc`f,/e<.r 7,v
11/7110. c.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelitiniina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,f'. 711/13) FEE QTY/FEE MISC ITEMS
Fc,-
PME Plan Check: $0.00
PME Unit Fee: $72.00
PME Permit Fee: $48.00
. T
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (F) No $0.00
Travel Documentation Fee: ITRA VDOC $48.00 i
Strong Motion Fee: 1BSEISMICR $1.36 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
q� �Bo- AIS $215.36 $0.00 TOTAL FEE: $215.36
Revised: 07/10/2014
STAI E OF CALIFORNIA
ALTERATIONS -HVAC
CM CF1R-ALT-03-E &*W OSM4 CALIFORNIA ENERGY C0MIJUSSION
CEFICATE OF COMPUANCE CFIR-ALT-03-E
AN erations-HVAC CZ 1,3 to 7 and 16(formerly CF-iR-ALT HVAC) (Page i of 1)
Sit Address: Enforcement Agency: Date Prepared: Permit#:
4?L7Ul di 0
Eq�nipment Type Equipment Efficiency New:Ducting,Plenums,Uneset Conditioned Thermostat
Required R-value Floor Area(so
O P ckaged System 'i Evaporator Coil AFUE COP 0 R-6 (CZ 1,3-7)Ducts Served by system Setback
0 S lit System Id Condensing Unit 3 SEER 0"1 (CZ 16)Ducts sq ft (If not already
HSPF 0 R-6(all CZ's)Plenums present,must
0 F mace 0 Uneset EER 0 R 5 or R7.5 Unesets be Installed)
H RS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
fo is allowed to be filled out b hand. For final inspection all forms are to be registered(no hand filled forms allowed and a co left onsite.
E
HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
indude new ducti
AI Equipment, CF1R ALT 02-E
denser Unit,-Evaporator Coll, CF2R:MECH-01,MECH-20-HERS
Ai Handler/Furnace CF3R:MECH-20-HERS
In' liar Requirement:Duct leakage(LIM or,: 10%to outside,or seal all accessible leaks)
Exe pted from dud leakage testing If:
^ '1 Dud system registered with HERS provider as previously sealed,or 0 2.There is less than 40 linear feet of dud in unconditioned
s ace,or 0 3.Existingduds ms are constructed,insulated or sealed with asbestos(list manufacture date of building
0 2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New 0ucts2 CF1R ALT 02-E
CF2R-MECH-01,MECH 20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24 HERSZ
Installer Requirement:Duct leakage<6%,Fan Efficacy(.SSW/CFM),Air Flow;t 350 CFM/ton(or Standards Table 150.0-C/D alternative)
013.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Ii dudes replacing or Installing All New CF1R-ALT 02-E
acts'and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH423 or 24)-HERS
Condenser Unit,Evaporator Coll,Furnace CF3R-MECH-20-HERS,ME 23 or 24}-HERS
Installer Requirement:Duct leakage:S 6%Air Flow 2 350 CFM/ton(or Standards Table 150.0-C/D alternative)
0 Exempted from dud leaks a testin g I existing duct ems are constructed,Insulated or sealed with asbestos.
DI4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
A ding or replacing duds in unconditioned CF1R-ALT
s ce but less than All New Duds' CF2R:MECH-2-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Dud leakage(<15%or,<10%to outside,or seal all accessible leaks)
0 Exempted from duct leakage testing I eAsting ductsystems are constructed,insulated or sealed with asbestos.
' I new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This incudes in walls,between floors etc.
2A New Duct system is when the dud system is constructed of at least 75 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
3 -5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for Iinesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the followi 1.5-2T 2%",2.5-3T-2W,3.5 to 4T-23r,5T-43C
Contractor(Documentation Author's/Responstbie Designer's Declaration Statement)
I rtify the following under penalty of perjury,under the laws of the State of California:
1 The information provided on this Certificate of Compliance is true and correct
2 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility.for the information on this document
3 That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Tide 24 Parts 1 and 6 of the California Code of Regulations(CCR).
4 That the energy features and performance specifications,materials,components,and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the CCR.
51 The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency forapproval with this building it application.
R ible Designer Name: SlBnatu►a Date Ste.
0 is �n ,r�t�s Ll
Phone:
For assistance or questions regaid—ng the Energy Standards,canted the Energy Hotline at:1400.772-3300 ,
t