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12040140 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20771 SHELLY DR CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 12040140 OWNER'SNAME: WATERS CHARLES SAND CONNIE C TRUST 244 GREAT MALL PKWV DATE ISSUED:04/26/2012 OW'NER'S PHONE: 4082572265 MILPITAS,CA 92683 PHONE NO:(408)93"730 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class L V LicA / 6 2 1 �LI r r r /� (1 CS MECH RESIDENTIAL COMMERCIAL Contractor A —P L U - ;Date, ,'H 6 77 L [hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE FURNACE(100,000 BTU 80% (commencing with Section 7000)of Division 3 of the Business&Professions AFUE) Code and that my license is in full force and effect. 1 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 Sq.Ft Fluor Area: Valuation:$3500 Section 3700 of(he.Labor Code,for the performance of the work for which this permit is issued. APN Number:35911030.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read(his application and stale 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 rcpresen(atives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by:��/✓ �T/..rte/ Date: Signature Date' Z ' ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors(o construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should 1 store or handle hazardous material. Section 3700 of(he Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safely Code.Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensmion laws of Califomia. If,after making this certificate of exemption,I Owner or auUwrjzcd agent: 1 , become subject to the Worker's Compensation provisions of the Labor Code,I must Date: '"1 26 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date 04/26/2012 09:30 14089340734 APLUS SJ PAGE 01/01 Simplified Prescriptive:Certificate of Compliance-V2008 Resident/alliVACAlterations CF-IR-ALT-HVAC Climate Zones 1, 3.7 _Site Address: - Enforcement Agency: Date: Permit A!: 20771 Shelly Drive Cupertino, CA 95014 City of Cupertino Apr 25, 2012 Equipment Typel List Minimum Efflclenc Duct insulation Conditioned Floor y2 requirement Area Thermostat ❑Package Unit 0 Furnace ®AFUE 78^/e 0 COP 0 Setback ❑Indoor Coll ❑SEER ,❑HSPF ' ❑R 6(CZ 1,3-5) Served by system If not ❑Condensing Unit ❑EER ❑Resistance 0 R 4.2(CZ 6, 7) loop Sf Installed)already present, must 6e ❑Other_ I.Equipment Type;Choosa a equipment eing instilled;-if more than one system, use another CF-IR-AGT-HVAC for each SyStem. Z MInlmum Equipment EfTclenctes; 13 SEER, 78%AFUE, 7.7HSPF for typical residential systems. Contractor(Documentation-Author's/Responsible.Designer's Declaration Statement) •I certify that this Certificate of Compliance documentation is accurate and complete. •I am eligible under Division 3 of the California Buslness;and Professions Code to accept resDonslblllty for the design identified on this Certificate of Compliance. •I certify that the energy features and performance specifications for the design identified an this Certificate of Compliance conform to the requirements OFTitle 24,Parts 1 and 6 of the California coda of Regulations. •The design features Identified on this Certificate of Compliance are Consistent with the information documented on other applicable compliance fortes,worksheets,calculations,plans and specifications Submitted to the enforcement agency for approval with the permit application. Name: lane Alo Signature: Jana As Company: A PLUS GENERAL CONTRACTORS INC Date: Apr 25, 2012 Address: 11330 KNOTT STREET ==Tar City/State/Zip: GARDEN GROVE/CA/92841 Phone: (714) 901-0500 --F' air ��`' Si � ♦ f-' i1 no j.—»-x w.-w fes. 1lNM.fit f: Reg: 212-AO020547A-00000000-0000 Regiatratioa Date/Time: 2012/04/25 16:37:46 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forme July 2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35911030 . 00 DATE ISSUED. . . . . . . : 04/26/2012 RECEIPT #. . . . . . . . . : BS000016626 REFERENCE ID # . . . : 12040140 SITE ADDRESS . . . . . : 20771 SHELLY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . ... . OWNER . . . ... . . . . . . . : WATERS CHARLES S AND CONNIE C ADDRESS . . . . . . . . . . : 20771 SHELLY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : APLUS HEATING& AIR- CONTRACTOR . . . . . . . : ADAM P. PHAM LIC # 31293 COMPANY . . . . . . . . . . : A PLUS HEATING & A/C ADDRESS . . . . . . . . . . : 244 GREAT MALL PKWY CITY/STATE/ZIP . . . : MILPITAS, CA 92683 TELEPHONE (408) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---`------ ---------- ---------- -ADMIN HOURS 1 .00 41.00 0.00 41 .00 0. 00 1BCBSC VALUATION 3, 500 .00 1 .00 0 .00 1 .00 0. 00 1BSEISMICR VALUATION .3, 500 .00 0 .50 0 .00 0 .50 0.00 1MFR=<100 UNITS 1.00 130 .00 0 .00 130. 00 0. 00 1MPERMITFE FLAT RATE. 1 .00 44 . 00 0 . 00 44 . 00 0 .00 1TRAVDOC FLAT RATE 1 .00 44 .00 0. 00 44 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260. 50 0. 00 260.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- --- CHECK 260.50 #2247 --------------- TOTAL RECEIPT 260. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------ 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 20771 Shelly Dr DATE: 04/26/2012 REVIEWED BY: Sean APN: BP#: "VALUATION: $3,500 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYSFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace furnace(100,000 BTU 80%AFUE . SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: -a - $130.00 Mech. Plan Check 0.0 hrs $0.00 I'houb. Plmr Check L'lec. Ph,r.C•heel, Mech. Permit Fee: IMPERMIT Pho,rb.1'rrmll I-ce: fi!1(% Permit)':r: Other Mech. Insp. 0.0 hrs $44.00 Orhtr Plumb/ns!:. ollrer Utc./rsp. 3lach. best:.4,',•: Plumb./rep. 13ec. he.P. I're: NOTE: This estimate floes not includejees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These ling are based on the prefintina information available and are only an estimate Contact the De r or addn'l info. FEE ITEMS R�ec Resolution 11-053 F.(L 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $uppl. PC. Fee PME Plan Check: $0.00 Permit Pix: S`uppl. Insp Fee PMH Unit Fee: $130.00 PME Permit Fee: $44.00 C'nns/ruclion 7nr: Administrative Fee: (ADMIN $41.00 Work Without Permit? Yes (F) No $0.00 Advanced Planning Fres: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an.Administrative Item Bl& Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEES $260.50 Revised: 04/01/2012 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO.CA 95014-3255 I sc CUPERTINO (408)777-3228• FAX(408)777-3333•buildina/cticuoertino.orD PLUMBING MFCHAMCAL ELECTRICAL ❑MISCI-3IANEOUS PROJECT ADDRESS ulI I S�Ar ,� 11. r" APNi �. — i I l - n3 `J OWNERNAME f`j�CYU� &9W ��I r1�m` PHONE TIM_?5rj_ E-Ma RI Iv STREET ADDRESS N 1^Y/1-rl V, w'� Dr" �Y• ITAk"" `C/ " no 615D► FAX CONTACT NAME 11J ` ' PHONE E-MAD" STREETADDRESS CITY,STATE. ZIP FA% ❑OWNER ❑ OWNTGI-a=m ❑ OM'N}R Aawr cmnRA=R ❑CONTRACTOR AGENT ❑ ARCm wr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER �j I LICENSE TYPE /��I A BUS.LIC x :31 A Plus Head &ac u COMPANY NAME mvrms, •(,A 95035 E4%1A1L ^1^m `f-/�cm FAX STREET ADDRESS CITY.STATE,ZIP s/f f PHONE ARCRMCTIENODJEEA NAME LICENSE NUMBER BUS.LIC 8 COMPANY NAME' E-MAD. FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OP $Lsm.DunEx ❑ MULTFFAMD.Y PROMACTINWI DLAND ❑ YES PROJECT W ❑YES IS THE BLDG AN ❑YES BUDDING: ❑COwAmcTALJyy�P� /I URBAN INTERFrACEARFA ❑ NO �jFLOOD ZONE ❑Q,NOO OCMFAHOME'I ❑NO DESCRIPTION OF WORK RGIITvvC/ old rncice , rG QCT? W nfJW 1n Sams ocaii 0M 100,00o &TU go (" hpmc TOTAL VALUATION: RECELVED BY: By my siguaunre below,I certify to each of the following. I am the property owoer or authorized agent to act on the property,awaer's behalf. I have read rids application and the information I have provided is cmrecL J have read tha Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to co tlDrize represmmdvea of Copertiao to enter the ab -id=f fPro^peny for i ecoon oscs. Signature of AppficmNAgenn Date; i�'I�vA 1 !i m4 IJW'P SUP LSMENTAL INFORMATION REQU= OFFICE USE ONLY u OVER-THF-COUNTER ❑ EXPRESS - ❑ STANDARD u Z ❑ LARGE S ❑ MAJOR AIEPMc;a4pp_1011.doc revised 06/11111