13030093CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19751 BIXBY DR I CONTRACTOR: A PLUS HEATING & A/C I PERMIT NO: 13030093 I
OWNER'S NAME: CHRIS HUANG 1 244 GREAT MALL PKWY I DATE ISSUED: 03/19/2013
OWNER'S PHONE: 4084064691 I MILPITAS, CA 92683 I PHONE NO: (408 ) 934 -0730 I
❑ LICENSED CQNCTQ&S DECLARATION
License Class l J Lib. #
Contractor 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.
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. 1 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 d
with all -non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Date 7 N
❑ : 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 Cityin 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
JOB DESCRIPTION: RESIDENTIAL
REPLACE (E) FURNACE, SAME LOCATION
Sq. Ft Floor Area: I Valuation: $4000
APN Number: 36909049.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS O + T ISSUANCE OR
180 DA LAST LED INSPECTION.
Date:
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 Manageme& District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505 25533, and 25534. t
Owner or authorized agent: Date: 1.9 t
CONSTRUCTION LENDING AGENCY
I hereby affurn 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
CUPERTINO
GENERAL PERMIT APPLICATION O
MEP
COMMUNITY' DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255 (� r
(408) 777 -3228 • FAX (408) 777 -3333 • buildina( cuoertino.org M I S
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MLSCELLANEOUS
PROJECT ADDRESS
7 I
APN - 3 6 9.- d 17 _ G Y 9
/^� 'I/
OWNER NAME Vl fl J
PHONE O� . �I>�,
�f
IE -MAII
STREETADDRESS I q ✓ CMf, STATE. ZIi' . .
-��
CONTACT NAME PHONE
E -MAa,
STREET ADDRESS
CITY, STATE. ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT .CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME H 6 �^ LICENSE NUMBER I
A Plus b
LICENSE n L ,0
BUS. LIC m
COMPANY NAME 2 Milpitas, .� 95035
E -MAIL
FAX
STREET ADDRESS
CITY. STATE, ZIP
PHONE
ARCHTTECTIENGINEER NAME
f-�
LICENSE NUMBER
BUS. LIC R
COMPANY NAME '
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
k,�moyc, old
htakr,
uplage Y\([ RkYJ
-r S oumle__ o WA
TOTAL VALUATION: pQ 0 - REC Y:
By my s e ignature below, I certify to each of the following: I am the property owner or authorized agent to act on property awn s be ve rea
application and the information I have provided is correct -j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the abov idea ' ed property for inspection putposes.
Signature ofApplicanNAgeuC Date: 3 3
f1
SUPPLEMENT ORMATION REQUIRED
OFFICE USE ONLY
OVER -THE- COUNTER
G
❑ EXPRESS
V
U
❑ STANDARD
❑ LARGE
r
❑ ISIAJOR
M- PMucApp- 2011.doc revised 06121111
��a CITY OF CUPERTINO
1 Ti Ti T V QTTM A rrnP — UT Tll .TIlNC DIVISION
ech. Plan Check 0.0 hrs $0.00 Plumb, Plan Check IEee. Plan Check
Mech. Permit Fee: IA PERMIT Plumb. Permit Fee: Elec. Permit Fee:
:her Mech. Insp. 0.0 hrs. $45.00 01her Plumb Insp. Oiher Elec. Insp. Li
=ch. Imp. .1,ee: Plumb. Insp. Fee: Elec, Insp. Fee:
JOTEr This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are
ADDRESS: 19751 BIXBY DR
DATE: 03/19/2013
REVIEWED BY: MELISSA
APN: 35911041
BP #:
VALUATION:
$4,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
PENTAMATION FURN /AC
PERMIT TYPE: i
USE:
Permit .Fee:
WORK
REPLACE E FURNACE SAME LOCATION
SCOPE
PME Unit Fee:
ech. Plan Check 0.0 hrs $0.00 Plumb, Plan Check IEee. Plan Check
Mech. Permit Fee: IA PERMIT Plumb. Permit Fee: Elec. Permit Fee:
:her Mech. Insp. 0.0 hrs. $45.00 01her Plumb Insp. Oiher Elec. Insp. Li
=ch. Imp. .1,ee: Plumb. Insp. Fee: Elec, Insp. Fee:
JOTEr This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are
$266.501 $0.00
an estimate. contact tae uepr ror aaan-t. tnlo.
MISC ITEMS
FEE ITEMS (Fee Resolution 11 -053 E f 7/1/12)
FEE
QTY/FEE
Plan Check Fee.-
SUP 1)1. PC" Fee .
PME Plan Check:
$0.00
Permit .Fee:
.Suppl. Insp Fee
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
Construction :.K.. .
Administrative Fee: 1ADMW
$42.00
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Bldv Stds Commission -Fee: 1BCBSC
$1.00
$266.501 $0.00
an estimate. contact tae uepr ror aaan-t. tnlo.
MISC ITEMS
Simplified prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR- ALT -HVAC
Climate Zones 1, 3 -7
Site Address:
Enforcement Agency:
Date: Permit #:
19751 BIXBY DRIVE Cupertino, CA 95014
City of Cupertino
Mar 18, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
Indoor
9 AFUE 78%
❑ COP
❑ R 6 (CZ i 3 -5)
Served by system
® Setback
[3 Coil
0 SEER
[3 HSPF
❑ R 4.2 (CZ 6, 7)
1800 sf
If not already present, must be
❑ Condensing Unit
❑ EER
❑Resistance
installed )
❑ Other_
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R- ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 .SEER, 78% AFUE, 7.7HSPF for typical residential systems.
Contractor (I cu:ntzatado:° AuthcL -'3 / Iesponsiblu DesiSner's Declaration Statement)
i. I certify that t" is Certificate of Compliance documentation is accurate and complete.
i S am e9gihl- ,-A—r U,,ision 3 of the California Bus;ness and Drof?ssi —s Code to accept responsibility for the design identified on this Certificate of
Com ?Farce.
o I certify tha` the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 74, Parts ]. and 6 of the California Code of Regt 1 rations.
. 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 enforcement agency for approval with the permit application.
Name: Jane Ala 'Signature: Jone Alo
Company: A PLUS >` Er:ERAL CONTRA( °i ORS INC
Date: Mar 18, 2013
Address: 11330 K1\10---7 STREET Y +�
License: 763154
City /State /Zip: GARDEN GROVE / CA 192841
Phone: (714) 901 -0500
Reg: 2 "_3- ?G015A�98- 000000000 -00Cn? Reg_E=ation Date /rime: 2013/03/18 17:52:33 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010