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11090113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21876 WILSON CT CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 11090113 OWNER'S NAME: VENKATRAMANAN SATHYAMANGALAM 244 GREAT MALL PKWY DATE ISSUED:09/19/2011 OWNER'S PHONE: 4083669862 MILPITAS,CA 92683 PHONE NO:(408)934-0730 La. LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 7631 5 tA (� V MECH r– RESIDENTIALCOMMERCIAL � Contractor A - C I S Date at/(Cliff `a ( I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE OLD FURNACE,REPLACE WITH NEW IN SAME (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION AND ADD ONE(1)NEW DUCT 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 Floor Area: Valuation:$4500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32649020.00 Occupancy Type: 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 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. Date: Signature Date _I ' OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I 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) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I 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(a)should I store or handle hazardous material. Section 3700 of the 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 Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: Q a forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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, ,sts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION sting of this permit.Additionally,the applicant understands and will comply .ith 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32649020 . 00 DATE ISSUED. . . . . . . : 09/19/2011 RECEIPT #. . . . . . . . . : BS000014790 REFERENCE ID # . . . : 11090113 SITE ADDRESS . . . . . : 21876 WILSON CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VENKATRAMANAN SATHYAMANGALAM ADDRESS . . . . . . . . . . : 21876 WILSON CT 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 4, 500 .00 1. 00 0. 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4, 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 #1966 --------------- 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: 21876 wilson ct. DATE: 09/19/2011 REVIEWED BY: bobs. APN: BP#: .VALUATION: 1$4,500 y°PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: woRK remove existing furnace with new add one new duct. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: 1 $130.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT F , Other Mech.Insp. 0.0 hrs $44.00 _j NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resohition 11-053 Ejf. 1,`I 1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 F7 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? Q Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item L Bidi,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE-T $260.50 Revised: 09/02/2011 GENERAL PERMIT APPLICATION rftMEV COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 'Is C CUPERTtPVO (408)777-3228 • FAX (408)777-3333• building c(.cugetno.org IBING ❑. ,-�MCAL RICAL ❑ESCELLANEOUS PROJECT ADDRESS S 0 n �N D OWNER NAME <r Q � Ka na,n�,��,-, PHONE �I/1e. /�/�p�/7 E-MAIL STREET ADDRESS 71 W/1(dor f CITY, STATE,ZIP Per*r7O, FAX CONTACT NAME D n '�� -/ 8/y y�-�nr PHONE I!rP(3-q3 407-3 -M� D STREET ADRESSLi STAIM,�ZIP/V FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑-.7GINEER ❑ DEVELOPER ❑ TENANT CONTR-CTOR NAME LICENSE NUMBER a/ LICINSE_TY� BUs.,!12—q COMPANY NAME Air onditioning, Inc. E-MAIL In ge /us � 1 F 6-g34_0�3 W2644 Great MS11PBrkyay STREET ADDRESS CITY,STATE.ZIP PHO 46- -0730ARCHTI'ECT/ENGINEER NAMEHpilas �� LICENSE NUMBER BUS.LJC -T COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP I PHONE USE OF 17 015-,r DUPLEX ❑ MULTI-FAbIILY PROJECT IN WILDL.AND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE ARE- ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK f6ff to TOTAL VALUATION:IWO I RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have 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 relating 'uilding ns c' n` epreseatatives of Cupertino to enter the above-i entifigd property for inspection pu{poses. Signature of ApplicandAgent: Date: jqj SUPPLEI'VENTAL 2#RMAT70N REQU=D OFFICE USE ONLY -OV-ER-THE-COUNTER c ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR NIEPMI.scApp_2011.doc revised 06121/11 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 1,3-7 Site Address: Enforcement Agency: Date: Permit#: 21876 Wilson Court Cupertino, CA 95014 City of Cupertino Sep 19, 2011 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat Package Unit ivll Furnace 78%o ❑COP R 6(CZ 1 3-5) Served by system 0 Setback D AFUE _]Indoor Coil C]SEER ❑HSPF If not already present, must F1 Condensing Unit El EER El Resistance R 4.2 (CZ 6, 7) 2000 sf be installed) IR Other <= 40' Ducts 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(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 Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. .I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. .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 Alo Signature: Jane Ala Company: A PLUS GENERAL CONTRACTORS INC Date: Sep 19, 2011 Address: 11330 KNOTT STREET License: 763154 City/State/Zip: GARDEN GROVE/ CA/92841 Phone: (714) 901-0500 Reg: 211-A0048435A-00000000-0000 Registration Date/Time: 2011/09/19 11:24:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Building Department City Of Cupertino 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: Wl` T PERMIT# &0 OWNER'S NAME: S. .e 1LQ MXM1rkPHONE# 4 6 — qg GENERAL CONTRACTOR: A-, P1 v$- BUSINESS LICENSE# -7 6 3 S ADDRESS: 2AA 4 drMA-V-, N Plc-� CITY/ZIPCODE: Lt S O a *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: Signature Date Please check applicable subcontractors and complete the following information: V 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