11050148 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7940 FALL CT CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 11050148
OWNER'S NAME: HAGAN JAMES R AND LINDA J TRUS 244 GREAT MALL PKWY DATE ISSUED:05/19/2011
n«NER'S PHONE: 4082555879 MILPITAS,CA 92683 PHONE NO:(408)934-0730
L LICENSED CONTRACTOR'S
DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT PLUMB r
License Class C.— �-V Lic.# '] S b 1 'LJ
/� 11 MECH RESIDENTIAL COMMERCIAL
Contractor /—� — l V Date "t
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FORCED AIR FURNACE AT 1 ST
(commencing with Section 7000)of Division 3 of the Business&Professions FLOOR
Code and that my license is in full force and effect. LOCATION,REPLACE EXISTING DUCT WORK
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 Sq.Ft Floor Area: Valuation:$4500
permit is issued.
APPLICANT CERTIFICATION APN Number:36213006.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature " Date � ( � Issued by: Dat,
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,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
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owne r authori d agent: '
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
UAPPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of cork's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c- ', and expenses which may accrue against said City in consequence of the
ag of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
w:�..all non-point source regulations per the Cupertino Municipal Code,Section
9.18• I understand my plans shall be used as public records.
Signature Date Licensed Professional
j t C)
CITY OFF
CITY OF CUPERTINO
FURNACE/AC
CUP RTI!' O PERMIT APPLICATION FORM
APN# it !� c Date: 5/tq l'
Building Address: I-q q V Faj( A v r, �
Owner's Name: j..., if U 1 ;nCta `(-r/ 0 Phone
- -
Contractor: Phone#: #06_pg34--073-0
k PIVS Fax#: 406-q,3 -0 73
Contractor License#: Cupertino Business License#:
7W5 154 319-67 3
Contact: W Phone#:
408-q-34 _0'7
��-ro�g a,v�
Fax #:
Building Perm/it Info:
Elect Plumb [�/ Mech
Residential Commercial
Job Description:
remove t rope acre fumotce (n &OMO- 1 O C� ft an- 1�2w d Uc-F s
For Residential Installations:
Attic ❑ 1 st floor 2nd floor ❑
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 Re uired ❑
Cost of Project: Type of Construction(Usage Class):
Ulm
Strapped 0 On Platform El Bonded New Location❑ Replacement
Project Size: Express ❑ Standard ❑ Lar e ❑ Major❑ �Gcve�
Valuation: +two
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7940 fall court DATE: 05/19/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$4,500
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK remove and re alce forced air furnace at 1st floor location replace existing duct work.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: $126.00
Mech.Plan Check 0.0 1 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs 1 $42.00 Li Li I
NOTE: Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (l ee Resolution 09-051 1 ff 7/b"10) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $126.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00 A
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50
Revised: 04/29/2011
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36213006. 00
DATE ISSUED. . . . . . . : 05/19/2011
RECEIPT #. . . . . . . . . : BS000013492
REFERENCE ID # . . . : 11050148
SITE ADDRESS . . . . . : 7940 FALL CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER HAGAN JAMES R AND LINDA J TRUS
ADDRESS . . . . . . . . . . : 7940 FALL CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4114
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
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. 00 126. 00 0. 00 126 .00 0. 00
1MPERMITFE FLAT RATE 1. 00 42. 00 0. 00 42 .00 0. 00
1TRAVDOC FLAT RATE 1.00 42 . 00 0. 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 211.50 0 . 00 211 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 211. 50 #1838
---------------
TOTAL RECEIPT 211.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-IR-ALT-HVAC
Alterations
Climate Zones 1,3-7
Site Address: Enforcement Agency: Date: Permit#:
7940 Fall Court Cupertino, CA 95014 City of Cupertino May 19, 2011
Duct insulation Conditioned Floor
Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat
Li Package Unit
�Furnace �d AFUE 78% LJ COP p Setback
,71 Indoor Coil :1 SEER ❑HSPF 0 R 6(CZ 1, 3-5) Served by system If not already present,
Lj Condensing Unit `71 EER ❑Resistance R 4.2 (CZ 6, 7) 1800 sf must be installed)
E6 Other Z 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 Alo
Company: A PLUS GENERAL CONTRACTORS INC Date: May 19, 2011
Address: 11330 KNOTT STREET License: 763154
City/State/Zip: GARDEN GROVE/CA/92841 Phone: (714) 901-0500
Reg: 211-A0024164A-00000000-0000 Registration Date/Time: 2011/05/19 11:20:00 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
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# C
OWNER'S NAME: Q,/h (,� a,/L PHONE# 10f3 -ar2-57
GENERAL CONTRACTOR: A 1plas BUSINESS LICENSE#
ADDRESS: all AMy MITViu CITY/ZIPCODE:
*Our municipal code requires all businessYs 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: S p
rplgete
ature ate
Please check applicable subcontractors and 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