13030093 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19751 BDCBY DR CONTRACTOR:A PLUS HEATING&A/C PERMIT NO:13030093
OWNER'S NAME: CHRIS HUANG 244 GREAT MALL PKWY DATE ISSUED:03/19/2013
OWNER'S PHONE: 4084064691 MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED C CTUR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
, REPLACE(E)FURNACE,SAME LOCATION
License Class l-1 2 J 9 Lia.it=r Z
Contractor Date 13
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:$4000
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 APN Number:36909049.00 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 DAYS O + T 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 180 DA LAST LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which,may accrue against said City in consequence of the �--
antin of this permit. Additionall the applicant understands and will com 1 ed by: Date-:---
granting
ate:
�' g p Y;. aPP p Y
with all.non-point source regulations per.the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date kc 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.
13 : 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 Manageme&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,Sections 25505 25533,and 25534. t
Section 3700 of the Labor Code,for-the performance of the work for which this Owner or authorized agent: Date: 1� t
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- CONSTRUCTION LENDING AGENCY
Compensation laws of California. It after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affurn 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 Cityin 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 OMEP
COMMUNITY'DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950143255 r
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinaCE.cuoerTino.org �1\
❑PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MLSCELLANEOUS
PROJECT ADDRESS I q 7 I "N- 36q- - d 17 _ v Y 9
,) N Pr -
OWNER NAME Vl f l PHONE 08. 1 �, I E-MAII
jjSTREET ADDRESS I q�I✓ I i3 y CICY.STATE.Zg' �f� -
CONTACT NAME I o PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT .CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPE? ❑TENANT
CONTRACTOR NAMEH 6 �^ LICENSE NUMBER I LICENSE n 10 BUS.LIC m
A Plus
COMPANY NAME 244 Milpitas,CA 95035
b E-MAIL L FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC R
COMPANY NAME' f-� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
Umoyc, old htakr, uplage Y\([ RkYJ
-r S oumle__ o ` WA
TOTAL VALUATION: pQ 0 - REC Y:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e propertyawn 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 of ApplicanNAgeuC f1 Date:
SUPPLEMENT ORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
G
❑ EXPRESS
v
�' ❑ STANDARD
U
❑ LARGE
❑ ISIAJOR
MI PMucApp-2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19751 BIXBY DRDATE: 03/19/2013 REVIEWED BY: MELISSA
APN: 35911041 BP#: *VALUATION: 1$4,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: i
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elee.Plan ChecA
Mech.Permit Fee: IA PERMIT Plumb.Permil I-ee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Oiher Plumb Inst. Li 01her Elec.Insp.
Allech.Insp.Fee: Plumb. Insp.Fee: Elec,Insp.Fee:
NOTE: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 prelimina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee.
Suppl. PC"Fee.
PME Plan Check: $0.00
Permit.Fee:
.Supp/.Insp Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Co nsiruction Tax:
Administrative Fee: 1ADMW $42.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $45.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item .
Bldg Stds CommissionFee: 1BCBSC $1.00
$266.50 $0.00 $266.50
Revised: 01/01/2013
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 Typel List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
®Furnace 9 AFUE 78% ❑COP ❑R 6(CZ i 3-5) Served by system ®Setback
[3 Indoor Coil 0 SEER [3HSPF If not already present, must be
❑Condensing Unit ❑R 4.2 (CZ 6, 7) 1800 sf installed
❑EER ❑Resistance )
❑Other_
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Eauipment Efficiencies:13.SEER, 78%AFUE, 7.7HSPF for typical residential systems.
Contractor(Icu:ntzatado:-t AuthcL-'s/Iesponsiblu DesiSner's Declaration Statement)
i .I certify that t"is Certificate of Compliance documentation is accurate and complete.
i r am e9gihl-,-A—r U,,ision 3 of the California Bus;ness and DrofPssi—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 Regi 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 U,'.'ERAL CONTRAC—ORS INC Date: Mar 18, 2013
Address: 11330 K1\10---7 STREET Y+� License: 763154
City/State/Zip: GARDENGROVE/CA 192841 Phone: (714)901-0500
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Reg: 2"_3-?GO'S4 8a 000000000-001? Reg_sLratio Date/rime: 2013/03/18 17:52:33 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010