10090052 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10149 CASS PL CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10090052
OWNER'S NAME: STUART HAMILTON 244 GREAT MALL PKWY DATE ISSUED:09/08/2010
NER'S PHONE: 4085680349 MILPITAS,CA 92683 1 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r PLUMB r
License Class C-2 V Lii,,.# 6 3 S MECH r RESIDENTIAL r COMMERCIAL r
Contractor _ �U ,�_Date (`�
JOB DESCRIPTION:REMOVE OLD FURNACE,REPLACE W/NEW IN SAME
I hereby affirm that I am licensed under the provisions of Chapter 9
LOCATION
(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 Sq.Ft Floor Area: Valuation:$5000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. DS
APN Number:35701038.00 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:
Signatures Datec l C 10
ROOFS:
U OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to anyy 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.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
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. 1 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.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. 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: Date:
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. V J
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
lnify and keep harmless the City of Cupertino against liabilities,judgments,
.,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
CITY OF CUPERTINO
4 ITEMS OF 8 PERMITRECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk:: Lot:
APN . . . . . . . . . 35' 01038 .00
DATE ISSUED. . . . . . . : 09/ 08/2010
RECEIPT #. . . . . . . . . BS(100011408
REFERENCE ID # 10090052
SITE ADDRESS 10:_49 CASS PL
SUBDIVISION . . . . . . .
CITY CUPERT I NO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STUART HAMILTON
ADDRESS . . . . . . . . . . : 10149 CASS PL
CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014
RECEIVED FROM . . . . : AP:_jUS HEATING& AIR-
CONTRACTOR . . . . . . . : ADAM P. PHAM LIC # 31293
COMPANY . . . . . . . . . . : A ?LUS HEATING & A/C
ADDRESS . . . . . . . . . . : 241 GREAT MALL PKWY
CITY/STATE/ZIP . . . : MI �PITAS, CA 92683
TELEPHONE (4)8) 934-0730
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---
1BCBSC VALUATION 5, 000. 00 1.00 0.00 1 .00 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 .00 0 .00 211 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 422 .00 #1483
---------------
TOTAL RECEIPT 422 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: I BP#: *VALUATION: 1$5,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARYSFD or Duplex 11I1 �C. PENTAMATION 1RMAP6
USE: F 00R.t r' - PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: 1 $126.001 1
Mech.Plan Check0.0 hrs $0.0077
Mech.Permit Fee: IMPERMIT I'rra�i�. Ise rnir T < ta. T�t ,•ir t.�
Other Mech.Insp. 0.0 hrs $42.00 Olh�"r Pb.=tnl; in"PLi —L— Oihcr l'-; hz,p-
Li
11"°h, Ili;`/) I cc' !'r4truiz h ;p. I ear_ I,1€c_Ifuh. FC
NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'1 info,
FEE ITEMS (Pee Resolution 09-0.51 Elf 7/1,10) FEIN; QTY/FEE MISC ITEMS
PME Plan Check: $x.00
1'c:ru2 r t I c .
Supp/, Irr.y P'(':v
PME Unit Fee: $126.00
PME Permit Fee: $42.00
C`)11swucrion 1 z
,�Icfnc,iticol Rcvicw 1=c-c-
Work Without Permit? 0 Yes (F) No $0.00
/'lcrrtrrirr,�z f c��4:
Travel Documentation Fee: 1TRAVDOC $42.00 A
.Strroilg;Vlolum 1-'cc: Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 11.00
SUBTOTALS: $211.00 $0.00 TOTAL FEE: $21-::: 1.00
Revised: 9/01/2010
as ri _top
M.Indoor Air Quality and Finishes
1.Use LovuNo-VQC Paint IAO/Health pts y=Yes D
2,Use Low VOC,Water-Based Wood Finishes 'IAQJHealth pts Y--yes. D
3.Use Low/ldo IOC Adhesives 3 IAOIHealth pts Y=Yes D
4,Use Salvaged Materials for.Interior Finishes 3 Resource pts y--yes D
5.Usti Engineered Sheet Goods with no addad Uraa
Formaldehyde 3 IAQJHealth'pts y--yes D
S.Use Exterior Grade Plywood for Interior Uses 1 IAD]Health pts y--yesD
7.Seal,ali Exposed PartielebDard or MDF 4 IAQIHEaIth pts y--yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes D
9.Use Fnger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D
10.Install Whole House Vacuum System 31AQ/Health pts y=yes D
® 1 1 1
N.Flooring
1.Select FSC Gerafied Wood Flooring E Resource pts y--yes D
2 Use Rapidly Renewable Flooring Materials Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes D
5.Use Exposed Concrete as Finished Floor i Resource pts y=yes D
6.Install Recycled Content Carpet with Low VOCs t Resource pts y=yes D
® 1 1 1
Total Points Available: 140 1301 57
Total Points Project Received: DI 0 0
6:data/prog�gre enbuild�noouidzlineslr;modalsr�loresnooin3fine12 i2o4protect�s
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/ SL BCONTRACTOR LIST
JOB ADDRESS: Q yC S P\INCE PERMIT# 16 1?60�
OWNER'S NAME: VC V-\ PHONE# . O S6 �3'9 q
GENERAL CONTRACTOR: A — V BUSINESS LICENSE# 6
ADDRESS: CITY/ZIPCODE: W\' G►
*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: Date
Si;nature
Please check applicable subcontractors and complete the following information:
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
q8 0
�wner/Contractor Signature Date
CITY OF CUPERTINO " -S Z
FURN.A.CE/AC
CUPE Of
PERMIT APPLICATION FORM
Date:
Building Address: I O I 4q
q / N/1 Ce
Owner's Name: I 1
g7ftone#:TD
Contractor: ho #: -Gl 34- 97-3-0
A pews 0VOLTI G Fax
Contractor License#: Cupertino Business License#:
Contact: Phone#: 08-934--(2-7 3
Fax #:
Building Permit In
Elect[ Plumb �. Mech [fi
Commercial LJ
Residential
Job Description: C q „/ In
ca�
r1mog old fvrnm(g, rglx e w (�/V
For Residential Installations: 2nd floor El
Attic El
1St 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 Required ❑
r
Project: Type of Construction(Usage Class):
Strapped On Platform Bonded New Location❑ Repl!!7:
Project Size: Express F-1Standard ❑ Large F] Major❑
FGreenioBuilding:
luatn:, r,.o GT C=
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