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10090051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22753 VOSS AVE CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10090051 OWNER'S NAME: JAMES&CLAUDETTE PRETTYLEAF 244 GREAT MALL PKWY DATE ISSUED:09/08/2010 NER'S PHONE: 4089731794 MILPITAS,CA 92683 PHONE NO:(408)934-0730 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB r License Class /C'z J Lic. MECH r RESIDENTIAL r COMMERCIAL F Contractor A — �� Date qV O 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:$4800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. D`5�j APN Number:34230034.00 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: t Date: '_ =( o * J Signature Date 1 ❑ 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. 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. 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. 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,l Q}vner or uthorized agent: //�� C� O become subject to the Worker's Compensation provisions of the Labor Code,I must Date: `C O 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 nn the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, ,s,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 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN 3430034 .00 DATE ISSUED. . . . . . . : 09/ 08/2010 RECEIPT #. . . . . . . . . BS(100011408 REFERENCE ID # . . . : 10090051 SITE ADDRESS . . . . . : 22"53 VOSS AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JA14ES & CLAUDETTE PRETTYLEAF ADDRESS 22'153 VOSS AVE CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014 RECEIVED FROM . . . . : AP:JUS HEATING& AIR- CONTRACTOR AD.kM P. PRAM LIC # 31293 COMPANY A ?LUS HEATING & A/C ADDRESS . . . . . . . . . . : 241 GREAT MALL PKWY CITY/STATE/ZIP MILPITAS, CA 92683 TELEPHONE (438) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ------- 1BCBSC VALUATION 4, 800. 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 -----4200 ------0_00 ---------- ---------- TOTAL PERMIT 211 .00 0 .00 211. 00 0 .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: DATE: REVIEWED BY: its I APN: BP#: EVALUATION: 1$4,800 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYr�[,il: PENTAMATION 1RMAP6 USE: SFD or Duplex 1•Z_COt 4 11 t:1: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.001 1 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT i" Pt o;d Other Mech.Insp. 0.0 hrs $42.00 �� , r.P,� f 'r ty,-� 3u�=�� f �t�3,� Li NOTE: Theseees are based on the preliminary in ormation available and are onl o. an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-OSI Elf. T"1/10) FEE QTY/FEE MISC ITEMS P/al! C hecA Fc'e: stfpp[ PC Fee PME Plan Check: $3.00 1'ennit Fcc.- Srpp/. hrsp Fce PME Unit Fee: $126.00 PME Permit Fee: $42.00 F7= Ci�ns7rrretivn T�r:� "1cotlsticed 1?cvit'1 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $2.2.00 S`t,nrry9oti��rr F °c�; Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC 91.00 SUBTOTALS: $211.00 $0.00 TOTAL FEE: $211.00 Revised: 9/01/2010 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: PERMIT OWNER'S NAME: a\vy"Q5 NE 0' GENERAL CONTRACTOR: —Q V S BUSINESS LICENSE# 7(�` y ADDRESS: ,�� K-c'`'�( CITY/ZIPCODE: -, .k�k5 *Our municipal code requires all businesses working in the city to have a City of Cupertino Ausiness 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 Signature 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 ( CJ ner/Contractor Signature Date �. na M.Indoor Air Quality and Finishes 1.Use Low/No-VOG Pah I AQIHealth pts Y--yes 0 P.Use Low VOC,Water-Based Wood Finishes 2.ADJHealth pts y=yes 3.Lite Low/No VOC Adfiesn*es 3 iAQ/Health pts y=yes 4.Use Salvaoed Materials for Interior Finishes 3 Resource pts y--yes 5.Use Engineered Sheet Goods with no added Uraa Formaldehyde 6 IAC?JHealth*pts y--yes 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ Hsalth pi, y=yes 7.Seal.aH E)Wsed.Parcl2toard or 44D 4 IAQ(Health pts Y--yes 0 B.Use FSC Certified Materials for Interior Finish Resource pts Y--yes 0 9.Use Fnaer-Jointed or Recycled-Content Trim Resource pts Y--yes 0 10.Install Whole House Vacuum System 3 IAQMe.Edth pts y--yesr N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Ranewable Flooring Materials 4 Resource pts Y=YBsl 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4.Install Natural Linoleum in Place of Vinyl 1 IAQ/Health pts y--yes 01 5.Use Exposed Concrete as Finished Floor 4 Resource pts yeses 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: X40 130 57 Total Points fro ect Recave�: 01 0 0 Cit � Iip 1 G:data/progslgre:nbuildnoguidelinaslremodelarlgreenpdintAnal212D4protac ad x s CITY OF CUPERTINO FURNACE/AC CUPS OF PERMIT APPLICATION FORM APN # Date:U o� v :!� 4 Building Address:n n .-7e� VOSS Ili al I 0 a Owner's Name- Phon n ins � n� �y�� {-� �I,-/i 1� Contractor: V U11G l•/I�IM�� 1 vU Phone#: 4 p6, A HCAil rl Fax#: 4o&- q�I� Contractor License#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect�J Plumb ❑'� Mech [ Residential Commercial Job Description: aCn �/ � � n S��M � I a �n �� Y� old r ACP, pyt e ( ► l�. S/,� , remo � For Residential Installations: 2nd floor ❑ Attic ❑ 1St floor [] Adhere to minimum setback requirement ❑ For Commercial Installations: Additional weight(structural calcs) Replacement same weight ❑ ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of construction(Usage Class): Strapped On Platform Bonled New Location❑ Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuat* n: �o 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. -7 Revised 01/07/09