10070177 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22753 VOSS AVE CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10070177
OWNER'S NAME: CHIARA VANLA 244 GREAT MALL PKWY DATE ISSUED:07/27/2010
1ER'S PHONE: 4089731887 MILPITAS,CA 92683 PHONE NO:(408)934-0730
19( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB
License Class V Lic.# t J
MECH r- RESIDENTIAL r- COMMERCIAL
Contractor A — ? ,y S Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UNIT B-RMV OLD FORCED AIR FURNACE&REPLACE
(commencing with Section 7000)of Division 3 of the Business&Professions W/NEW
Code and that my license is in full force and effect. FORCED AIR FURNACE IN SAME LOCATION&ADD A/C
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:$8000
permit is issued. D-SO
APPLICANT CERTIFICATION APN Number:34230034.00 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
Z-1 Issued b*------ Date: i
Date
❑ 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:
I,as owner of the property,am exclusively contracting with licensed contractors to
constrict 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: HAZARDOUS MATERIALS DISCLOSURE
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 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. I 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 Owner or autl ized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: 27
APPLICANT 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 work'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
i lily 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
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$8,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY 7t ! ill' APPLICATION 1 RMAP6
SFD or Duplex
USE: p � TYPE:
xW
as
p0
3 �
APPLIANCE/EQUIP TYPE CAPACITY FE E ID QTY BP FEES
Furnace, Forced-Air 1 MFF=<100 1 $126
A/C Units (<=10K cfm) 1BRE_MAIR 1 $63
TOTALS: $189.00
Mech.Plan Check 0.0 1 hrs $0.00
Mech.Permit Fee: IMPERMIT _. .
Other Mech.Insp. 0.0 1 hrs 1 $42.00
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 09-051 Eff' 7,1/09) FEE QTY/FEE MISC ITEMS
f.:l'e,° ( Fit'
PME Plan Check: $0.00
t': qI it
PME Unit Fee: $189.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (D No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
BldU Stds Commission Pee: IBCBSC $1.00
SUBTOTALS: $274.00 $0.00 TOTAL FEE: $274.00
Revised: 7/22/2010
CITY OF CUPERTINO
5 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN . . . . . . . . : 3430034 . 00
DATE ISSUED. . . . . . . : 0727/2010
RECEIPT #. . . . . . . . . : BSC00010976
REFERENCE ID # . . . : 1OC70177
SITE ADDRESS . . . . . : 22' 53 VOSS AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CH]ARA VANLA
ADDRESS . . . . . . . . . . : 22' 53 VOSS AVE UNIT B
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : APLUS HEATING& AIR-
CONTRACTOR . . . . . . . : AD124 P. PHAM LIC # 31293
COMPANY . . . . . . . . . . : A PLUS HEATING & A/C
ADDRESS . . . . . . . . . . : 244 GREAT MALL PKWY
CITY/STATE/ZIP . . . : MIIPITAS, CA 92683
TELEPHONE . . . . . . . . : (4C8) 934-0730
FEE ID UNIT QUANTITY 7,MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 8, 000 . 00 1 .00 0 . 00 1 . 00 0 .00
1BREMAIRHA NO.UNITS 1 . 00 63 .00 0 . 00 63 . 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 274 . 00 0. 00 274 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 485. 00 #1435
---------------
TOTAL RECEIPT 485 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
y FURrJACE/AC
CUPEkT1NO PERMIT APPLICATION FORM
APN # Date:
CJ 5 q , -- /0
Building Address 153 V A n 5
Owner's Name:
c r_;n 0— VaAta-
Phone#•q06 , 7,3
Contractor: n Phone#: fv_j3q r-0 73-C-)
A PI�S Fax#: -9- 73y:
Contractor License#: Cupertino Business License#:
-V 577
Contact: Phone#: — —O7-3D
p"Id Fax #: 073
Building Permit Info:
Elect d Plumb Er---
Mech
Residential -0 Commercial ❑
Job Description: J
kAMOWD el 101? 41wd �v- I ram X"04• lVd
For Residential Installations:
Attic ❑ 1St 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 Required ❑
Cost of Project: Type of Construction (Usage Class):
L 0
Strapped On Platform �- Bonded New Location Replacement
Project Size: Express ❑ Standard ❑ Large [:] Major❑
Valuation: 16000
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
M.Indoor Air Quality and Finishes
1.Use LowlNo-VOC Paint 1 IAQIHealth pts y=yes7
p
2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHeaJth pts y=yes p
3.Use Low/No VOC Adhesives 3 IAO/Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes -p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ/Health'pts y=yas
p
p
S.Use Exterior Grade Plywood for Interior Uses 1 IAQ/HeaJth pts y=yes
7.Seal all Exposed Paracieboard or MDF 41AQ/Health pts y--yes p
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes p
10.Install Whole House Vacuum System 3 lAQ/Hea1th pts y=yes p
1 1 1
H.Flooring
1.Select FSC Certified Wood Flooring B Resource pts Y--yes p
2 Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes p
4.Install Natural Linoleum in Place of Vinyl 5[AO/Health pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes p
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes p
1 1 1
Total Points Available: 1401__ n-01 57
Total Points Protect Received: 01 OF-70
Wr 7/271,0
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