10060009CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10140 N BLANEY AVE
CONTRACTOR: A PLUS HEATING & A/C
PERMIT NO: 10060009
OWNER'S NAME: JIM & PATRICIA MCAFEE
244 GREAT MALL PKWY
DATE ISSUED: 06/02/2010
-"WNER'S PHONE: 4084460160
MILPITAS, CA 92683
PHONE NO: (408) 934-0730
LICENSED CONTRAC OR'S DECLARATION TION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class / Lic. # J J
FEMOVE & REPLACE OLD FURNACE, ADD A/C
%
Contractor Date
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
Sc. Ft Floor Area:
Valuation: $8500
performance of the work for which this permit is issued.
1 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
permit is issued.
APN Number: 31621074.00
Occupancy Type:
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 OF PERMIT 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless e City of Cupertino against liabilities, judgments,
costs, and expense which m# ccrue against said City in consequence of the
granting a it. Addi ally, the applicant understands and will comply
Is sued by: Date:
with all n n-p nt I ions per the Cupertino Municipal Code, Section
9.18. t'
RE-ROOFS:
Signature Date
Al I roofs shall be inspected prior to any roofing material being installed. If a roof is
in: talled without first obtaining an inspection, I agree to remove all new materials for
in: pection.
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
1, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I I ave read the hazardous materials requirements under Chapter 6.95 of the
CF lifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
mountain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Ht alth & 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
mo terial. Additionally, should I use equip nt or a ices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
aii contaminants as defined by A a Air lity Management District I
performance of the work for which this permit is issued.
wi.1 maintain compliance wit the C e in n' ipal Code, Chapter 9.12 and
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
tho! Health & Safety Code, Se ti s2 0 3 and 25534.
/
permit is issued.
Owner or authorized agent: 4 Date:
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I h;reby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
we rk's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
Is, and expenses which may accrue against said City in consequence of the
I u iderstand my plans shall be used as public records.
,iting 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
d___
CITY OF CU?ERTINO
5 ITEMS OF 5 PERMIT R3CEIPT
Sec: Twp: Rng: Sub: Blk: -jot:
APN ........: 31621D74.00
DATE ISSUED.......: 06/02/2010
RECEIPT #.........: BS000D10539
REFERENCE ID # ...: 10060DO9
SITE ADDRESS .....: 10140 N BLANEY AVE
SUBDIVISION ......
CITY .............. CUPERPINO
IMPACT AREA ......
OPERATOR: SylviaM
COPY # : 1
OWNER ............: JIM & PATRICIA MCAFEE
ADDRESS ..........: 10140 N BLANEY AVE
CITY/STATE/ZIP ...: CUPERPINO CA, CA 95014-2330
RECEIVED FROM ....: A PLU,3 HEATING
CONTRACTOR .......: ADAM ?. PHAM LIC # 31293
COMPANY ..........: A PLUS HEATING & A/C
ADDRESS ..........: 244 G:2EAT MALL PKWY
CITY/STATE/ZIP ...: MILPITAS, CA 92683
TELEPHONE ........: (408) 934-0730
FEE ID
UNIT
QUANTITY
AMO'JNT
PD -TO -DT
THIS REC
NEW BAL
----------
1BCBSC
-------------
VALUATION
----------
8,500.00
----------
1.00
----------
0.00
----------
1.00
----------
0.00
1BREMAIRHA
NO.UNITS
1.00
63.00
0.00
63.00
0.00
1BSEISMICR
VALUATION
8,500.00
0.90
0.00
0.90
0.00
1MFR=<100
UNITS
1.00
L26.00
0.00
126.00
0.00
1MPERMITFE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
TOTAL PERMIT
----------
;232.90
----------
0.00
----------
232.90
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
232.90
---------------
232.90
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
REFERENCE NUMBER
--------------------
1:363
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
CITY OF
CUPEkTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
/030o Torre &e
777-300
mwwolll,
APN # r4, C)U
Date: 2 _ 0
Building Address: to w IV.Q/a,�N A(e-
Owner's Name: Jim
�- 81iG Q A ^C 4)ctv,
Phone #: (406) 44,0 _ O / (a O
Contractor:
Phone 0 TV
P/M 1��G
Fax #: (408) q34-0
Contractor License #:
Cupertino Business License #:
71v 3/5V
31 C7? -C/ 3
Contact:
Phone #: (*6)q -0730
vv /
ggrrl (� l pl'lai%'�"
Fax
Building Permit Info:
Elect Q-- Plumb ❑-� Mech
Residential R Commercial ❑
ob Description:
Vfflo e, lace w1n-ew f wme i� see �o�aH017. �
ololprove and �P �
For Residential Installations:
Attic ❑ l st floor 2°d 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):
Strapped ❑ On Platform Bonded New Location Replacement
Project Size: Express 0/Standard 0 Large ❑ Major ❑
Valuation:
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
CUPEkTINO
CITY OF CUPERTINO
FURNACT AC
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1 MRAPPVNT
Residential for the i -istall/relocate/ or
replacement of ea appliance vent
install & not incl in an appl permit.
M
FURNACE
FURN/AC
1PGASRES
Residential for ea gas piping system of
1-4 Outlets
P
1BPGAS
For each gas piping system of 5 or
more per outlet.
P
1
1BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICR
Residential Seismic
B
1 MECPLNCK
Mechanical Plan Cl- eck
M
/
1MFR=<100
Furnace Syst <=10Ck BTU install or
relocate ea forced-ax/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btilh
M
1MFRN>100
Furnace Syst > 1001: BTU install or
relocate ea forced- ax/gravity type
furnace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
M
1 EPERMITFEE
Electric Permit Fee
E
1MPERMITFEE
Mechanical Permit ' ee
M
1 PPERMITFEE
Plumbing Permit
P
1 TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
CITY OF
CUPEkTINO
CITY OF CU.PERTIlNO
FURNACE/AC
FEE SCHI',DULE
Quantity
Fee ID
Fee Description
Fee
Grout)
Permit Type
FURN/AC
AIR
CONDITIONING
1BCAIRHAN
Commercial A/C Units <= IOk CFM
B
1 MCRAA
Commercial Mech Repair/alt/add
M
1 BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
1 BSEISMICO
Seismic Commercial
B
1PGASCOM
Commerical for ea ga3 piping System
1-4 outlets
P
1 PGASRES
Residential for ea gas piping system
of 1-4 Outlets
P
1BPGAS
For each gas piping system of -5or
more per outlet. Comin/Resid
P
1
1 BREMAIRHAN
Residential A/C units <= 1 Ok CFM
B
1MRRAA
Residential Mech Repair/alt/add
M
1 BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
1 BSEISMICR
Seismic Residential
B
1 EPERMITFEE
Electric Permit
E
1 MPERMITFEE
Mechanical Permit
M
1PPERMITFEE
Plumbing Permit
p
1 TRAVDOC
Travel Documentation
B
1 BUSLIC
Business License
B
,.,. ,,,v -W. A„ �Ua.,.y a.JU I uuaijca
1. Use Low/No-VOC Paint
1 IAQ/ilealth pts
y=yes
2. Use Rapidly Reneivable Flooring Materials
4 ReSOLMe pts
2. Use Low VOC, Water -Based Wood Finishes
2 A&iealth pts
y=yes
y=yes
3. Use Low.No VOC Adhesives
is
3 IAQ/liealthY=Y
P
es
5. Use Exposed Concrete as Finished Floor
4. Use Salvaoed Materials for Interior Finishes
3 Resc urce pts
y=yes
.0
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
61AQ/Health is
P
Y=Y es
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/liealth pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ/liealth pts
y=yes
8. Use FSC Certified Materials for Iniedor Finish
4 Resc urce pts
y=yes
0
9. Use Finger -Jointed or Recycled -Content Trim
1 Resc urce pts
y=yes
0
10. Install Whole House Vacuum System
3 IADHealth pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2. Use Rapidly Reneivable Flooring Materials
4 ReSOLMe pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural LinDIeUrn in Place of Vinyl
5 IAQ/health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available: 00j 4Q
Total Points Project Received: QI
k
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