10050192 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22063 BAXLEY CT CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10050192
OWNER'S NAME: ANTHONY RODRIGUES 241 GREAT MALL PKWY DATE ISSUED:05/26/2010
,WNER'S PHONE: 4082191310 M LPITAS,CA 92683 PHONE NO:(408)934-0730
LICENSED CONTRACTOR'S DECLARATION JC,B DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class 0 Lie.# qGS IS g REPLACE FURNACE IN SAME LOCATION,AND ATTIC
REPLACE A/C UNIT
Contractor t ) S Date 5;1-2 61 0
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:$12500
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:35606024.00 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 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 the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Is:cued by� Date: Z
with all non-point source regulations per the Cupertino Municipal Code,Section _
9.18.
26 RE-ROOFS:
Signature Date Al'I roofs shall be inspected prior to any roofing material being installed.If a roof is
in:tailed without first obtaining an inspection,I agree to remove all new materials for
in:pection.
I7 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 I ave read the hazardous materials requirements under Chapter 6.95 of the
Cs lifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Management 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 th>Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this t
permit is issued.
Owner or authorized agent Date: 2Io 1 O
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 hereby affirm 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.)
Lc nder's Name
APPLICANT CERTIFICATION Lc nder'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
^,)n the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
�s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
P ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Li sensed Professional
9.18.
Signature Date
CITY OF C-UPERTINO
FURNACT AC
UPEkTINO PERMIrr APPLICATION FORM
Iob56 ( q2
APN # v Date:
Building Address:
7
Owner's Name: Afton n�,� v" Phone#:
K•v
03
Contractor/ ¢ Phone#: (406) 931. - 0 7327
rf P't44 Wa Hn j �f IC, Fax#: ) -473`
�t� �'l T
Contractor License #: Cupertino Business License M
7103 ( /gg 3
Contact: p Phone#: (4063) 3 –07eO
�I�� r h � Fax #: B q3 - 10 73
Building Pen-nit Info:
Elect [.- Plumb �� Mech
Residential Commercial ❑
Job Description: _ /�„ n PA _ --sQ&,Q 16�
FA-U i -/-Le A-f��
For Residential Installations:
Attic ❑✓ 1" 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 Constn.ction (Usage Class):
-R 1 a 5-6-0 k .
Strapped ❑ On Platform Kl— Bonded E New Location Replacement
Project Size: Express Standard ❑ 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 CUPERTINO
FURNACE/AC
-UPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
FURNACE FURN/AC
IPGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
funiace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btn/h
1MFRN>100 Furnace Syst > 100 c BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Pen-nit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentaton B
1BUSLIC Business License B
CITY OF CUPERTINO
FURNAC-E/AC
CM OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= IOk CFM B
1MCRAA Commercial Mech Repair/alt/add M
/ 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
1 TYPES
1 1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comr-i/Resid
/ 1BREMAIRHAN Residential A/C units <= 1 O CFM B
r 1MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
IEPERMITFEE Electric Permit E
IMPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)'` L-1 2 points
11. Permeable Paving, (Note) L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, (detail) S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A•1 1 point
,..:' TOTAL POINT:; 40 points
Plan Review Process Work Book Page-12-Revised 3/25/08
1NMI
M.Indoor Air Quality and Finishes
1.Use Low,No-VOC Paint 1 IAQ'Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ'HEalth pts y=yes p
3.Lite Low.1iJo VOC Adhesives 3 IAQ Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Res Durce pts y=yes p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ'Health'pts y=yas p
S.Use Exterior Grade Plywood for Interior Uses 1 IAQ'Health pts y=yes p
7.Seal all E=xposed Particleboard or MDF 4 IAQ'Health. pts y=yes p
B.Use FSC Certified Materials for Interior Finish 4 ResDurce pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim i Res)urce pts y-yes p
10.Install Whole House Vacuum System 3 IAC/Health pts y-yes p
N.Fiaoring
1.Select FSC Cerified WDDd Flooring B Reso irce pts y=yes p
2.Use Rapidly Renewable Flooring Materials 4 Re501rce pts y=yes p
3.Use Recycled Content Ceramic Tiles 4 ReSo Jrce pts y—yes p
4. Install Natural Linoleum in Place of Vinyl 5 IAOIHealth pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y=yes p
6. Install Recycled Content Carpet with Low VOCs 4 Reso irce pts y=yes p
6 � �
Total Points Available: 1401 130 571
Total Points Project Received:
G:data/prrogslgreenbulldingcguidelines/remodelarslgreenpointsfinal2 i2.04proteotedxls
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RHCEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: ],ot:
APN . . . . . . . . : 35606024 . 00
DATE ISSUED. . . . . . . : 05/26,12010
RECEIPT # . . . . . . . . . BS000010489
REFERENCE ID # . . . : 10050/92
SITE ADDRESS . . . . . : 22063 BAXLEY CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER ANTH014Y RODRIGUES
ADDRESS 22063 BAXLEY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4744
RECEIVED FROM . . . . : A PLUS HEATING
CONTRACTOR . . . . . . . : ADAM ?. PHAM LIC # 31293
COMPANY A PLUS HEATING & A/C
ADDRESS 244 G.ZEAT MALL PKWY
CITY/STATE/ZIP . . . : MILPIrAS, CA 92683
TELEPHONE . . . . . . . . : (408) 934-0730
FEE ID UNIT QUANTITY AMOJNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 12, 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 12, 500 . 00 1.30 0 . 00 1 . 30 0 . 00
1MFR=<100 UNITS 2 . 00 252 . 00 0 . 00 252 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 359 .30 0 .00 359 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 359.30 1350
---------------
TOTAL RECEIPT 359 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Community Development
31 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
,UPEkTINO
Buildin r Department
JOB ADDRESS: PERMIT #
2.9-0(03 /�b1 2
OWNER'S NAME: AnMo figap,9 PHONE # -/
GENERAL CONTRACTOR: Plus FAX # 0 73
I am not using any subcontractors: 1),- ti 2
Si a`_vre Date
Please check applicable subcontractors and com let? 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
4RWk---,
Z�f
Owner/Contractor Signature Date