Loading...
10020089 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 20805 GREENLEAF DR CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10020089 OWNER'S NAME: LEON HAYES 244 GREAT MALL PKWY DATE ISSUED:02/16/2010 NER'S PHONE: 4082523573 MILPITAS,CA 92683 PHONE NO:(408)934-0730 ©— LICENSED CONTRACTOR'S DECLARATION ^ /' ~_ �/ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 2 V� Lic.# �b �� J i r— I— I— / / MECH RESIDENTIAL COMMERCIAL Contractor Date Z-14-!0 JOB DESCRIPTION:HVAC,CHANGE OUT EQUIPMENT&DUCT(FURNACE& I hereby affirm that I am licensed under the provisions of Chapter 9 A/C) (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:$4500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32609004.00 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 M 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. r' Issued by: U _ / v Date: Signature �— Date 2 U U 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. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct 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 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(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 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 zed a 2- become subject to the Worker's Compensation provisions of the Labor Code,I mu:t Date: 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 relatin; 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 mnify 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 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609004 . 00 DATE ISSUED. . . . . . . : 02/16/2010 RECEIPT #. . . . . . . . . BS000009756 REFERENCE ID # . . . : 1CO20089 SITE ADDRESS 2C805 GREENLEAF DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LEON HAYES ADDRESS 20805 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM APLUS HEATING&AIR- CONTRACTOR ADAM P. PHAM LIC # 31293 COMPANY A PLUS HEATING & A/C ADDRESS 264 GREAT MALL PKWY CITY/STATE/ZIP . . . : M:=LPITAS, CA 92683 TELEPHONE (,608) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 500 .00 1. 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 4, 500 . 00 0 . 50 0 . 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE 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 232 . 50 0 .00 232 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 232 . 50 #1201 --------------- TOTAL RECEIPT 232 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FUR1vACE/AC PE T cu � INO PERMIT APPLICATION FORM N # __ Date: _-16 - 10-1 i Buil 'ng Address-, 7Fax 0 Qil one#: Own 's Name: _�;- 3one#:Contract r: 4a-4q-54#: Contractor License#: upertino Business License#: -7C 3/ S� Phone#: Contact: y08 ' cel `0730 Fax #: Building Permit Info: Elect NPlumb Mech Residential Commercial ❑ Job Description: V,144 C, For ResidentJ Installations: 2°d floor ❑ Attic El1 S` 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 e[f Construction (Usage Class): Cost of Project: yp 5-0 0 On PlatfoSapperm ❑ Bended ❑ New Location❑ Replacement. trd ❑ Project Size: Express ❑ Standards. 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 %C10F FEE SCHEDULE CUPEI�TINO Fee Descriplion Fee Permit Type Quantity Fee ID Grou or M 1MRAPPVNT Residential for the install/relocate/ replacement cf ea appliance vent install &not incl in an appl permit. FURN/AC FURNACE 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each ga,, piping system of 5 or P more per out:et. 1BCBSC Cal Bldg Staldards Commission Fee B TYPES ALL PERMIT 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Sy,;t<=100k BTU install or M relocate ea .orced-air/gravity type furnace/buraer, incl ducts/vents attached to such appliance up to and include 10(,000 Btu/h M 1MFRN>100 Furnace Syst> 100k BTU install or relocate ea forced-air/gravity type furnace/bu.-ner,incl ducts/vents attached to such appliance over 100,000 Biu/h E lEPERNiITFEE Electric Permit Fee 1MPERIVIITFEE Mechanical Permit Fee M plumbing P 1 PPERMITFEE g Permit 1TRAVDOC Travel Documentation 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Building Department JOB ADDRESS: PERMIT # ;7, zoo OWNER'S NAME: PHONE # (7 — Z$ Z 357 1 GENERAL CONTRACTO • FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI:vESS 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 Owner/Contractor Signature Date