10010019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10360 IMPERIAL AVE CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10010019
OWNER'S NAME: LINDA KIZER 244 GREAT MALL PKWY DATE ISSUED:01/06/2010
NER'S PHONE: 4082531290
MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATION BLDG F ELECT PLUMB
BUILDING PERMIT INFO. B
License Class CvZ Lic.# 7
11:4 LA MECH F RESIDENTIAL COMMERCIAL
Contractor Date
�.--- JOB DESCRIPTION: INSTALL NEW FAN IN ATTIC W/NEW CERIN
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:$5000
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:35719115.00 Occupancy Type:
permit is issued.
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply ....
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by:" �•''.=�'—�" ?w. r Date:
9.18.
Signatur Date :��7C 1 0
RE-ROOFS:
jJ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner u ize.
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
inify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. / Licensed Professional
Signature - 1._ Date
l�
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35719115 . 00
DATE ISSUED. . . . . . . : 01/06/2010
RECEIPT #. . . . . . . . . : BS000009497
REFERENCE ID # . . . : 10010019
SITE ADDRESS . . . . : : 10360 IMPERIAL AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LINDA KIZER
. ADDRESS . . . . . . . . . . : 10360 IIMPERIAL AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : APLUS HEATING & AIR
CONTRACTOR . . . . . . . : ADAM P. PHAM LIC # 31293
COMPANY . . . . . . . . . . : A PLUS HEATING & A/C
ADDRESS . . . . . . . . . . : 244 GREAT MALL PKWY
CITY/STATE/ZIP . . . : MILPITAS, CA 92683
TELEPHONE . . . . . . . . : (408) 934-0730
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 51000 . 00 1 . 00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 5, 000 . 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 #1138
---------------
TOTAL RECEIPT 232 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
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IT
IIS A0RI)ANI XVII 1 '►IE CITY OE i
COP[P i INC)C(A)i'/AM) '0f)iNANCES
DATE___
f
SIGNED
This set of plans and specifiCations MUST J
be kept on the lot)at all times and it is °.Fs
unlawful to make any Changes or alterations
on same without written permission from
the Building Department, City of Cupertino.
The stamping of this plan and specifications
SHALL NOT be held to permit or to be an f
approval of the violation of any provisions
of any City Ordinance or State Law.
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SEE SEC. SQ2,6.2CONVENIENCE OUTLET N
04 ` (RECEPTACLE) `
F41� R4aF P;rcl `� pQ WORKING ``� � -AR Ttla EQUIPMENT
�REATFR THAN iv SPACE AT
CONTROLS 30x30
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24"WIDE i a
WARM-AIR - SOLID FLOORINGI
FURNA-CE ACCESS WAY
20'MAX - fq4'?
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CITY OF
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CITY OF CUPERTINO
FURNACE/AC
CUPERTINO
PERMIT APPLICATION FORM
APN# � ,� _.-- Date:
Building A dress: .� 6 O .. Ave,
Owner's Name: ; Z Phone#:
tic �-r 1.� n�.� -40 �Ll 10
Contractor: Phone#: 4 pt 3 _ 07 3-0
A Ptu !; Fax#. 4 0 9 3
Contractor License#: Cupertino Business License#:
-7 (o 3 (9-4 3 IC2-53
Contact: Phone#:,4o% _q 3 q _ 0 7 3 0
Fax#: �0 _ _ 07 3 W
Building Permit Info:
Elect Q�'. Plumb Mech
Residential 21 Commercial ❑
Job Description:
1 Y\:W h1 e v\J FA 1A i om �'i h A44-`C, W/nCv1
�
For Re
si ential Installations:
Attic 1St floor � 2na floor ID
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):
S-&V-0 V 9
Strapped ❑ On Platform ❑ Bonded ❑ New Location Replacement
Project Size: Ex ress ❑ 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
CITY OF CUPERTINO
FURNACE/AC
N
FEE SCHEDULE
UE
1 BUSLIC Business License B
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= l 0k CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1 BREMAIRHAN Residential A/C units <= 10k CFM B
1 MRRAA Residential Mech Repair/alt/add M
/ 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
1 TYPES
1 BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
I
IMPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B
Community Development
10300 Torre Avenue
t �jj r
�af.�
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#fto INO
Building Department
JOB ADDRESS: PERMIT # --ti 0
YNn cc
OWNER'S NAME: t A g,,. i—t y) c PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date