10010022 IN O BUILDING PERMIT 0:10010022
CITY OF CUPERT PLUS HEATING&A/C PERMIT N
• CONTRACTOR:A P
DR#A DATE ISSUED:01/06/2010
244 GREAT MALL PKWY
BUILDING ADDRESS: 10380 LOCKWOO PRONE NO'(408)934-0730
OWNER'S NAME: BARBARA BAYHA MILPITAS,CA 92683 r�iER S PHON
E: 4082532685 � ELECT r— PLUMB
R'S DECLARATION BUILDING PERMIT INFO: BLD COMMERCIAL
LICENSED CONTRALTO MECH RESIDENTIAL
License Class 2®� C1-IANGE OUT FURNACE&ADD ON A/C
Date JOB DESCRIPTION
Contractor pro of Chapter 9
I hereby affirm t at I am licensed under the p ess&Professions
(commencing with Section 7000)of Division 3 of the Busin
Code and that my license is in full force and effect.
b affirm under penalty of perjury one of the following
two declarations:
I here y
maintain a certificate of consent to self-insorr Code ,for the Valuation'.$5000
or Worker's
Compensation,asp
I have and will provided for by Section 3700 of the Lab
Sq.Ft Floor Area:
performance of the work for which this permit is issued. as provided for by Occupancy Type:
,
I have and will maintain oWCo aCompensation Insurance,for the performance of the work for which this APN Number:334229017.#A
Section 3700 of the Lab
permit is issued. WORK IS NO►r STARTED
APPLICANT CERTIFICATION T EXPIRES IF CE OR
this application and state that the aboveand S apt laws relating PERMIT IT ISSUANCE
n is
I certify that I have readand county ordnance to enter 180 DAYS OF PERM
correct.I agree to comply with all city representatives of this city WITHIN INSPECTION.
construction,and hereby authorize rep ores. (We)agree to save LAST CALLED
to building for inspection pure ud mems,
above mentioned property 180 DAYS FROM
upon the harmless the City of Cupertino against liabilities,j g
indemnify and keep rue against said City in consequence of me 1 Date:�--
costs,and expenses which may ac c g licant understands and will comply Issued b '
granting of this permit. Additionally,the the Municipal Code,Section
with all non-point source regulations p
9.18.
Date RE-ROOFS:
Signature roofing material being installed.If a roof is
Signa inspected prior to any I agree to remove all new materials for
All roofs shall be insp an inspection,
installed without first obtaining
OWNER-BUILDER DECLARATION a Law for one of inspection.
i.� Date:
b affirm that I am exempt from the Contractor's License
I hereby ensation, Signature of Applicant:
the following two reasons: employees with wages as their sole comp g
1,as owner of the property,
or my OR BETTER
he structure isnot intended or offered for sale(Sec.704 , ROOF COVERINGS TO BE CLASS"A"
will do the work,and t ALL
Business&Professions Code) contracting with licensed contractors to
am exclusively
1,as owner of the property, HAZARDOUS MATERIALS DISCLOSURE 6.95 of the
ct the project(Sec.7044,Business&Professions Code). uirements under Chapter
construct three
of perjury one of the following 25533,and 25534. I will main au
P I have read the hazardous materials
25505, ter 9.12 and the Health&
I hereby affirm under penalty Chap
' nce with the Cupertino Municipal Code,
ions: Consent to self-insure for Worker's California Health&Sae or handle hazardous material.
declarations* comp should I store
I have and will maintain a Certificate of Conse Safety Code,Section 25532(a)
ed for by Section 3700 of the Labor Code,for the Quid I use equipment or devices which emit hazardous
District I will
Compensation,as proved Additionally,should Area Air Quality Management
Perm is issued. rovided for by the Bay Chapter 9.12 and the
performance of the work for which this pensation Insurance,as p contaminants as defined by ertino Municipal Code,
maintain compliance with the Cup
I have and will maintain Worker's o the performance of the work for which this &Safety
Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code, Health
permit is issued. r which this permit is issued,I shall j.—��(�
pe Date: (o
I certify that in the performance of the work fo
r so as to become subject to the Worker's Owner
person in any mann tion,I
not employ
any P this certificate of exemption,
I must
ensation laws of California. If,after making
of the Labor Code, CONSTRUCTION LENDING AGENCY rmance of wot
Corn P ensatio p performance become subject to the Workers Comp Perm shall be deemed revoked. a enc for the p
with such provisions or this p I hereby affirm that there is a construction lending g y
forthwith comply
for which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATIONLender's Name
this application and state that the aboces a d Sa�laws relating Address
---------------
correct.
certify that I have readand county ordinances to enter Lender's Ad
correct.I agree to comply with all city representatives of this city
construction,and hereby authorize rep agree to save
to building for inspection purposes.(We) g judgments, ARCHITECT'S DECLARATION
upon the above mentioned property of Cupertino against liabilities,judg public records.
_mnify and keep harmless the City in consequence of the Plans shall be used as p
eases which may accrue against said City� 1 I understand my
and exp applicant understands and will comp y
.�r►ting of this permit..Additionally,
per the Cupertino Municipal Code,Section Licensed Professional
With all non-point souregulations
9.18. to
Date
Signature
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
� 1
7 ITEMS OF 14 COPY #
Sec: Twp: Rng: Sub: Blk: Lot:
APN 334229017 .#A
DATE ISSUED. • • • • " 01/06/2010BS000009500
RECEIPT # . " 10010022
REFERENCE ID # • • •
SITE
ADDRESS 10380 LOCKWOOD DR #A
SUBDIVISION . • • • • • •
CITY CUPERTINO
IMPACT AREA
OWNER BARBARAB YHA DR # B
: 10380 LO
ADDRESS • • • • . CUPERTINO, CA 95014
CITY/STATE/ZIP
RECEIVED FROM . . . . : APLUS HEATING & AIR# 31293 CONTRACTOR ADAM P. PRAM
LIC
A PLUS HEATING & A/C
COMPANY • • " ' . 244 GREAT MALL PKWY
ADDRESS • • • • . . . . MILPITAS, CA 92683
CITY/STATE/ZIP . . ' : (408) 934-0730
TELEPHONE . . • • • • • •
THIS REC NEW BAL
-
_
_
FEE ID UNIT
QUANTITY AMOUNT---------- ----PD-TO-DT------ ----- 1 . 00 -----0 . 00
_____ VALUATION5, 000 .00 0 . 00 0 . 50------------- - --- 1.00 0 .00 0 .00
1BCBSC5, 000 .00 0 .50 42 . 00 0 . 00
1BSEISMICR VALUATION 1 .00 42 .00 0 .00 42 .00 0 . 00
1EPERMITFE FLAT RA'Z'E 1 .00 42 . 00 0 .00 126 .00 0 . 00
1MPERMITFE FLAT RA'Z'E 2 .00 126 . 00 0 .00 0 .00
1 1
MRRAA UNITS . 00 42 . 00 0 .00 42 . 00 0.00
00
1PPERMITFE FLAT RATE 100 42 . 00 0 . ----------
1TRAVDOC FLAT RATE ---------- ------, ---- 295 . 50 0 . 00
295 .50 0 .00
TOTAL PERMIT
VOICE ID
DESCRIPTION
----------
VOICE ID DESCRIPTION_--__ ________ ------------------
___----- --------------- 507 FINAL PLUMBING
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
CITY OF CUPERTINO
�W-
FURNACE/AC
�1OF SCHEDULE
��TFEE
CUPEi �NO
Fee Permit Type
Quantity Fee ID Fee Description Grou
FURN/AC
AIR
CONDITIONING cial A/C Units<= 10k CFM B
1 BCAIRHAN Commer
Commercial Mech Repair/alt/add
M
1 MCRA.A
fission Fee B ALL PERMIT
1BCB
SC Cal Bldg Standards Comm TYPES
ISMICO Seismic Commercial
B
1BSE
i
1PGA
SCOM Commerical for ea gas piping in g System P
1-4 outlets P
1PGASRES
Residential for ea gas piping system
of 1-4 Outlets tem of 5 or P
1BPGAS For each gas piping sys sid
more per outlet. Comm/Re B
1 BREMAIRHAN
Residential A/C units <— lOk CFM
Residential Mech Repair/alt/add
M
1M
Commission Fee B ALL PENT
IBC
BSC Cal Bldg Standards Comm TYPES
EISMICR Seismic Residential
B
IBS
IEPERMITFEE Electric Permit E
M
1M
PERMITFEE Mechanical Permit
C
PPERMITFEE Plumbing Permit
P
1
VDOC Travel Documentation
B
1 TRA B
1BUSLIC Business License
0
M.Indoor Air Quality and Finishes 1 IAWHealth pts y—yes 0
I-�*'M010-VOG 2 IAOJJHealth pts y=yes 0
2,Use Low\10C.Water-Based Wood Finishes 31AQ/Health pts Y=Yes
' s for interior Finishes 3 Resource pts y=yes
4.Use Salvaged Material 0
5.Use Engineered Sheet Goods with no added Urea 6 IAQ/Health'pts y=yes 0
Formaldehyde 1 1AQ1Haalth pts Y=YBB 0
6,Use Exterior Grade Plywood for Interior Uses
�, 4lAQIHealth.pts Y=yeS 0
7. .` 4 Resource pts y=yes
B.Use FSC Certified Materials for Interior Finish D
cled-Content Trim 1 Resource pts Y=yeS p
9.Use Finger-Jointed or Recy 31A(JHealth pts y—yes
10.Install Whole House Vacuum System
N.FlooringD
Certified Wood Flooring B Resource pts y=Yes 0
1.Select FSC 4 Resource pts y=yes
2 Use Rapidly. Flooring 10Ws D
Ceramic Tiles 4 Resource pts Me 0
3.Use Recycled Content C 5 IA{�/Health pts y—yes
4,Install Natural Linoleum in Place of Vinyl 0
4 Resource pts y=Yes 0
5.Use Exposed Concrete as Finished Floor
VOCs 4 Resource pts y—yes
6.Install Recycled Content Carpet with
140 1;5ul 57
Total Points Available:
.� 0 77 0
Total Points Project ReCelVed.
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Community Development
10300 Torre Avenue
Cupertino CA 9501
Telephone(408)7773
228
{ Fax(408)777-3333
CITY OF
-upEkTINO
Bu�ldlnDe
PERMIT # v2�---
j0B ADDRESS. .................
..............
3 LOG w PHO #
.#c) AME: FAX#
OWNER"S N /L/IAL CONTRACT
GENE
• an subcontractors:
Date
I am not using y afore
lete the f ollowin information: #
le subcontractors and com BUSINESS LICENSE
Please check a licab BUSINESS NAME
SUBCONTRACTOR
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring:Carpeting
Linoleum/ Wood
as / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
Owner/Contractor Signature