09100102 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 10236 WILL CT CONTRACTOR:A PLUS HEATING& PERMIT NO:09100102
A/C
`OWNER'S NAME: JACKSON KAREN L 244 GREAT MALL PKWY DATE ISSUED: 10/16/2009
vWNER'S PHONE: 4082520561 MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class I ay � Li,.# *763J 5'.st tr
�
5 p� MECH RESIDENTIAL COMMERCIAL
Contractor r--+f:l(;k`i t1'e Lt�TlG� Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: HVAC INSTALLATION ADD ON AND
(commencing with Section 7000)of Division 3 of the Business&Professions REPLACE FURNACE
Code and that my license is in full force and effect.
1 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:$8000
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 APN Number:31625021.00 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.1 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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�� -16-0
'6_J� RE-ROOFS:
mature Date 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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 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)
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 have read the hazardous materials requirements under Chapter 6.95 of the
California 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 1
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 the Health&Safety Code,Sections 25505,,,2`5533,and 25534. ,I
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:-7� � '�- Date:
permit is issued.
1 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.)
Lender's Name
APPLICANT CERTIFICATION Lender'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
i the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
amnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting 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
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-,UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: - -r� (�'Lty� PHONE # OY—
GENERAL CONTRACTOR: tq � 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
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 31625021 .00
DATE ISSUED. . . . . . . : 10/16/2009
RECEIPT #. . . . . . . . . : BS000008945
REFERENCE ID # . . . : 09100102
SITE ADDRESS 10236 WILL CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JACKSON KAREN L
ADDRESS 10236 WILL COURT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2224
RECEIVED FROM . . . . : APLUS HEATING & CO
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 8, 000 . 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, 000 . 00 0 . 80 0. 00 0 . 80 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
---------- ---------- ---------- ----------
TOTAL PERMIT 253 .80 0 . 00 253 . 80 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 253 .80 1063
---------------
TOTAL RECEIPT 253 .80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITE'OF
............. .. ..._._.._.
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # (S
�� `� Date: 10/16/2009
Building Address: 10236 Will Court.,Cupertino,CA 95015
Owner's Name: Jackson, Karen Phone#: 408-252-0561
Contractor: Phone#: 408-934-0730
APlus Heating &AC, Inc.
Fax#: 408-934-0734
Contractor License#: 763154 Cupertino Business License#:
31293
Contact: Phone#: 408-934-0730
Derrick Pham
Fax#: 408-934-0734
Building Permit Info:
Elect [D-- Plumb 0--� Mech Q
Residential x Commercial
Job Description:
HVAC Installation add on and replacement Furnace
For Residential Installations:
Attic ❑ I" floor 0 2nd 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 Re uired ❑
Cost of Project: Type of Construction(Usage Class):
$8,000.00 ��R
Strapped ❑ On Platform ❑ Bonded New Location Replacement
Project Size: Express ❑ 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
CITY OF CUPERTINO
13 FURNACE/AC
CUiPER.'TINO FEE SCHEDULE
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 Ok CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
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
1 BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1 BREMAIRHAN Residential A/C units <= l Ok CFM B
1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B
CITY Of
CITY OF CUPERTINO
FURNACE/AC
CUPERTtNO FEE SCHEDULE
floor mounted unit heater.
Quantity Fee ID Fee Description Fee Permit Type
Group
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
FURNACE FURN/AC
1 PGASRES 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.
r 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
I TYPES
1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
IEPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B