13070181 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21910 BYRNE CT CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 13070181
OWNER'S NAME:. Ph,4101.% + Li d ern l L 244 GREAT MALL PKWY DATE ISSUED:07/30/2013
OWNER'S PHONE: 4083872232 /� MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALO
License ClassesIc— Lic.# �2 3;1:15 ADD(N)A/C IN REAR YARD&REPLACE(E)FURNACE
Contractor A `� �� Date b 1 SAME LOCATION
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:$9000
I have and will maintain Worker's Compensation Insurance,as provided for by
w�t/ Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35716083.00 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 WITIIIN 180 DAYS O + 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 LAST D 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 f7
granting of this permit. Additionally,the applicant understands and will comply by: 317
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
22 E-ROOFS:
Signature (/ Date d J All roofs shall be inspected prig o 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I 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 the Health&Safety Code,Sections 25505 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this —7 �O
permit is issued. Owner or authorized agent: Date: !
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.)
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify 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
GENERAL PERMIT APPLICATION �`
MEP
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 '`
CUPERTINO (408)777-329-8.• FAX(408)777-3333 buildinaQ.guoerano.org M I C
❑PLUMBING NMCHANICAL ELECTRICAL ❑MISCEL ANEOUS
PRO.IECT ADDRESS 0 /� ^
T1 ✓1'�i'/ID APN R
OWNERNAME /j Zo a PHONE DV V$7-22-32-1 E-MAIL
V
STREET ADDRESS 24 it(o 12 ryrL e g yH y CITY,STATE,ZIP �i�y O A�/ AX
CONTACT NAME A P16 ,Henn �V1A C PHONE I E-MAIL /
k ay
STREET ADDRESS Milpitas,CA. ry CITY,STATE,ZIP FAx
Ph:408-934-0790 Pax�08-W"734
❑OwNER ❑ OwNER-BumDER ❑OWNER AGEN CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPEt ❑TENANT
CONTRACTOR NAMEA Plus Heat, $ A/ LICENSE NUMBER 7� f LICENSE Bus.LIC m A
COMPANY NAME Milpltes,CA W35 E-MAII (/y FAX L
Ph.-408 934 G739 r- A08-04'
STREET ADDRESS CITY,STATE,ZIP PHONE
01
ARCHTTECT/ENGINNEEERNAME LICENSE NUMBER BUS.LIC P
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �FDorDUPLEX ❑ MULTI-FAMILY PROTECT INWII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ElYES
BUILDING: ❑ IA
CONOWERCL URBAN INTERFACE AREA [3NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK D/1/Y)11 /� /�/d` /n �,^ W;*
n� ao, opo
6� / ace /n ��({A(�(%/o 6'T 0,n .
Mol he W Aja
TOTAL VALUATION: 1010
By my signature below,I certify to each of the following: I am the property owner or authorized agent ct on th property owner' alf I have rea s
application and the information I bave provided is co cLYhave read the Description of Work and verify it is ac 10comply with all applicable local
ordinances and state laws relating to bail ' g on ti a nze representatives of Cupertino to enter the above-identified pro erty for inspection pudposes.
Signature of Applicant/Agent !1 Date: '
SUPP RMATION REQUIRED OFFICE USE ONLY
VER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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❑ LARCE
r ❑ MAJOR
A,HPMIscs1pp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21910 BYS NE CT DATE: 07/30/2013 REVIEWED BY: MELISSA
APN: 35716.083 BP#: *VALUATION: 1$9,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK [APP�-(N)A/C IN REA YARD & REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: r. $209.00
s
a
Mech.Plan Check 0.0 hrs $0.00 PlwtA Platt Check Elec.1'lan Cheek
Mech.Permit Fee: IMP RMIT Plumh.Permit Pee: Elec.Permit Fee:
rOther Mech.Insp. 0.0 hrs 47.00 Other Plumb Insp. Other Elec.Insp. Li
Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does notincludefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based o the relimina information available and are onlyan estimate. Contact the Det or addn'1 info.
FEE ITEMS 6FIge Resolution 11- 3 E . 711112 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sztlrl�l. PC Fee .
PME Plan Check: $0.00
Permit.Fee:
Suppl. Insp Fee
PNM Unit Fee: $209.00
PME Permit Fee: $47.00
Cont-fiction Tax.
Administrative.Fee: IADMIN $44.00
Work Without Permit? Yes (2) No $0.00
Adva nced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item.
Bldy-Stds Commission Fee: 1BCBSC $1.00
-
$348.901 $0.00 $348.90
Revised: 07/01/2013
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 1,3-7
Site Address: Enforcement Agency: Date: Permit#:
21910 BYRNE COURT Cupertino, CA 95014 City of Cupertino l3ul25, 2013
Duct insulation Conditioned Floor
Equipment Type1 List Minimum Eff ciency2 requirement Area Thermostat
❑Package Unit
®Furnace ®AFUE 78% ❑t.OP ❑R 6(CZ 1 3-5) Served by system ®Setback
®Indoor Coil ®SEER 13.0 [31-SPF E3 4.2 CZ 6 7 2000(CZ If not already present,must be
®Condensing Unit [3 EER [3 Resistance ) installed)
❑Other
1.Equipment Type:Choose the equipment be"ng installed;if more than one system,use another CF-1R-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEE R,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's Responsible Designer's Declaration Statement)
•I certify that this Certificate of Compliance d cementation is accurate and complete.
•I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
•I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
•The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms,worksheets,calculations,plans and s ecifications submitted to the enforcement agency for approval with the permit application.
Name: Jane Alo ISignature:Jane Ala
Company: A PLUS GENERAL CONTRACT RS INC Date: Jul 25, 2013
Address: 11330 KNOTT STREET I License: 763154
City/State/Zip: GARDEN GROVE/"CA/92841 Phone: (714) 901-0500
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& PAN, $
Reg: 213-A0055909A-000000000-0000 Registration Date/Time: 2013/07/25 10:28:01 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
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FOR CODE
eviewed By, _
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COMMUNITY DEVE LOPMENT DEPARTMENT
This settt of plans and specification E MUST be kept at the
— job s'si4 during construction. It is i nlawful to make any LE
....... c u es or alterations on san a or t9 deviate
therefrom,without approval frory he Building Official
--{ The starhping of this fann and`spe t
be hell to.permit or to oval of the violation ._ -_- _ _._ �G.
__.
of an yj prov' of an r ance or State Law.
PERMIT NO. �
h Aft
PLOIN
SCa P� CHECKED By
DATE
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