14050019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19710 WHEATON DR CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 14050019
OWNER'S NAME: CORTES RICHARD M AND HELEN J 244 GREAT MALL PKWY DATE ISSUED:05/02/2014
OWNER'S PHONE: 4082537030 MILPITAS,CA 92683 PHONE NO:(408)934-0730
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPLACE(E)FURNACE,SAME LOCATION
License Class AP(,
��/Z 0 Lic.# L 5 T
Contractor AP 4(.S �• ( , Date Jam' 2
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:$3000
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:31628006 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 WITHIN 180 DAYS OE-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 DALAS 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 s Z
granting of this permit. Additionally,the applicant understands and will com Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signatur A-NAA� Date S �� 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 I 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)
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,Sectio s 25505,25P4,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this \ /
permit is issued. Owner or authorized agent: Date:` 2
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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 OM E P&
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O
CUPERTINO (408)777-3228-FAX(408)777-3333-buildinaCcDcuoerino.org M I
\�
4
[]PLUMBING JMECHANICA1 [—]ELECTRICAL ❑ivIISCELLANEOUS
PROJECT ADDRESS 147/0 Oeahon Dri v0zAPN� -3
OWNER NAME k ch a d �I orf- I� PHONE q-06--253
K 2-702 E-MAIL
STREET ADDRESS l g7,110 Wh .I V n D6 ve, CITY.STATE,ZIP Cuptr*
t,
0 q Sp/ I FAX
CONTACT NAME A PI►/C PHONE 406-45q,0730
06-•q2 '0 7/3+0 E-MAIL
ST?=,&MDRESS n l rq �I JreO Mall f'lu� =,STATE,ZIP7 I J �17V
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME �y PIU (' LICENSE NUMBER--&3
3 I� LICENSE TYPE/�n j� BUS.LIC
COMPANYNAME 1 r J E-MAIL ( (/�j{/ FAX
STREET ADDRESS �* AW t N yv CITY.STATE,zIP A/j�j-Ms ►
ARCHITECTIENGINEERNAME �(/�� CENSE NUMBER BUS.LIC R
COMPANY NAME' E-MAIL. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ NfULTt-FAMILY PROJECT IN WB.DIAND ❑ YES PROJECT LN ❑YES IS THE BLDG AN ❑YES
BUILDING: I-]COMMERCIAL URBAN INTERFACE AREA 13NO FLOOD ZONE ❑NO ECHLER HOME? ❑NO
DESCRIPTION OF WORK WOW
W /���;J-6n J�MOW/
fi c n
D Do 0 1� n q ce, tn cS nt- OC�th-vn
� s
TOTAL VALUATION:(300 0
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on he p o er s behalf. I have read this
application and the information I bave provided is correct,I readthe Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ding construction` a orize representatives of Cupertino to enter the above-identified pro for inspection pulposes.
Signature of Applicant/Ageut f� Date: 2
SUPPLEMENTAL INFORMATION REQ OFFICE USE ONLY
❑ OVER-THE-COUNTER
r ❑ EXPRESS
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W ❑ STANDARD
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❑ LARGE
r ❑ MAJOR
LEPNAsc4pp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 19710 WHEATON DR DATE: 05/02/2014 REVIEWED BY: MELISSA
APN: 316 28 006 BP#: `VALUATION: 1$3,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE H) QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $139.00
2017m
Mech.Plan Check 0.0 hrs $0.00 Muni!), 111an Check I-h--:.F'i:zn
Mech.Permit Fee: IMPERMIT f'Irr szh. 1'en-n Fac':
EDOther Mech.Insp. 0.0 hrs 1 $47.00 0"/'wr it--c- bly,
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prefimiina information available and are only an estimate. Contact the Dept/or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/131 FEE QTY/FEE MISC ITEMS
7PJ1t3 _. i.'c'
PME Plan Check: $0.00
1'c:nn'i:1'ee:
.furpp/' Insp 1-ee
PME Unit Fee: $139.00
PME Permit Fee: $47.00
(.'0i7S1!'N(ri0n KLY.
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes C) No $0.00
(]L,'
Travel Documentation Fee: ITRAVDOC $47.00 A
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
.a
$278.50 $0.00 TOTAL FEE: $278.50
Revised: 04/01/2014
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 1,3-7
Site Address: Enforcement Agency: Date: Permit#:
19710 WHEATON DRIVE Cupertino, CA 95014 City of Cupertino May 2, 2014
Duct insulation Conditioned Floor
Equipment Typei List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
®Furnace ®AFUE 78% ❑COP ❑R 6 PCZ 1 3-5) Served by system ®Setback
❑Indoor Coil [I SEER [3HSPF If not already present,must be
❑Condensing Unit [3 EER ❑Resistance ❑R 4.2(CZ 6, 7) 1800 sf installed)
❑Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
•I certify that this Certificate of Compliance documentation 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 specifications submitted to the enforcement agency for approval with the permit application.
Name: lane Alo Signature: Jane Alo
Company: A PLUS GENERAL CONTRACTORS INC Date: May 2, 2014
Address: 11330 KNOTT STREETLicense: 763154
City/State/Zip: GARDEN GROVE/CA/92841 Phone: (714) 901-0500
t
Reg: 214-A0030522A-000000000-0000 Registration Date/Time: 2014/05/02 11:22:44 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010