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12120023 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22334 SANTA PAULA AVE CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 12120023 OWNER'S NAME: CALAFIORE THOMAS F AND FLORENC 244 GREAT MALL PKWY DATE ISSUED: 12/06/2012 OWNER'S PHONE: 4087251557 MILPITAS,CA 92683 PHONE NO:(408)934-0730 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class G20 Lie.it 76 IS4 REMOVE AND REPLACE FURNACE IN SAME LOCATION, NEW Contractor Anue, - 6- L° Date12< DUCT SYSTEM I hereby affirm that I am licensed under the provisions of Chap er 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: 1 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:$4500 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:35705044.00 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 0 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 DAY M 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. /q RE-ROOFS: Signature Date ((� All roofs shall be inspected prior to any roofing material being installed.If a roof is 7 T_ 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(Scc.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 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 25:93,255339 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this2 Owner or authorized agent: Date: permit is issued 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,1 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,andexpenses 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 ti E COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DNISION ^� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M ' S C CUPERTINO (408)777-3228• FAX(408)777-3333•buildinarD�cuoertino.orD ' Y PLUMBING 0 IMaiANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS 22331-- S,S" pGl,ua a e/ APNR 3e;11 05 t)gZ4 OWNERNAME fiOrm c �t�t�l�4ore-� /� PHONE 4 --725 I1 �(EE-mAAm MHET ADDRESS 22.334 EvINJRAW �C�`y Aig, •STATE.ZD'V f+/ apprJ e7not-17 V1 FAX CONTACr NAME A Plus Headna&AIC PHONE E-MAII, STREET ADDRESS . ,s CRY,SFATE.ZIP FAX Mk"❑ CA M OwHER ❑ OWNER-BUB.DER ❑ owtmtAGDv]' IZRACMR ❑CONtRALTORAGENT ❑ ARLwrELT ❑EN NEER ❑ DEVELOPER ❑MJANr CONTRACTOR NAME WCENSENUF®ER I WCENSE TYPE BUS' WC' n� COMPANY NASD: 244 GFeat MBN E-MAIL FAX STREET ADDRESS Ph:408-934.0730 FWil 934-0784 CRY.STATE,ZIP PHONE ARCH[TEMENGINEFRNAME WCENSE NUMBER BUS.WC,7 COMPANYNAME' E-MAB. FAX STREETADDRESS CRY,STATE,ZIP PHONE USE OF ❑sFD.DunEx ❑ MMMAM,Y PRO=TNwBDIAND ❑ YEY PROIECTN ❑YES MS BLDOAN ❑YES BUBDNG: [3GOND.,AOAL URBAN NtERFACE AM NO FLOODZONE ❑ND EICHLER HOME4 ❑NO DESCABMON OF WORX R.P,moq, o dfLArnqtcQ. apJace w14-k new l n SMP, WCQUhon fJ TOTALVALUATION: T RECENEDBY: By my signature below,I certify toeata followiag: I am the property owner or anthorized agent m act on the prop owner's behalf. I have read this application and the mformaboa I have p d i corsmtwi have rmd tha Description of Work and verify it is accurate. I agree m comply with all applicable local ordinances and state laws relating m a trio, I:iothne representatives of Cupertino to enter me above-identified property for inspection ptooses. Signature ofApplica t/AgenC Date: ig SUPPLEMENTAL INFORMATION REQUIR..ED OFFICE USE ONLY yt OVER-THE-COUNTER YCl EXPRESS O u ❑ STANDARD V 3 ❑ LARGE c ❑ MAJOR MEPMrra4pp_201I.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 22334 SANTA PAULA AVE DATE: 12/06/2012 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: $4,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION FURNIAC USE: PERMIT TYPE: WORK REMOVE AND REPLACE FURNACE IN SAME LOCATION NEW DUCT SYSTEM SCOPE Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Chuck Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee: Elec. Permit ree: Other Mech.Insp. 0.0 hrs L $45.00 Other Plumb Insp. Li Other Elec.Insp. ,14ech. Imp. f-ee.: Plumb. hrsp.Fee: Elec.Insp. Fee: NOTE: This estimate does not ineludefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School Dstrict,etc). These fees are based on the prefindna in ormatlon available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS(Fee Resolution 11-053 Eff WZ121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $133.00 IMFR=<Ioo I Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax. Administrative Fee: IAD.LIIN $42.00 Work Without Permit? © Yes 0 No $0.00 0 Advanced Planning Fee: $0,00 Select a Non-Residential 0 Travel Documentation Fee: 1zRavDOC $45.00 Building or Structure i Strong Motion Fee: IESEISMlCB $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1ECESC $1.00 ryp �.n '}.k"r'"'ry.(✓ .f� f YFkX $133.50 $133.00 `'rtTO.TALFE ; $266.50 ��� Revised: 10/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 1, 3-7 Site Address: Enforcement Agency: 1 Date: Permit#: 22334 SANTA PAULA AVE Cupertino, CA 95014 City of Cupertino Dec 5, 2012 Duct insulation Conditioned Floor Equipment Typei List Minimum Efficiency2 requirement Area Thermostat p Package Unit H Furnace ®AFUE 78% p COP_ HR 6(CZ 1, 3-5) Served by system ®Setback p Indoor Coil O SEER_ p HSPF If not already present must *Condensing Unit p EER_ 0 Resistance 0 R 4'2 (CZ 6, 7) 14.00 sf be installed) ®Other > 40' Ducts 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: Jane Alo Signature: Jone Alo Company: A PLUS GENERAL CONTRACTORS INCDate: Dec 5, 2012 Address: 11330 Knott St. License: 763154 City/State/Zip: Garden Grove/CA/92841 Phone: 714 901-1958 q" Reg: 212-A0068584A-000000000-0000 Registration Date/Time: 2012/12/05 19:38:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forme July 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: uG PERMIT# OWNER'S NAME: PHONE# 4ag - —0750 GENERAL CONTRA TOR: BUSINESS LICENSE# . ADDRESS: rk- r CITY/ZIPCODE: CA q50aK— *Our municipal code requires all bn§►ne ...working 1 the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 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 lass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor.Signature Date