13030152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21867 WILSON CT CONTRACTOR:A PLUS HEATING&A/C PERMIT NO:13030152
OWNER'S NAME: SCHUSTER ROBERT O AND DONNA L 244 GREAT MALL PKWY DATE ISSUED:03/28/2013
OWNER'S PHONE: 4082559317 MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lic.# 7 `w, q- REPLACE(E)FURNACE,SAME LOCATION.INSTALL(N)
A/C UNIT IN REAR YARD.INSTALL(N)DUCT SYSTEM
Contractor AAA- - Date
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:$9800.
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:32649016.00 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 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 DA ,AST 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 Z 3
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Sectio
9.18.
FF 22 RE-ROOFS:
Signature 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 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
1,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. j
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: . .t/L� Date: 124!
� F
permit is issued. � ILt
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
` V
GENERAL PERMIT APPLICATION \
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTIPiO (408)717-328• FAX(408)777-3333•building(dcuoertino.org 41 k) m I C
❑PLUMBING MECHANICAL ELECTRICAL 0MISCE9LLANE0US /
PROJECT ADDRESS16
OWNERNAME Q('J�nr� \(�/� PHONE�OQ,�1 E-MAIL
STREETADDRESS�,�WWIIt�ii�1l, W 11SOh coLr+- CITY,STATE,ZII'�CJJC(Apor wi l O Cleo) FAX
CONTACT NAME PHONE I' 1r E-MAII�V
STREET ADDRESS 244 G(W Md Pbrkmy CITY,STATE,ZIP FAX
Milpitas,CA 95035
ax:.
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENt' xcomrRAcToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE E O HUS.LIC
COMPANY NAME 244 Goeit hi 66j EMAIL FAX L
Milpitas,CA 95035
STREET ADDRESS 730 Fax:408-934-0734 CITY,STATE,ZIP PHONE
ARCHmc T/ENGnmm NAME, w ' pt LICENSE NUMBER BUS.LIC R
COMPANY NAME' 'v E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF C&FD or DUPLEX ❑ IVIULTI-FAMILY PROJECT INWB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO ` III CHLER HOME? ❑No
DESCRIPTION OF WORK n/']/1A o`/n n i s fi 1 A rnAce' re '/a ce VV L+V 1 I/e
in I u�vK�1[. N AJ`G in 15 Lvyt � - L, � TG
TOTAL VALUATION: 0 EIV-ED BY:
By my ,e signature below,I certify to each of the following: I am the property owner or authorized agent to act on th prop owner's alf read this
application and the information I have mv'ded is correcL111 have read the Description of Work and verify it is accurate. I agree to comp y with all applicable local
ordinances and state laws relating to struction. I authorize representatives of Cupertino to enter the above-iden ifi d pro erty for inspection pu{poses.
Signature of ApplicandAgent Date: _1�0
SUZ'PL AL INFORMATION REQUIRED 1 / OFFICE USE ONLY
OVER-THE-COUNTER
Ly A,1
1 ❑ EXPRESS
=� ❑ STANDARD
u
❑ LARGE
❑ MAJOR
MEPM=s _pp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21867 WILSON CT DATE: 03/28/2013 REVIEWED BY: MELISSA
APN: 326 49 016 BP#: "'VALUATION: 1$9,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E FURNACE SAME LOCATION. INSTALL N A/C UNIT IN REAR YARD. INSTALL N
SCOPE DUCT SYSTEM
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Mech.Plan Check "00 $0.00 .Plumb. Flan Check Elec..Plan(.,heck
Mech.Permit Fee: IMPERMIT Plumb. Permit Fete: Elec. Permit fee:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb In.rp. Ohher Elec,Insp,
A3ech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the preffinWha information available and are only an estimate Contact the Dept./or addn'1 info,
FEE ITEMS(Fee Resolution 11-053 Elf. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
Suppl. PC Fee: 0 Reg. ® OT0.0 hrs $0.00 $133.00 IMFR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00 F 71 # Mechanical
Permit Fee: $0.00 $67.00 IBREMAIR A/C Units(<=1OK cfin)
Suppl. Insp.Fee-0 Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction :Tess:
Administrative.Fee: IADMIN $42.00
Work Without Permit? ® Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRAVDOC $45.00 1
Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.98 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.00
$133.98 $200.00 $333.98
Revised: 01/01/2013
Simplified PrescriptiveCertificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 1, 3-7
Site Address: Enforcement Agency: Date: Permit#:
21867 WILSON COURT Cupertino, CA 95014 City of Cupertino Mar 27, 2013
Duct insulation Conditioned Floor
Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
®Furnace ®AFUE 78% ❑COP ®R 6(CZ 1, 3-5) Served by system ®Setback
®Indoor Coil ®SEER 13.0 [3HSPF If not already present, must
®Condensing Unit ❑EER ❑Resistance ❑R 4.2 (CZ 6, 7) 1700 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: ]ane Alo Signature: Jane Alo
Company: A PLUS GENERAL CONTRACTORS INC Date: Mar 27, 2013
Address: 11330 KNOTT STREET License: 763154
City/State/Zip: GARDEN GROVE f CA/92841 Phone: (714)901-0500
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Reg: 213-A0018586A-000000000-0000 Registration Date/Time: 2013/03/27 20:06:46 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
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