10070085 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10292 BRET AVE CONTRACTOR:A PLUS HEATING&A/CPERMIT NO: 10070085
OWNER'S NAME: GAIL JOHNSON 244 GREAT MALL PKWY DATE ISSUED:07/12/2010
NER'S PHONE: 4084107750 MILPITAS,CA 92683 PHONE NO:(408)934-0730
❑ LICENSED CONTRACTOR'S DECLARATION r-
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class t5 q. Lic.# L"2O
r r
__ MECH RESIDENTIAL COMMERCIAL�
Contractor �'��t� � Date � �Z ��i
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMV OLD FURNACE&REPLACE W/NEW FURNACE IN
(commencing with Section 7000)of Division 3 of the Business&Professions SAME
LOCATION&ADD A/C
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.
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 Sq.Ft Floor Area: Valuation:$9500
permit is issued. QS V
APPLICANT CERTIFICATION V APN Number:37510039.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
' Issued b Date: , 17.E&j
Signature
u OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must O� or au th rized agent: Z
forthwith comply with such provisions or this permit shall be deemed revoked. 1,10
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
.,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR.- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$9,500
"PERMIT TYPE: Mechanical Permit PLYLN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex �. APPLICATION 1R3SFDADD/REM
USE: t r�t e:tt TYPE:
as
O O
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
A/C Units (<=10K cfm) 1BR=MAIR 1 $63
Furnace, Forced-Air 1MFI2=<100 1 $126
TOTALS: $189.00
Mech.Plan Check "00 $0.00
Mech.Permit Fee: IMPERMITc
Other Mech.Insp. 0.0 1 hrs $42.00
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-05I Eff 7/1,09) FEI QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $181.00
PME Permit Fee: $4 :.00
Travel Documentation Fee: ITRA VDOC $41.00
0.0 hrs Standard Hourly Rate
Bldg Stds Commission Fee: IBCBSC $1 .00 $0.00
SUBTOTALS: $27Z .00 $0.00 TOTAL FEE: $274.00
Revised: 6/30/2010
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIP RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl,--: Lot:
APN . . . . . . . . : 37510039 .00
DATE ISSUED. . . . . . . : 07/12/2010
RECEIPT #. . . . . . . . . : BSDO0010840
REFERENCE ID # 1OD70085
SITE ADDRESS . . . . . : 10292 BRET AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CU?ERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GAIL JOHNSON
ADDRESS . . . . . . . . . . : 10292 BRET AVE
CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014
RECEIVED FROM . . . . : AP-JUS HEATING & AIR
CONTRACTOR . . . . . . . : ADAM P. PHAM LIC # 31293
COMPANY . . . . . . . . . . : A ?LUS HEATING & A/C
ADDRESS . . . . . . . . . . : 241 GREAT MALL PKWY
CITY/STATE/ZIP . . . : MI�PITAS, CA 92683
TELEPHONE . . . . . . . . : (4)8) 934-0730
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 9, 500. 00 1 . 00 0. 00 1. 00 0 . 00
1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 .00 63 . 00 0 .00
1MFR=<100 UNITS 1. 00 126 . 00 0 .00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 274 . 00 0 . 00 274 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 274 . 00 #1418
---------------
TOTAL RECEIPT 274 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
`:UPEkTINO PERMIrT APPLICATION FORM
APN #c��75 / � .� Date:
Building Address: 1 0292 ��pi& "e
Owner's Name: 66t!L (To
hMOr? Phone M /�O� l 410 , .779V
Contractor: Phone #: �,��93L�-0730
!" l u S (7��`ng � r/ l� Fax#:
8 3 of
Contractor License M Cupertino Business License M
Contact: Phone#: 8 13 — 515
Fax #: 06
Building Permit Info:
Elect Plumb Er--- Mech
Residential Commercial ❑
ob Description:
wore old furnace aid replace w//vl ace ir7, same, /ornfiQq.
For Residential Installations:
Attic F-11 S` floor El floor 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 Required ❑
Cost of Project: Type of Cor.struction (Usage Class):
Strapped ❑ On Platform [} Bonded New Location Replacement
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Valuation: -� I S-OT
Green Building: Please complete relevant portion c f the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09
WE •Y1.1 t r-y tJ • _! -
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint IAC)/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes p
3.Use Lovr/IJo VOC Adhesives 3 IAQ1Health pts y=yes p
4.Use Salvaoed Materials for Interior Finishes 3 Resource pts y--yes p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde i.IAQJHsalth'pts y=yes p
6.Use Exterior Grade Plywood for IntariDr Uses IAQ/Health pts y=yes p
7.Seal all Exposed Particleboard or MDF IAQ/Health pts y=yes p
8.Use FSC Certified Materials for Interior Finish t Resource pts y—yes p
9.Use Finger-Jointed or Recycled-Content Trim Resource pts y=yes p
1D.Install Whole House Vacuum System 3 IAQ/Health pts y=yes p
N.Flooring
1.Select FSC Certified Wood Flooring B resource pts y=yes p
2 Use Rapidly Renewable Flooring Materials 4 3esourr;e pts y=yes p
3,Use Recycled Content Ceramic Tiles 4 �esDurce pts y=yes p
4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 resource pts y=yes p
6. Install Recycled Content Carpet with Low VOCs 4 �BSDurce pts y=yes p
� � B
Total Points Available: 4Q 1301 57
0
Total Points Project Received: pl 0 V9
1 11 /11
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: C 2_q PERMIT#
OWNER'S NAME: PHONE # Civ i-1 llV '775-0
GENERAL CONTRACTOR: — p S BUSINESS LICENSE # (� 3
ADDRESS: LZCITY/ZIPCODE: C?
*Our municipal code requires all businesses worki g it 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 SUBCONTFACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Si;nature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
1 'Z
w Contractor Signature Date