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10040127 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1154 HUNTERSTON PL CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10040127 OWNER'S NAME: SCHOLL DAVID P AND TINA M 244 GREAT MALL PKWY DATE ISSUED:04/20/2010 .NER'S PHONE: 4084464692 MILPITAS,CA 92683 PHONE NO:(408)934-0730 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Li,.# f �6� I � MECH F RESIDENTIAL F COMMERCIAL Contractor A2,y S Date 2G p I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACING FURNACE&ADDING A/C SAME LOCATION 85000 (commencing with Section 7000)of Division 3 of the Business&Professions BTU Code and that my license is in full force and effect. BTU 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:$8500 permit is issued. APPLICANT CERTIFICATION APN Number:36222023.00 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 DA OM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Zo –l� � Issued by: Date: Signature Date L{ 2 ❑ 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 I 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 ner or au orized agent: forthwith comply with such provisions or this permit shall be deemed revoked. � Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 u—the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c.,...s,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 Li 124/1 Licensed Professional CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36222023 . 00 DATE ISSUED. . . . . . . : 04/20/2010 RECEIPT #. . . . . . . . . BS000010230 REFERENCE ID # . . . : 10040127 SITE ADDRESS . . . . . : 1154 HUNTERSTON PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER SCHOLL DAVID P AND TINA M ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5069 RECEIVED FROM . . . . : APLUS HEATING&AIR-C CONTRACTOR ADAM P. PHAM LIC # 31293 COMPANY . . . . . . . . . . : A PLUS HEATING & A/C ADDRESS 244 GREAT MALL PKWY CITY/STATE/ZIP . . . : MILPITAS, CA 92683 TELEPHONE (408) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 500 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 8, 500 .00 0 . 90 0 . 00 0 . 90 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 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 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE 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 358 . 90 0 . 00 358 . 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 358 . 90 #1284 --------------- TOTAL RECEIPT 358 . 90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL H CITY OF CUPERTINO d k:. FURNACE/AC CUPEI�TINO PERMIT APPLICATION FORM APN # _ Date: -)/1 C) L41/ L Building Address: 115 vrrk-e��1 Owner's Name: y O � # C-h CA l •W t46 A y Contractor: Phone#:� a q?y A ? N s Fax#: C-11 Contractor License#: Cupertino Business License#: Contact: p Phone#• LI 0< 13 - 5-19\J bOAV 1 Do-d �G- CFax #: 1`{� QDI ��( �OV Building Permit Info: Elect Plumb Mech Residential Z Commercial ❑ Job Description: AJ C— SAyy\e For Residential Installations: Attic El1St floor � 2"d 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 Construction (Usage Class): Strapped ❑ On Platform ❑ Bonded New Location❑ Replacement-, Project Size: Express ❑ Standard ® Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO A SU-1 FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst<=100k BTU install or M lrelocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst> l 00k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO 15-11, FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= 1 Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B / 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M IPPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B