04120095 CITY OF CUPERTINO �• rs ♦ �' sen '� /pry"�'6 (•
BUILDING DIVISION PERTCO1VT12A
BUIDINGADDRFSS: ATLAS HEATING PERO"T"004120095
7765 ORION LA
NER'S NAME: PERMITISSUE DATE
GEORGE CUAN 155 SAN LAZAR
PHONE: SANITARY NO. '--CONTROL NO.
(408) 739-0516
ARCHT ECTIENGINEER: /.;•,• - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH.
L000 LICENSED CONTRACTOR'SDECLARATION JobDescri tiom
F ' I Mm y fi m Nal 1 am limned under p sof CMpxr 9(commencing p
iW with Sccf T )af Division3of NCBuan":a9a50g ti,u Code.andmYlicuxis -- - - - —� _-
.« kfnnrae erre . ✓✓✓ ��- 37 FURNACE-A/C •?
j�_ Lkcn
A CHITECTS OECLAR /
u1 underwnJ Y pians dull ne ourtl az P trite C� p
3�t; Licensed Protrsd...I
OWNER-BUILDER DECLARATION
iy I hereby mffl m that I am acmpt from than Conuanots License Law for the -
p o fallowing came.(Section 7031.5,address and Professions Code:Any city or County b
which inquires a permit to commuct,altar,improve,demmL h,or repair any structure
prior o its issuance,also requires the applicant for such permit.0I.a signed smement
that he is licensed pursuant to lnc pmvisions of the C'noncwr's License LA"(Chapter 9 Sq.Ft. Floor Area V `�JValuation
%5� (Commencing with Section 7000)of Division 3ofthe Business and Professioru Code)or
i tut be is exempt therefrom and Ne toadbs for the alleged exemption.Any violator of
Semu.n 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of
not mac thm row hundred dollars($5W).
Bi - Occupancy Type
p I,azownerofllupmpmy,amYemployaswiNwagauftGmkc tendon,
will do the work and the swctum Is not intended oroffered forsmo(Sec.1044,Business
And Pmfessiom License,Tho Committees L: n. Law des oMI Appy In An. .of Required Inspections
,unfairly who builds orimproves themon,andwho d.essuch work himselfor through his
Own employees,provided thatsuch improvements are not intended or.@n:d forsala If.
howewn Ne building or improwmem is sold within one you of compicdon.Ne owner-
builder will have du burden of moving tut he did on build or improve for purpose of
ale,).
1,is;owner of the pm,mrt-am excluiwly mnpxung with]!Caused contractors m
contract doe project(Sec.7044.Business and Rofailou Code:)The Contractor's Li.
Came Taw does not apply in an owner of Property who milds or improves menton,ted.
who contracts for men pojeeu with a eonuactor(s)licensed pursuant to the Comrml.es - -License Law. -
0lamacmptundoSec. •Bg,PCfalbismamn
nm Data
WORKERS COMPENSATION DECLARATION — - - —
I kreby a(Eom under penalty of perjury ore of du following declanuou:
l ham and will mainuin a certificate or Cation to self-imma for WorkefsCompcn-
alion,az provided(a by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑I have and will mainuin Worker's Compenauon Imunnce,az requited by Section -
37Wofthela1orCade,for the performance of the work for which this permit is issued - - -
MyWorkees�COMPFN
cc carrierd Policy nu, r
�rt)gr: iny No.: WO ��ya�ccS'
NFRO WORKERM S'
SURANCE
(Thus Auction need not W enio lead iftoe permit is formic hundred dollars($1,10)
or less)
I acrd•that in the performance of the work for which this permit u issued.I shall not
employ any person in any mannerm az in become subject o the W.rkers'Compenaton
Laws of Califomia.Dau _
Applicant
NOTICE TO APPLICANT:If,afar making this Ceni0cate of Exemption,you should
become subject in the Worker's Compcotsation provisions of to Labor Code,you must
.J Z, forthwith comply with such provisions or Nis permit shall he dccmcd rcvnkcd.
Z O CONMUCT1ON LENDING AGENCY
[-+ I hereby aRrn that Nam is a construction lending agercy,for to Perform==of
W the work for which this permit is isoucd(Sec.3091,Civ.C.)
fA lender's Name
0. Lender's Address
C.)Q 1 certify that I haw rod this city
and county
and duan thm Inc show iws retaiing in
0 F Wilding
I ague to comply with all miry and ceumy ominarcas and sou laws upon t e
C.) alow-gconswmiro and herfou by impaction purposes.
CL
this city ocnluupon the
}C above-menudgm pmpedyfani impaction purposes.
(We)agree o ave.indemnify and keep humluss the City of Cup udn.against
))
Uh Iiabmocaju,e of U,cro and expenses which may in any wayattn¢agaiul aid City
CJ2 in eonxquence of toe grmting of this permit.
" APPLICA -pNDERST NDS AND WILL COMPLY' LTH ALL NON-POINT Issued by:s4vzDate
SO E�uUwLAT�IONS.
"nugy;.fA Puca Ucomie , v'� D Re-roofs
fe
HAZARDOUS MATERIALS DIS CL URE Type of Roof
Will do Applicam or future building occupant stere or handle huaodo0S material
Art defined by the Cupenino Mu 'dpal Code.Chapter 9.11,and do Health and Safay
-.nee.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Dy.
Will thea rant or r Item ildk Occupant use a If a roof is installed without first obtainingan inspection,I agree to remove
pP g p a Air u or deka which 13e
emir haardous air contain'mus az JchnN by Ne Bay Area Air Quality Managcmcnt all new materials for inspection.
Disuia?
❑Yes ��``,,,If//JP///yyy,.y(I� '
1hewoatthe WAaN Jmaanrialsmquiomcmaunacr Chapwr6,95of Nc Califory
nu H.t &Safety Cak,3ttuuns2N15,35533md2534.1undasund NaifNc Wilding
Jou hot curendy naw a hu me ot h id my nese irobilky b mtiry the occum (the
rcyorcmcvnknmur azmeor .rp = of
Signature of Applicant Dater
naor Gutheyed agent aS
All roof coverings to be Class "B"or better
CITY OF CUPERTINO
1• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 4
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36218043.00
DATE ISSUED. . . . . . . : 12/15/2004
RECEIPT #. . . . . . . . ..: 28049
REFERENCE ID # . . . : 04120095
SITE ADDRESS . . . . . : 7765 ORION LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GEORGE CUAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ATLAS-TRILLO
CONTRACTOR . . . . . . . : TRILLO, KELLY LIC # 4269
COMPANY ATLAS HEATING
ADDRESS . . . . . . . . . . : 155 SAN LAZARO AVE
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408)739-0516
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
__________ _____________ __________ __________ __________ __________ __________
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00
BREMFURN NO UNIT 1.00 14 .31 0.00 14.31 0.00
BENERGY PERMIT FEE 1.00 34 .86 0. 00 34 .86 0.00
BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICRE VALUATION 8, 000.00 0.80 0.00 0.80 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 176.54 0.00 176.54 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -_____-____--_____
CHECK 176.54 3473
TOTAL RECEIPT 176.54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
-� CITY OF CUPERTINO
FURNACE /AC 7
• CUPEkTINO PERMIT APPLICATION FORM
APN # O� � Dale: ,
Building Address: '
'19 (b-5 O % Or> L-CrQ-
Owner's Name: Phone #:
a - a �
Contractor: License #:
13"7
Contact: Cr Phone#:
N—ny-N mo- -z-
Applicant/Contractor:
Building Permit Info:
Bldg lec Plumb Mec
Job Description:
Residential: Ra'' -fr) , A A Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
` Type of Construction: Oc pancy G g
Qt
li able Fee ID Fee Description Fee Grou
/ BENERGY Energy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm
\ MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Ouilets ELECTRICAL
—" BSEISMICRE Seismic Fee Res BUILIDNG
EPERMITFEE Elec Permit Issuanec ELECTRICAL
MPERMITFEE Mech Permit Issuanc:,: MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
BPERMFEE Bid Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG