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07080167 CITY OF CUPERTINO y� �� r GT(jR j��} MA►TION. BUILDING DIVISION r ERMIT _ PERMIT NO. BUIL DtNGADD Ess: ATLAS HVAC 07080167 1055 FARALLONE DR PERMIT ISSUE DATE OWNER'S NAME: 08 17 2 0 0 7 PAUL TAKAC S I & KAI SA HOLMAN 19 6 5 KYLE PARK CT SAMTARY NO. CONTROL NO. NE: (408) 28EI-8931 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDGELECT PLUMB MECH L� P (� m Z LICENSED CONTRACTOR'S DECLARATION Job DCSCTIptIOn w p, I hereby affirm that I am licensed under provisions of Chapter 9(commencing U w with Section 7000)of Division 3 of the Business and Professio Code. nd my license is RTR FURNACE E / ADD A/C ;Z,u rn in full farce and eff,t v�Z License Chis Lin. p Datc (/ Contractor F4 RCHITECTS DECLARAT O i a< t understand my plans shall be used as public records yU U.i- Licensed Professional O< OWNER-BUILDER DECLARATION 3< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :n O following reason.(Section 7031.5,Business and professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation 9 $7000 t" prioto its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area ?a thatr he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 i tT- (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36939034`°C � not more than five hundred dollars(5500). 0 I,as owner of the property.or my employees with wages as their sole compensation, Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7044.Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Or improves tractors Li-. cense Law does not apply w an owner of property P who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason 0 I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: LJ I have and will maintain a Certificate of Consent to self-insure for Workers compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,Cor the performance of the work for which this permit is issued. My Worker's Compensation losurance cam r and Policy number are: Carrier. Polity No.: CE T KATE OF EXE ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of F(� the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name 0+ Lender's Address [certify that 1 have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (we)agree to save,indemnify and keep harmless the City of Cupertino against /n r+ liabilities,judgments,costs an which may in any way accrue against said City Date in consequence of the granting of his per tl. U Z APPLIC STANDS,AN ILL COMPLY WITH ALL NON-POINT Issued try: SOUR ONS v Re-cool's Signal re - pplI_VC actor Date 'I a of Roof HAZAR M:r."upaa,ERIALS DISCL SURE Type Will the applicant or future bur store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety � Ali roofs shall be inspected prior to any roofing material being installed. Code,Section 25532(a)? 0Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant oy uluro building occupant use equipment ordevices which all new materials for inspection. emit hazardous air contarrl[nantsas lncd by the Bay Area Air QualityManagement District? 0 Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safc C e,Sections 25505.25533 and 25534.1 understand that if the building does nol fly ha a tenant,that it is my responsibility to notify the occupant o[the Date require Lc w �ustbc �Pfiortosuance of a Certific of Oce ancy. Signature of Applicant All roof coverings to be Class"B"or better Date Owner trcd agent CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: CathyS 8 ITEMS OF 14 COPY # : 1 Sec: Twp: R.ng: Sub: Blk: Lot: APN 36939034 .00 DATE ISSUED. • • • • ' " : 08/17/0007 RECEIPT #. • • • • • " " : 07080167 2416 REFERENCE ID # • • • SITE ADDRESS 10`_,53 FARALLONE DR SUBDIVISION • • . . . " : CU]'ERTINO CITY . . . . . . . . . . . . IMPACT AREA • " OWNER PAJL TAKACSI & KAISA HOLMAN ADDRESS 10553 FARALLONE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 : AZLAS - TRILLO RECEIVED FROM • ' " : TF.ILLO, STEVE LIC # 4269 CONTRACTOR : ATLAS-TRILLO HVAC COMPANY 165 KYLE PARK CT ADDRESS • " " SIGN JOSE, CA 95125 CITY/STATE/ZIP ��08)286-8931 TELEPHONE . . • • • • • THIS REC NEW BAL UNIT QUANTITY AMOUNT PD-TO-DT -_____ _ FEE ID ---------- -- -----34 .86 0. 00 ---------- --------- ------1. 00 34 .86 0. 00 0.00 PERMIT FEE 0.00 10.26 BENERGY 1.00 10 .26 14 .31 0. 00 BREMAIRHAN NO.UNITS 14 .31 0. 00 0.00 NO UNIT 1. 00 0 .00 1.20 BREMFURN 1.00 1 .20 0 70 0. 00 BREMRECEPT NO. OUTLETS 0 70 0. 00 0 . 00 7 , 000. 00 0. 00 38 .37 BSEISMICRE VALUATION 1.00 3837 38 .37 0.00 1. 00 38.37 EPERMITFEE FLAT RATE 38 .37 0.0.0000 0. 00 MPERMITFEE FLAT RATE 1.00 38.37 _ ---------- PPERMITFEE FLAT RATE ---------- ------- - 176 .44 0.00 176 .44 0. 00 TOTAL PERMIT AMOUNT-- MOUN,r REFERENCE NUMBER - METHOD OF PAYMENT -_---_--_ ---_-_------ ----------------- - ---- 341 .22 8872 CHECK --------------- 341.�2 TOTAL RECEIPT VOICE ID DESCRIPTION ______-- VOICE ID DESCRIPTION______ _- -------- -------------------- ----------------------- -------- 304 ROUGH ELECTRICAL 303 ROUGH MECHANICAL 508 FINAL MECHANICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FUI CE/AC CUPEkTINO PERMIT APPLICAI,ION FORM 6 -77n GO ?N# 3 y 3763f - G.o Date: cc t -�-7 Building Address: / Owner's Name: Phone#: I Pfio ne, #: �., Contac : Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ P Mb ❑ Mech ❑ Job Description: ResidentiA Commercial ❑ For Residential Installations: Attic ❑ 1 st floor ❑ 2nd floor❑ Adhere to min set back requirement For Commercial Installations: eplacement same weight ❑ Additional weight (sbuctural calcs) ❑ otructural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Cons ction: Occupancy group: Strapped ❑ On Platform U Bonded Sq.Ft. Floor Area: New Location ❑ Replacement 191, Qty. if ApplicableFee ID Fee Description Fee Group bBENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A'C Unit> 10,000 cfin MECHANICAL BREMAIRHAN AC Units<= 10, 000 cfm MECHANICAL BREMRECEPT R 11cptl, Switch & Outlets ELECTRICAL BSEISMICRE S,;ismic Fee Res BUILDING BSEISMICOM S,-ismic Commercial BUILIDNG EPERMITFEE E.ec Permit Issuance ELECTRICAL MPERMITFEE M ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE B'.dg Permit Fees BUILDING BPLANCHK P'.an Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING