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07080168 CITY OF CUPERTINO ISUILGiNG DIVISION PERMIT PERMIT NO. BUILQ( (1QD N RWATERFORD DR ATLAS—T RI LLO HVAC 07080168 / j UU PERMIT ISSUE DATE OWNER'S NAME: L00 WEI Z AND REIKO M TRUSTEE 1965 KYLE PARK CT 08/17/2007 SANITARY NO. CONTROL NO. NE: (408) 286-8931 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH L (� 0 Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 vI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is R/R FUR NAC E y in full force and n z License Cliss Lic.N p Date Contractor FRCHITEUFS DECLAR 1 N I a< 1 understand my plans shall be used as public records iA.0 u.y Licensed Professional o a OWNER-BUILDER DECLARATION a 1 hereby affirm that 1 am exempt from the Contractors License Law for the :p o following reason.(Section 7031.5,Business and Professions Code:Any city or county : which requires a permit to construct,after,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation ?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $2200 i F= essions Code) r (commencing with Section 7000)of Division 3 of the Business and Profu that he is exempt therefrom and the basis for the alleged exemption.Any violation of p pN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 616 0 3 :iJ l7' not mon:than five hundred dollars(3500). ❑f,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 Required Inspections 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work Com nsauon Insurance carrier and Policy nu ber are: f Carrier: Policy No.: CERTIFICATFUFb EMPTION 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 ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY [~t — I hereby affirm that there is a construction lending agency for the performance of (Y.> the work for which this permit is issued(Sec.3097,Civ.C.) LL7 Q Lender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is Ci. correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City / U Z in consequent of the granting of tht mit. Date + APPLICA DERSTAND D WILL COMPLY WIT ALL NON-POINT Issued t y: SOURC IR G L ON Re-roof 3 �. Signatu pplicani/Contrac I DaO Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roo-is installed without first obtaining an inspection,I agree to remove Will the applicant of f ure building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑ I have"d the hazardous materials requirements underChapter 6.95 of the Califor- nia Health&Safety Code,Sections 25 25533 and 25534.1 understand that if the building d icurrently have a tcna a is my responsibility to notify the Occupant of the Date tri m which et prior to issuance of a Cc (Occup y. SignatureofApplicant '- All roof coverings to be Class"B"or better Owncr or authorized age Date CITY O:? CUPERTINO 6 ITEMS OF 14 PERMCT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: BLk: Lot: APN 35616013 . 00 DATE ISSUED. . . . . . . : 03/17/2007 RECEIPT #. . . . . . . . . . B.3000002416 REFERENCE ID # . . . : 0'7080168 SITE ADDRESS . . . . . : 7530 WATERFORD DR SUBDIVISION . . . . . . CITY C'JPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LOO WEI Z AND REIKO M TRUSTEE ADDRESS . . . . . . . . . . : 7530 WATERFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5234 RECEIVED FROM . . . . : ATLAS - TRILLO CONTRACTOR . . . . . . . : T:�ILLO, STEVE LIC # 4269 COMPANY . . . . . . . . . . : APLAS-TRILLO HVAC ADDRESS . . . . . . . . . . : 1365 KYLE PARK CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : ( 108) 286-8931 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 . 86 0. 00 34 .86 0. 00 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BSEISMICRE VALUATION 2, 200. 00 0.50 0. 00 0.50 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 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 164 .78 0. 00 164 .78 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERT INO URNA-C.f"9 CUPEkTINO PERMIT APPLICATION FORM 67tk (o A ?N # Date: Building Address: Owner's ame: Phone f Cupertino Business License #: Contac : Phone: � U Building Permit Info: Bldg ElElect :'lumb Mech Job Description: -� Residentia Commercial ❑ For Reside tial Installations: Attic ❑ 1st floor ❑ 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: eplacement same weight EJ Additional weight(s:ructural calcs) ❑ -cructural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Cop2tion: Occup Strapped ❑ On Platform ❑ Bonded L Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Fee Group Applicable Fee ID Fee Description P BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER IJC Unit> 10,000 cfm MECHANICAL BREMAIRHAN AJC Units <= 10, 000 cfin MECHANICAL BREMRECEPT I:ecptl, Switch & Outlets ELECTRICAL BSEISMICRE �;eismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL / MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Ilan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEKTINO Build:in De artment JOB ADDRESS: PERMIT # IlAkv-rn,/j- A --7/9 OWNER'S NAME: PHONE # -44/ GENERAL CONTRACTO : aJ` 14AC FAX # I am not using any subcontractors: ature Date Please check a licable subcontractors an coni lete the To,owin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ate Owner/Contr Wr Signature