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07090046 CITY OF CUPERTINO BUILDING DIVISION PERMIT C�11C GT+QI ��C» TUI�� ; PERMIT NO. BuluTf1V'9EsCOLLINGSWORTH ST ATLAS—TF.ILLO HVAC 07090046 bb PERMIT ISSUE DATE OWNER'S NAME: LEONG THEODORE E TRUSTEE 1965 KYLE PARK CT 09/10/2007 SANITARY NO. CONTROL NO. NE: (408) 286-8931 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description 1 U j I hereby affirm that I am licensed under provisions of Chapter 9(commencing :z m with Section 7000)of Division 3 of the BusLiciness and Professions Code,and my license is REMOVE F: REPLACE FURNACE r l a. in full force and e t ? Licen I •S O Date Contractor 1 F ARCHITECTS DECLAkAT ON i�< I understand my plans shall be used as public records >yU a H Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 3 p 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 > prior to its issuance,also requires the applicant for such permit to rile a signed statement t'q,Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 •t $3000 t-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 617 0 5:; �Number Occupancy Type not more than five hundred dollars(SW. ❑1,as owner of the property,or my employees with wages as their sole compensation. will do the work,and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cade:)The Contractors Li- ccuse 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 contractors License Law. ❑1 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: have and will maintain a Certificate of Consent to self-insure for WorkeesCompen- on,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. #C] �havc and will maintain Workers Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. Worker ompensauorance ca 'er and Policy number arc: Carrier. Policy No.: CERTIFICATE O EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 Workers Compensation provisions of the Labor Code,you mast Qforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Fr.�•+ I hereby affirm that there is a construction lending agency for the performance of - fY.> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Lenders Address U 0 1 certify that 1 have read this application and state that the above information is L correct.1 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 W ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against r liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in co ye c of the granting is permiL Date APPLIC DERST AND WILL COMPLY WITH ALL NON-POINT Issued by SOUR R U TI 0 Re-roofs Sig AppIicant/Contractor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as deftncd by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes []No /5;;, 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- /ff nia Health&Sam(ty Code,Sections 25505,25533 and 25534.1 understand that if the building 1 U does not coftntly have a tenant,111 it is my responsibility to notify the occupant of the mquimm i ch must bt ytt�rfo'r to Issuance of a Ccrtirwate of pan Signature of Applicant D to All roof coverings to be Class"B"or better Owner thorized age — Date CITY OF C UPERTINO 0 c)`� �0 �(,,o URINAI RM CUPEk 1N0 PERMIT APPLICATION PO _ Date:,; Building Address: - - � � l Owner's ame: 7 �f Phone#: 7T -�/ 6�- Phone: I Lteense yq Contact: Phone\ C Cupertino Business License #: Building Permit Info: Bldg ❑ Elect �— PI Amb -- Mech - Job Description: ;p_f K Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor❑ Adhere to min set back requiremeMd For Commercial Installations: :placement same weight ❑ Additional weight(stnictural cales) ❑ otructural Calculations required for new installation C� New installation Planning Approval Required ❑ Cost of Project: 6 U Type of Construct on: Occupancy group: Strapped ElOn Platform LJBonded r=4 - Sq.Ft. Floor Area: New Location ❑ Replacement El� Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En;rgy BUILDING BREMFURN Fwnace MECHANICAL BREMACOVER AX- Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Se.smic Fee Res BUILDING BSEISMICOM Se.smic Commercial BUILIDNG / EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Moch Permit Issuance MECHANICAL I PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS GEs Piping System Fee PLUMBING BUSLIC Blsiness License BUILDING CITY OF CUPERTINO 6 ITEMS OF 20 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN 35E17053 .00 DATE ISSUED. . . . . . . : 09/10/2007 RECEIPT #. . . . . . . . . : BSC00002600 REFERENCE ID # . . . : 07C90046 SITE ADDRESS . . . . . : 21, 06 COLLINGSWORTH ST SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LEONG THEODORE E TRUSTEE ADDRESS . . . . . . . . . . : 21, 06 COLLINGSWORTH ST CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4709 RECEIVED FROM . . . . : ATLAS-TRILLO CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269 COMPANY . . . . . . . . . . : ATLAS-TRILLO HVAC ADDRESS . . . . . . . . . . : 19E,5 KYLE PARK CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408)286-8931 FEE ID UNIT QUANTITY I,MOUNT 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 3, 000. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 MPERMITFEE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 172 . 04 0. 00 172 .04 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 Community Development r 10300 Torre Avenue x >, Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-,UPEkTINO Building Department JOB ADDRESS: PERMIT # z1-70U u 1 [ in sw �� 7 t, II) �P OWNER'S NAME: U'Y1 e U PHONE # .2 GENERAL CONTRA OR: A f - ( !) k VAC FAX # 7< I am not using any subcontractors: U i€;na Date Please check applicable subcontractors and co m Mete the following 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 LQV� er/Contrac or ignature Date