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07090048 CITY OF CUPERTINO BUILDING DIVISION PERMIT 1'' TRQ2 I� }�ZMTf31�I� PERMIT NO. BUILDING DDRESS: y1� FT BAKER DR ATLAS—TF.ILLO HVAC 07090048 PERMIT ISSUE DATE OWNER'S NAME: MIAOKI SHIMAZAKI 1965 KYIhE PARK CT 09/10/2007 SANITARY NO. CONTROL NO. JE: (408) 28E -8931 BUILDING PERMIT INFO ARCHITECT/ENGTNEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description UF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z,UW with Section 7000)of Division 3 of the Business an4 Pro(essiuns Code,and my license is ADD A/C UNIT. =y in full force and "- v�z Licen G Lic.# O Da U Contractor ARCHITECT'S DECLA ATI EN d< I understand my plans shall be used as public records tyU u.y Licensed Professional O a OWNER-BUILDER DECLARATION 1 hereby alTIrm that 1 am exempt from the Contractor's License Law for the :p O following reason"(Section 7031.5,Business and Professions Code:Any city or county % 0! which requires a permit to construct.alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement:XM .Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. $5000 2 (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 6110 3() ( Number Occupancy Type not more than five hundred dollars(5500} ❑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 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.U. 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.). (:11.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 conuactor(s)licensed pursuant to the contractors License Law. ❑I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- on,as provided for by Section 3700 of the Labor Code,for the performance of the for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. My Worke ompensauon InsZancr and Policy nu b are: Carrier: PolicCER I CATEMON I l;OM WOR CERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) 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 O forthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY E~"CA 1 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 Lender's Name az Lenders Address U C) I certify that 1 have read this application and state that the above information is vt h—' correct.I agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorize representatives of this City to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and p harmless the City of Cupertino against (/) liabiliti udg cnts,costs and expert ich may in any way accrue against said City U Z in con qucncc C the granting gftl'fI rmit. APP CA RST ND WILL COMPLY WITH A NON-POINT Issued by: Date ly_ ?4,e,7,7So CE E L 6 Re-roofs Sig of Applicant/Comra r 6atc Type of R sof HAZARDO 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(a)? All roofs:ihall be inspected prior to any roofing material being installed. ❑Yes ❑No If a roof i:.installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Secti 25505,25533 and 25534.1 understand that if the building ql1ok7 docs not c ntly have a ten that it is my responsibility to notify the occupant of the _LD require n hich mus met prior w issuance of nM�� Dat Signature of App ' nt.All roof coverings to be Class"B"or better Own uthorized CITY OF CTPER'TINO 070 ? 0 o�q FUR CUPEkTINO PERMIrT APPLICAPTION FORM 'N# Date 35-10110 0 0 Building Address: q10' Name: Phone #: Owner S rvt Gc - k� z T "All at I ; t13-7 a VAC Cont ct: Phone: j Cupertino Busines Lice se#: —M�+/ Building Permit Info: Bldg ❑ >✓1�t—� Ply MecT— ' Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor❑ Adhere to min set back requirement For Commercial Installations: ,placement same weight ❑ Additional weight(stnictural calcs) ❑ ,cructural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of ConsfA,ictpn' � Occupancy group: Q U � Strapped ElOn Platform Bonded Sq.Ft. Floor Area: New Location Replacement E Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En;rgy BUILDING BREMFURN Funace MECHANICAL BREMACOVER AX-Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/'� Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Se.smic Fee Res BUILDING BSEISMICOM Se smic Commercial BUILIDNG EPERMITFEE Eloc Permit Issuance ELECTRICAL MPERMITFEE Mf:ch Permit Issuance MECHANICAL PPERMITFEE Plimbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK PlEn Check Fee BUILDING BP AQ Gzs Piping System Fee PLUMBING BUSLIC Business License BUILDING CITY OF CUPERTINO 7 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bll:: Lot: APN 35E11030. 00 DATE ISSUED. . . . . . . : 09/ 10/2007 RECEIPT #. . . . . . . . . . BS000002600 REFERENCE ID # . . . : 07090048 SITE ADDRESS 910 FT BAKER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MIl,OKI SHIMAZAKI ADDRESS 910 FORT BAKER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4010 RECEIVED FROM . . . . : ATLAS-TRILLO CONTRACTOR TR::LLO, STEVE LIC # 4269 COMPANY ATLAS-TRILLO HVAC ADDRESS 1965 KYLE PARK CT CITY/STATE/ZIP . . . : SAP1 JOSE, CA 95125 TELEPHONE (408)286-8931 FEE ID UNIT QUANTITY liMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1 .20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 5, 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 169 .19 0. 00 169 .19 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 510.42 #8929 --------------- TOTAL RECEIPT 510.42 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEKTINO Buildin De artment JOB ADDRESS: PERMIT# ►� J� Grp OWNER'S NAME: PHONE # S.. -q3 1 S GENERAL CONTRACTOR: .Aq j j VW FAX # I am not using any subcontractors: Signa 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 Til er/ actor Signature ate