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07090149 T77777777777 777=77777777777�:,::::-: CITY OF CUPERTINO BUILDING DIVISION PERMITN (}RTI4: ' PERMIT NO. BUILp,I[dG�rDp� 'hNT AVE ATLAS TRI LL0 HVAC 07090149 jj y YSKPERMIT ISSUE DATE OWNER'S NAME: BHUTANI RUCHI 1965 K'LE PARK. CT 09/21/2007 SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: ADD A/C UNIT BLDG ELECT PLUMB MECH p zO LICENSED CONTRACTOR'S DECLARATION lob Description U C I hereby affirm that i am licensed under provisions of Chapter 9(commencing _,(�� with Section 7000)of Division 3 of the Business and Professions Code.and my license is =y in full force and effecf 1 License i•ic•S C F p Datc 3 4 Contractor Q ARCHITECTS DECLARATION i < l understand my plans shall be used as public records >yU U.y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the jp 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 Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation -_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area a t—tn (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 APN Number Occupancy Type not more than five hundred dollars($500). ❑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 ROI apply to an owner of q p 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 sal:.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's U- cense Law does not apply to an owner of property who builds or improves themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors 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: ❑1 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. ❑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 Workers ompensauon Insurances carrier and Policy number �am: CartM !�_Policy No.;f T�y1J/ L&Y CERTIFICATE OF EXEMPTION 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 Qforthwith comply with such provisions or this permit shall be deemed revoked. 7_2 CONSTRUCTION LENDING AGENCY 'r~-r 1 hereby affirm that there is a construction lending agency for the performance of _ G(, the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name z Lenders Address J 0 1 certify that 1 have read this application and state that the above information is t.rr 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. t7. (We)agree to save,indemnify and keep harmless the City of Cupertino against E"to liabilities,judg a is,costs and expenses which may in any way accrue against said City U z in conseq,c a granting of this permit. Date APPLICA ERSTAND WILL COMPLY WITH ALL NON-POINT Issued by G SOURCE EG A Re-roofs Signature of Applicant/Contractor Dale T of R oof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M ici 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 ❑ 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 defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? Cl Yes 1 have read the hazard• materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code,Sections 25505.25533 and 25534.1 understand that if the building docs not current ave a tenan at it E my responsibility to notify the occu t of the rcyuircmcn r ust prior to issuance of cru iicate of Signature of Applicant Date All roof coverings to be Class"B"or better owner o ho.. agent Date CITY OF CUPERTINO } F CF/ .0 IN CvPE1�TINO PERMIT APPLICATION FORM N # Date`. Ll Building Address: Owner's N Phone #: Conta t: Phone: 1 Cupertino Business License#: AAA ��( a Building Permit Info: Bldg ❑ Elect E�7�� Plumb �� Mech Job Description: mc�- J Residentialr Commercial ❑ For Residential Installations: Attic Ell st floor El2nd floor F-1 Adhere to min set back requirement For Commercial Installations: ,placement same weight E] Additional weight(strzctural calcs) -1 otructural Calculations required for new installation 11 New installation Planning Approval Required ❑ Cost of Proj t: Type of Com ction: Occup cy up: T Strapped ❑ On Platform ®' Bonded Sq.Ft. Floor Area: New Location ❑ Replacement 2-l" Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En-,rgy BUILDING BREMFURN Fu:-nace MECHANICAL BREMACOVER A/'- Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/"-Units <= 10, 000 cfin MECHANICAL BREMRECEPT Recptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Eloc Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Pl�m Check Fee BUILDING BPGAS GEs Piping System Fee PLUMBING BUSLIC Bi.siness License BUILDING CITY OF CUPERTINO 7 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36924042 . 00 DATE ISSUED. . . . . . . : 09/21/2007 RECEIPT #. . . . . . . . . : BS000002722 REFERENCE ID # . . . : 07090149 SITE ADDRESS 879 BRENT AVE SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BHLTANI RUCHI ADDRESS . . . . . . . . . . . 879 BRENT DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4552 RECEIVED FROM . . . . : ATIAS-TRILLO CONTRACTOR TRILLO, STEVE LIC # 4269 COMPANY ATIAS-TRILLO HVAC ADDRESS 19E5 KYLE PARK CT CITY/STATE/ZIP . . . : SAT JOSE, CA 95125 TELEPHONE (4C8)286-8931 FEE ID UNIT QUANTITY FMOUNT 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 3, 900. 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL Community Development 10300 Torre Avenue as Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT #T OWNER'S NAME: A huja-vz-,' 1,-1` PHONE # GENERAL CONTRACTOR: A=4-(,!�s- n 1 I H LA C FAX # I am not using any subcontractors: Date Please check applicable subcontractors and co m )lete 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 Tile Owner on ignature Date