12020124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20607 PARADISE DR CONTRACTOR:ATLAS-TRILLO PERMIT NO: 12020124
HVAC
OWNER'S NAME: KENNETH TAN 1965 KYLE PARK CT DATE ISSUED:02/28/2012
ow ' .R'S PHONE: 4085646935 SAN JOSE, CA 95125 PHONE NO:(408)286-8931
LICENSED CONTRACTOR'S DECLARATION I
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 'q
NIEC119 RESIDENTIAL COMMERCIAL.
Contractor A-4f&1 fiYl,1(6 AVAC Dat'x/.—zu 1-2,
JOB DESCRIPTION: INSTALL A/C UNIT A'r SIDI?YARD
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
AP\Number:35)I5011.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theVv �_ —f Z
granting of this permit. Additionally,the applicant understands and will comply Issued by: tiL Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 1.� All roofs shall be inspected prior to any roofing material being installed. 11'a roof is
installed without first obtaining an inspection.I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
I,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&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California health&Safety Code,Sections 25505,25533;and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,, coon�2551-1,�2555533 �d2551�4
Section 3700 ofthe Labor Code,for the performance of the work for which this L
Date:
Owner or authorized ag
permit is issued.
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHI TECI''S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35915011 . 00
DATE ISSUED. . . . . . . : 02/28/2012
RECEIPT 4 . . . . . . . . . : ES000016136
REFERENCE ID # . . . : 12020124
SITE ADDRESS . . . . . : 20607 PARADISE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : KENNETH TAN
ADDRESS . . . . . . . . . . : 20607 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ATLAS-TRILLO
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : ATLAS-TRILLO HVAC
ADDRESS . . . . . . . . . . : 1965 KYLE PARK CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 286-8931
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ------- ---
1ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00
1BCBSC VALUATION 5, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 . 00 65 . 00 0 . 00
1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
TOTAL PERMIT 195 . 50 0 . 00 195 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 195 . 50 8493
---------------
TOTAL RECEIPT 195 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
12 I FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20607 Paradise Drive DATE: 02/28/2012 REVIEWED BY:
APN: BP#: VALUATION: 1$5,000
PERMIT TYPE: Mechanical Permit =PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK Install AC unit at side yard.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 # $65
TOTALS: $65.00
N,Ieeh.Plata Check ET
hrs $0.00
Mech.Pen-nit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs 1 $44.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public FVorks,Fire,Sanitary Sewer District,School
District,etc.). These -ees are based on the relinina information available and are o!A an estimate. Contact the LeEt Lr addn'l info.
MISC ITEMS
- :FEE ITEiS
PME Plan Check: $0.00
LJ
PME Unit Fee: $65.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00
Work Without Permit? 0 Yes G No $0.00
Travel Documentation Fee: ITRA VDOC $44.00
'on -u: IBSEISMICR $0.50 Select an Administrative Item
Fe-ea I BCBSC $1.00
SUBTOTALS: $1 95.501 $0.00 TOTAL FEE: $195.50
Revised: 1/19/2012
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Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones I and 3-7
dEnfor ernent Agen y: Da Permit#:
te,4 r•es '
Conciftioned Duct insulation
Thermostat
E ui ment T eList Minimum Efficienc z Floor Area reguirement
❑Packaged Unit Over 40 ft of ducts ❑Setback
❑Furnace ❑ ❑COP Served by system added or replaced in
❑Lpdoor Coil ER� ❑HSPF - (If not ah eadp present,must be
� sf unconditioned space installed)
ondensing Unit ❑EER ❑Resistance ❑R 6' (CZ 1,3-5)
❑Other
L Equipment Type: Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each systema
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
Y I am eligible under Division 3 of the California Business and Professions.Code to accept responsibility for the design identified on this
Certificate of.Compliance.
and performance specifications for the design identified on this Certificate of Compliance conform to the
I certify that the energy features
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
a The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the pen-nit
application.
Signature:
Name:
Company:
Date: ;7 4,
Addres :�f r :' '-"' .�• .License:
/e
Pho
L2t2l/_S�tIlle/
:
BY: t
OFFICE 'COPY"
'Ofit;, l�r;,rrlerrtrrl I orrrhlurnre T'm'rii,� --
GENERAL PERMIT APPLICATION MEP
LM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(cDcupertino.org
MISC
CUPEitTINC3
1202012`/
PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS J - FaT,
7yyt_ - 7APN9 15011
OWNER NAME PHONE ,+�� E-MAIL Ice
STREET ADDRESS G ,
CITY, STATE,ZIP � �.�/,� � FAX
CONTACT NAMF Pf E J E-MAIL
STRE T ADDRESS CIT ,STATE,ZIP /63 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCu ONTRACfOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEn //ti LICE SE M LICENSE Ty�PE BUS.LIC#
37
COMPANY NAM E-MAIL FAX
STREET ADDRESS q CITY,STATE,ZIPt7t
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. C#
i
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: E]COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: RECEIVED BY:
'f2�
By my signature below,I ertify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have p s c ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b i In on. I authorize representatives of Cupertino to enter the above id I e 'pr erty r inspection purposes.
Signature of Applicant/Agent: Date: •G
SUPPLEMENTAL INFORMATIO D OFFICE USE ONLY
OIS VER THE-GY)LWER
a
❑ EXPRESS
W
� ❑ STANDARD
❑ LARGE
a
MAJOR
MEPMiscApp_2011.doc revised 06/21/11