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07060223
CITE'OF CUPERTINO BUILDING VISPON PERMIT CO. D1GT R I EUI M iTIEIN PERMIT NO. BUILL1trl1�ApST — )hTTE AVE ATLASTF.ILLO HVAC 07060223 l PERMIT ISSUE DATE OWNER'S NAME: DANIEL SO 1965 KYIdE PARK CT 06/26/2007 SANITARY NO. CONTROL NO. INE: (408) 28E -8931 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH i p 0 LICENSED CONTRACTOR'S DECLARATION Job Description UF I hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Section 70(()) f Division 3 of the Busincst and Professions CAdc,and my license is REMOVE S: REPLACE FURNATE, ADD 3 TON A/C UNIT. w in full force and t n z License Cl Lic.# - LLu Date Contractor ARCHITECTS DECLARAtl(514 i a a I understand my plans shall he used as public records �yU ti Licensed Professional OWNER-BUILDER DECLARATION 'r I hereby affirm that I am exempt from the Contractors License Law for the p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county 9 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 file a signed statement r>q.Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $6000 Z F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 691104(1 �Number Occupancy Type not more than five hundred dollars(5500). ❑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 forsate(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.). ❑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 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: N I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- a' as provided for by Section 3700 of the Labor Code,for the performance of the w for which this permit is issued. 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. y Work es Compensation Insuran a Cartier and Policy mbet Carrier. Policy No.: CERTIFICA F EXEMPTION FROM O ERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY 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.) QLender's Name a z Lender's Address U C) I certify that 1 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 Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. C1. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,ju is.costs and expenses which may in any way accrue against said City U Z in cone ce c grantin 's permit. Dace ►– APP5�� COMPLY WITH ALL NON-POINT Issued by:SOU - Re-roofs Signature of Applicant/Contractor Type of R sof HAZARDOUS MATERIALS DISCL URE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino u opal Code.Chapter 9.12,and the Health and Safety Code,section 25532(a>7 All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant or future building occupant use equipment or devices which If a roof i.,installed without first obtaining an inspection,I agree to remove - emit hazardous air contamina defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth& e Codc.Section 25505,25533 and 25534.1 understand that if the building does not haeage my responsibility to notify the occupant of the requi c awhi oissuanceofaCeruliicateof cupaney SignatureofApplicant Date All roof coverings to be Class"B"or better Owner or authorized — Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 36511040.00 DATE ISSUED. . . . . . . : 06/ 26/2007 RECEIPT #. . . . . . . . . . BS(100001809 REFERENCE ID # . . . : 07060223 SITE ADDRESS . . . . . : 10`_•51 BETTE AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DANIEL SO ADDRESS 101)51 BETTE AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4501 RECEIVED FROM . . . . : ATI,AST-TRILLO CONTRACTOR TR==LLO, 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 ��.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -•--------- ---------- ---------- ---------- BENERGY PERMIT FEE 38.37 34 .86 0. 00 34.86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMFURN NO UNIT 1. 00 14.31 0. 00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1 .20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 6, 000. 00 0. 60 0. 00 0.60 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 176 .34 0. 00 176 .34 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 176. 34 #8793 --------------- TOTAL RECEIPT 176 .34 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 CUPERTINO 7 c)6 --03 U NACEfAC PEkT CUP PERMIT APPLICATION FORM APN# ` J Date: Building Address A_ „O Owner's Name: �/T Phone #: T) Contractor. Phone. Licens 9.- ) (o AV A C (q-0 � ti � n Co act: Phone: Cupertino Business License#: z4� Building Permit Info: Bldg ❑ Elect [ ' Plumb CEJ-'.,._ Mech Job Description )q_ Ak a jlu r Residential .�r Commercial t For Residential Installations: Attic El St floor El 2d floor El Adhere to min set back requirement For Commercial Installations: _eplacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of P ct: Typeti oon:f ConstrucOccupancy group: �_3 Strapped ❑ On Platform Bonded ©' Sq.Ft. Floor Area: New Location Re lacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Fi rnace MECHANICAL BREMACOVER A C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R,;cptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Scismic Commercial BUILIDNG EPERMITFEEf, El ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING IL BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC B asiness License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY Of "UPEI�TINO Fax(408)777-3333 Building Department JOB ADDRESS: 1�-�f-�C e PERMn 706IT# �� 0 ��3 OWNER'S NAME: ( PHONE # z� r GENERAL CONTRACTOR: - / Zj tAIr, FAX# , I am not using any subcontractors: 1,2 Si€n e ate Please check applicable subcontractors and com lete the o Win 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 ' e Owner/Contractor Signature 6ate