07060225 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � IE�}RMiT�ON:
PERMIT NO.
BUILLIINpDRNS:STELL ING RD ATLAS-TRI LLO HVAC 07060225
113 3 43 PERMIT ISSUE DATE
OWNER'S NAME:
LUIZ KATHARINA L AND LAWRENCE 1965 KYLE PARK CT 06/26/2007
SANITARY NO. CONTROL NO.
ONE: (408) 286-8931
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0
i p Q LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing R&R FURNACE E & ADD 4 TON A/C UNIT.
Z
with Section 7000)of Div'ion 3 of thc Business and Professions Code,and my license is
t
<0. in full force and e
? License Cl Lic.#
t- pam Contractor
R HITECTS DELLA AOR
)a< 1 understand my plans shall be used as public records
)WU
lo.O in Licensed Professional
OWNER-BUILDER DECLARATION
n r I hereby affirm that I am exempt from the Contractors License Law far the
pO following reason.(Section 703 1.5,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 FtFloor Area Valuation
-^a that he is licensed.pursuant to the provisions of the Contractor's License Law(Chapter 9 ;;q. . $7000
2 ts-� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Q 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 6 61110 2 .Aff Number Occupancy Type
not more than rive 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 for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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:
❑I 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 Worker's Insurance carrier and Policy number are:
Carrier;, (Co nsati /(�Policy No.: —
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 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 must
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
F.t►�- I hereby affirm that there is a construction lending agency for the performance of
pC r' the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Lender's Address
U Q 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
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
H ) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in co ce of the granting of this permit. Date V v ��
AP A UNDER STA AND WILL COMPLY WITH ALL NON-POINT Issued by
RCE GULATI 7 6 _
Re-roofs 1/
-Siblit're of Applican Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building occupant store or handle hazardous material
as dcftncd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes x1nants
Will the applicanilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conteefined by the Bay Area Air Quality Management all new rr.aterials for inspection.
District?
[:]Ycs
1 have rea a ous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&S c C Sections 25505,25533 and 25534.1 understand that if the building
docs not c nt It tenant,that it is ponsibilit 1' the occupant or the
requirem is wh c must mel p' uancc of a to cu Icy Signature of Applicant Date
All roof coverings to be Class"B" or better
Owner o zed agent are
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: BlY: Lot:
APN 36E11102 . 00
DATE ISSUED. . . . . . . : 06/26/2007
RECEIPT #. . . . . . . . . : BS000001808
REFERENCE ID # . . . : 07060225
SITE ADDRESS . . . . . : 134 S STELLING RD
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LU--:Z KATHARINA L AND LAWRENCE
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5204
RECEIVED FROM . . . . : ATLAS-TRILLO
CONTRACTOR . . . . . . . : TR--LLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : ATLAS-TRILLO HVAC
ADDRESS . . . . . . . . . . : 1965 KYLE PARK CT
CITY/STATE/ZIP . . . : SAIT JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)286-8931
FEE ID UNIT QUANTITY J1MOUNT 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 7, 000. 00 0.70 0. 00 0.70 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 176.44 0. 00 176 .44 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 176 .44 #8793
---------------
TOTAL RECEIPT 176.44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
CITY OF C UPERTINO
Vi FURNA.0 /AC
CUPEkTINO PERMIT APPLICATION FORM
�ll /
APN# � Date:
Building Address-
Owner's Name: Phone#: Z
Contractor: � Phone: License fl:
Contact: Phone: Cupertino Business License#:
7 02 �P
Building Permit Info: ,� J
Bldg ❑ Elect ! Plumb Mech
Job Description:
ResidentiaKUI Commercial ❑
For Residential Installations:
Attic ❑ 1St floor ❑ 2nd floor❑
Adhere to min set back requirement
For Commercial Installations: �,t
.Zeplacement same weight ❑ Additional weight(s rictural calcs) ❑
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
� o o 0
Strapped ❑ On Platform Bonded CT-s Sq.Ft. Floor Area:
New Location Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY En:,rgy BUILDING
BREMFURN Fumace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C 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 Plan Check Fee BUILDING
BPGAS GEs Piping System Fee PLUMBING
BUSLIC Bu siness License BUILDING