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09010025
CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: PERMIT ISSUE DATE OWNER'S NAME: A N CONTROL NO. 408) 286-8931 BUILDING PERMiTINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB0 MECH 0 u O p LICENSED CONTRACTOR'S DECLARATION Job Description m5 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z m with Section 70t1o)ofDivision 3 of the Business and Profession$Code.and my license is RMV R P LC FURNACE,ADD A/C UNIT D H in full force and eff" / 9134- License C1 t/ e Contractor Dat ARCHITECT'S DECLAAATl t I understand my plans shall be used as public records �yU O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the no following reason.(Section 7031.5,Business and Professions Code:Any city or county K.9 which requires a permit to construct.alter,improve,demolish•or repair any structure - prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq Y F-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $8400 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 70315 rty by aapplicant for a permit subjects the applicant to a civil penalty of APN Number not more than eve hundred dollars(M). 36616005 . 00 0 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.7(94,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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.70",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. 0 I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Workers Compen- ioo-,as provided for by Section 3700 of the Labor Code,for the performance of the vJ or which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3 of the Labor Code,for the performance of the work for which this permit is issued. My Work? ompe ation insuranc carrier and Policy number arc:7/� Cama; S` Policy No.-Mw (� CERTIFI ATE OP EXEMPT ION 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.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 Worker's Compensation provisions of the Labor Code,you must ',Z forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY Fes. I hereby affirm that there is a construction lending agency for the performance of Q!> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lcndees Address I certify that I have read this application and state that the above information is 0 correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives or this city to enter upon the W above-mentioned property for inspection purposes O m (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City ww� V z in con c o�DE of this permit. Date "V �-+ APP A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: S GU l9 Re-roofs — Sr aturcofApp tmetor - °ate T of Roof H MATERIALS DISCLOSURE Type 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 Cotte•Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. DYes e If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as dafmcd by the Bay Area Air Quality Management all new materials for inspection. ;trio? ❑Yes _ 1 havc mad the hazardous materials requimmcnts under Chapter 6.95 of the Califor- nice H & cty Cadc,Sections 25505.25533 and 25534.1 undcrstaand that if the building (/ d tb ndy havc t.that it is my responsibility to notify the occupant of the tri c mel prior to issuance of a Certificate f Occa cy. Signature of Applicant D to All roof coverings to be Class". 'or better Owner or authorized agent Date CITY OF CUPERTINO FURNACE/AC CUPEk INO PERMIT APPLICATION FORM APN# Date: 3 , � tooC) o � I o Build' Address: � Owner's Name: Va #:y-Contractor:4� 0' �[ V Contractor License#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect [ Plumb - ' Mech [ " Residential Commercial ❑ Job Description: For Residenti Installations: Attic 1St floor El2nd floor 1:1 Adhere to minimum setback re uirement For Commercial Installations: tl Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): 9 oo Strapped ❑ On Platform ❑ Bonded New Location Replacement Project Size: Express ©--Standard ❑ Large ❑ Major❑ Valuation: V� Green Building:IPlease complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revised 6/16/08 CITY OF CUPERTINO alo FURNACE/AC CUPERTINO FEE SCHEDULE Group FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B ►% f2- 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type f imace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M ' 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Quantity Fee ID Fee Descri tion Fee Permit Type INPUT Resources Eniergy ,O M. n oor Air uahty an Firms es 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes I I I k7770 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 1 0 1 1 Oil Total Points Available: 1401 130 57 Total Points Project Received:1 Of 01 0 a G:data/progs/greenbuildngguidelines/remodelers/greenpointsBnal212.Aprotected.xls —4 /�� CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36616005 . 00 DATE ISSUED. . . . . . . : 01/07/2009 RECEIPT # . . . . . . . . . . BS000006918 REFERENCE ID # . . . : 09010025 SITE ADDRESS . . . . . : 7582 WATERFORD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MURAMATSU EARL A AND SATOMI ADDRESS . . . . . . . . . . : 7582 WATERFORD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5234 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 400 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 8, 400 . 00 0 . 90 0 . 00 0 . 90 0 . 00 1EPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00 1MPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00 1MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 .38 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 287 .44 0 . 00 287 . 44 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 287 .44 #9682 --------------- TOTAL RECEIPT 287 .44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue a .„ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # n ot DY O R'S NAME: PHONELLZ GENERAL CONTRACTOR: Q/- W, C FAX# I am not using any subcontractors: Signature ate Please check applicable subcontractors and complete the followin 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 Sh�Tile t Rock 4ZU Owner/Contractor Signature ate