09040009 CITY OF CUPERTINO
BUILDING DIVISION PERMIT + L� J� I TQR x .
BUILDING ADDRESS: PERMIT NO.
10490 CASTINE AVE ATLAS-TRILLO HVAC 09040009
OWNER'S NAME: PERMIT ISSUE DATE
T AWR FNC F WONC QA /Q1
S A CONTROL NO.
`NE:
(408) 286-8931
ARCHITECl7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 70()0)of Division 3 of the Business and Professions Code,and my license is RMV/RI'LC F,URNC & ADD A/C
H in full force and e
Z License Cl Lic.fl
n t-a Date Al Contractor
ARCHITECT'S DECLARA ON
I understand my plans shall be used as public records
�yU
4 wo y Licensed Professional
n n 3 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
in O following mason.(Section 703 1.5,Business and Professions Code:Any city or county
e m which requires a permit to construct.alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5500
y 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(s500). 32641C32 . 00
❑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 Contractors License Law does not apply to an owner of Cl 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
sale.).
❑I.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-insum for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 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 Worke s ompensauo I urance c 'cr and Policy number am:
Carrier. _Policy No.:
CERTIFICATE O E PTION FROM WO CRS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic 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 Workcrs'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.
CONSTRUCTION LENDING AGENCY
F~-h her I hereby affirm that there is a construction lending agency for the performance of .
GY, the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL correct.I---to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
W above-mcntiorred property for inspection purposes
L5. (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgmcnts,toss and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date ��Gy
APPLICA DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR ATIONS.
/ Re-roof's
Si of Applicant/Contraco Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
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
Code.Section 25532(a)? -. All roo's shall be inspected prior to any roofing material being installed.
❑Yes e�
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or sere building occupant use equipment or devices which
emit hazardous air contamina ts as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read and u aterials requirements under Chapter 6.95 of thc Califor-
nia Health $alety" ons 25505,25533 and 25534.I understand that if the building
does 99etcurmn ve a tenant.that it is my responsibility to notify the occupant of the
rcyufremc hic must be met prior to issuance of a Certificate of Oc u cy Signatu-e of Applicant Date
6 91 All roof coverings to be Class' ''or better
Owner or authorized agent Date
og oq
CITY OF CUPERTINO
FUPNACE/AC
%clCUPEI�TINO PERMIT APPLICATION FORM
APN #.� � Date:
� c
Building Address:
c-a Aze
Owner's arae: Pho
Contractor: Pho #:
%1 OMA- Fax#:
Contractor License M Cupertino Business License M
'T' 3 -
Contact: Phone#:C�
Fax #:
Building PermitInfo:
Elect [ i Plumb Mech
Residential Commer ial ❑
Job Description:
zzd z-141
For Residential Installations:
Attic ❑ 1St floor 1] 2°d floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installatic n ❑
New installation Planning Approval Required ❑
Cost of • Type of Construction (Usage Class):
7;76
Strapped ❑ On Platform ❑ Bonded= New Location Replacement
Project Size: Express ❑ Standard ❑ Large ❑ Major❑ _
Valuatio
Green uilding: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09
_ CITY OF CUPERTINO
FURNACE/AC
CITY°fFEE SCIH:EDULE
CUPEkTINO
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE
FURN/AC
1MCRAA Commercial-Repa.r/Alteration/Add to M
ea heating applian,:e,refrigeration unit,
cooling unit,absor)tion unit,or ea
heating,cooling,absorption or
evaporative coolir g system,incl
installation of con rols regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliarce,refrigeration
unit,cooling unit,"IAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of con-xols regulated by
this code.
1 MCSUSHTR Commercial Instz ll/Relocate ea M
suspended heater.recessed wall htx, or
floor mounted unit heater.
::T1PBPGAS0M
SCCommerical for ca gas piping System P
1-4 outlets
For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1MRRAA Residential Rep,Lir/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
' heating,cooling,absorption or —
evaporative coo'ing system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Inst;�il/Relocate ea M
suspended heatcT,recessed wall htr, or
floor mounted unit heater.
CITY OF CUPERTINO
FURNACE/AC
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= l Ok CFM B
1MCRAA Commercial Mesh Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for c a gas piping system P
of 1-4 Outlets
1 BPGAS For each gas p.ping system of 5 or P
more per outlet. Comm/Resid
1 BREMAIRHAN Residential A/C units <= l Ok CFM B
f 1MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standerds Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residential B
IEPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Pennit M
1 PPERMITFEE Plumbing Perm:t P
` 1TRAVDOC Travel Docume�ztation B
1BUSLIC Business License B
INPUT Resources Energy AQ,'Health
1.Windows
1.Instaq Emirgy-Efficient Windriws 0
� e,p 1 Energy pt y=yes
2 Energy pts Y=yes 0
b.LOW-1=tnissivity(L� E) 0
C.Low.Conductivity Flames 2 Energy pts y=yes
2.Install Low Heat Transmission Glazing 1 Energy pt Y=Yes 0
J.Heating Ventilation and Air Conditioning
1.Use Dud Masfic on AM Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
11AQ/Health t es 0
3.Vent Range Hood to the Outside P Y=y 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes
Energy pts y=yes 0
5.Install Solar Attic Fan 0
6.Install Attic Ventilation Systems 1 Energy pt Y=YeS 0
7.Install Whole House Fan Energy pts y=yes
8.Install Sealed Combustion Units 0
a.Furnaces IAQ/Health pts y=yes
b.Water Heaters
IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with 0
Through-the-Wall Heat Pumps 3 Energy pts Y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes
11.Install AC with Non-HCFC Refrigerants Resource pts y=yes0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace i Energy pts y=yes
0
13.Retrofit Wood Burning Fireplaces 0
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt Y=yeS 0
c.Install Airtight Doors 1 Energy pt y=yes
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts Y=YeS 00
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes PY 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health is Y= es 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 00
2.Install Solar Water Heating System 10 Energy pts Y=YeS 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes
4.Install Photovoltaic(PV)System 0
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
17
7.Install Radiant Barrier 3 Energy pts y=yes
V 0
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts Y=Yes 00
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
M.Indoor Air Quality and Finishes INPUT Resources Energy IAQ/Health
1.Use Low/No-VOC Paint 1 IAQIHealth 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 6IAQ/Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
8.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 0
N.Flooring
1.Select FSC Certified Wood Flooring 8 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 0
1 i 1
Total Points Available:1 1 1401 130 57
Total Points Project Received: 1 01 0 0
L31)-7L �
G:data/pmgs/l ireenbuildngguidelines/remodelers/greenpointsfinal2.12.o4prdectedads
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
',UPEkTIN0
Buildfin De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: ,,Z , PHONE # Q�
GENERAL CONTRACTO :1 a - # C FAX #
I am not using any subcontractors: - -
Signature -"` Date
Please check applicable subcontractors and complete 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/Contractor Signature Da