11090059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18970 TILSON AVE CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 11090059
OWNER'S NAME: WU PEYJEN ET AL 1965 KYLE PARK CT DATE ISSUED:09/08/2011
PHONE: 4083683000 SAN JOSE,CA 95125 PHONE NO:(408)286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am'A used under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE&AIR
(commencing with Section 7000)of Division 3 of the Business&Professions CONDITIONING
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$8000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:37509011.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of ertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and a enses which may acc agains said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of is pe t. Addition ly,the mea ant understands and will comply
with all non point so regul ons p e pertino Municipal Code,Section
9.18. t / Issued b ' ..-.._.�'." � Date:
V
Signature Date 17
cw
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined b the Bay Area Air Quality Management District I will
maintain compliance Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall H alth afety Co ,Sec' 25505,25533,and 25534.
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,I ue or auth ag t:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mrk's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
r and expenses which may accrue against said City in consequence of the
:ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
vi—i all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 18970 tilson ave. 7DATE: '09/08/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$8,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PENTAMATION FURN/AC
USE: _T PERMIT TYPE:
PRIMARY SFD or Duplex
WORK replace exisiting furnace at attic location add new a/c unit.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $65
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $195.00
Mech.Plan Check0.0 hrs $0.00
F
Mech.Permit Fee: ]MPERMIT
Other Mech.Insp. 0.0 hrs $44.00 Ej
NOTE: This estimate does not include fees due to other Depts(i.a Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (I ee Resohrtion 11-053 E/f "'bl1) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $195.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00
Work Without Permit? 0 Yes Q No $0.00
Travel Documentation Fee: IIRA VDOC $44.00
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $325.80 $0.00 TOTAL FEE: $325.80
Revised: 09/02/2011
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-VAC
Climate Zones 1 and 3-7
Manufachnrer �/ -- Model Number.
-- QQ
----— - — - N - — -
I �j
Site Address: Enforcement Agency: Date: Permit No.
Equipment Type' List Minimums Conditioned Duct Insulation Thermostat
Efficiency Floor Area requirement
❑Packaged Unit >sVYM ❑COP Served by Over 40 ft of ducts ❑Setback
urnace EER ❑HSPF system Added or replaced (if not already
❑Indoor Coil "EZR ❑Resistance sf in Unconditioned present,must
ondensing Unit 0 space be installed)
❑Other ❑R 6(CZ 1,3-5)
1. Equipment Type: Ch se the equipment being installed,if more than one system,use another CF-IR-ALT-
HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7 HSPF 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.
• 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
• I certify that the energy features and performance specifications for the design identified on this
Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California.
Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information
documented on other applicable compliance forms,wor ets,calculations,p ecifications
submitted to the enforcement agency for approval with the t fication.
Name: Signature:
C ate:
Address: se No.:
Ci /State/ hone No.:
Planning Approval- Setback from property:
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CU1'FRTf
4)C8 77-3228• FAX(408)777-3333•buildingCa)cupertino.org
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OWNER NAME ' �^ P �� IL
STREET ADDRESSq J O I /� ST P w 1
CONTACT NAME AIL
ST RE CIT , ZI CA I to 7�
❑OWNER ❑ OWNER-B LDER ❑ OWNER AGENT NTRACTOR ❑CONTRAL GENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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C R �� LICEN N�Q LICEN BUS.LIC H
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ARCHITECT/ENGINEER N&E LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ISE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACES AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK ) p -_—I\j
TOTAL VALUATION: �` RECEIVED BY: '1.J
By my signature below,I certifykhave
h of the to
ll : am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information r ided Iave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatinildin cn. au orize representatives of Cupertino to enter the above-identifiw-oroperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEME TAL INFORMATION REQUIRED OFFICE USE.ONLY,
THZr-COC J,ER
a
F ❑ EXPRESS
STANDARD
LARGE
a
MAJOR
MEPMiscApp_201 Ldoc revised 06/21/11
Building Department
City Of Cupertino
L2 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: cw\1 PERMIT#
OWNER'S NAM C PHONE#
GENERAL CONTRACT BUSINESS LICEN
ADDRESS: S CITY/ZIPCODE:
*Our municipal code requiro all busi esses working int a city to have a City of Cupertino �Iss license.
NO BUILDING FINAL OR FINA OCCUPANCY INS CTIO (S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND LL ONTR TO E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. � 5 R- If
1 am not using any subcontractors: (�
Sig ture Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Ro
le
Owner/Co tractor Signature Date