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09100162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22321 KENDLE ST CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO:09100162 OWNER'S NAMErLENA 1965 KYLE PARK CT DATE ISSUED: 10/23/2009 ER'S PHONE: 4087339701 ©S �� m� SAN JOSE,CA 95125 PHONE NO:(408)286-8931 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB f— License Class Lic.# (� o MECH RESIDENTIAL COMMERCIAL Contractor� LLC Date /0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTIOMFURNACE REPLACEMENT (commencing with Section 7000)of Division 3 of the Business&Professions 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 Sq.Ft Floor Area: Valuation:$2180 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32613106.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply IssuedJy with all non-point source regulati er the Cupertino Municipal Code,Section 9.18. Signature / ate AU '? _C�w RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is Li OWNER-BUILDER DECLARATION installed without first obtaining an inspection,1 agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. / I certify that in the performance of the work for which this permit is issued,I shall Owner or suth v6 e q 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 become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION inify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date U CITY OF CUPERTINO 7 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 32613106 .00 DATE ISSUED. . . . . . . : 10/23/2009 RECEIPT #. . . . . . . . . : BS000009024 REFERENCE ID # 09100162 SITE ADDRESS 22321 KENDLE ST SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : 0s/l c s tek OWNER *TT.,**TAT m - ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1024 RECEIVED FROM . . . . : TRILLO RENOVATIONS 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 2, 180 . 00 1 . 00 0.00 1 . 00 0 .00 1BSEISMICR VALUATION 2, 180. 00 0 .50 0. 00 0 .50 0 .00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1. 00 63 .00 0. 00 63 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 .00 0. 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 232 .50 0. 00 232 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 823 .50 #5275 --------------- TOTAL RECEIPT 823 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL ��v �/ � Z- CIT-YOF -CITRERTINO VAN, --R �-!TY OF C 1- P E R"T!\N; -D PEP—NITT APPLIC-A'T ION FORM - 1 K�.i�c� i.� �r� -7 3`2> v,4 7 2 1W IT) 0 ll7C S5 icti I fl� 'Is C or-Lt a c t: Phol-le 41- VA �6, rax 4: Buildin,,,Perinit Info: Elect Plumb Mech Tr- ' Residential Commercial E] Job Description: For Residential Installations: Attic ❑ I't floor 2nd floor Adhere to minimum setback requirement El For Commercial Installations: Replacement same weight ❑ Additional weight 'structural calcs) ❑ Structural Calculations required for new installation 0 New installation Planning Approval Required El Cost of Project: Type of Construction (Usage Class): � ( �� `/B Strapped F-1 On Platform E-1 Bonded New Location ❑ Replacement -4 i V-11-naticon. Green Buildinu: Must attach Green Building Check dist to '-f-his aup--H.0 rZ\1 CITY OF CUPERTIN0 fk- FURN-ACE/AC CITY OF ;D 7r 'T TTURNA F aj C11 MC -c-PL NCK Mechanical Plan Check iw I--N4FR=<100 Furnace Syst <=100k BTU install or M relocate ea forced-air/gravity type fl-u-nacelbumer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h_ INTRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type fun-iace/burner, inelducts/vents attached to such appliance over 100,000 Btu/h lEPERTN11T-FEE -Electric Permit Fee E 11VIPERMITFEE Mechanical Permit Fee M IPPERMITFEE Pl-umbinc,Permit P ITRAVDOC Travel Documentation B IBUSLIC Business License B Community Development 10300 Torre Avenue !'' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTINO Building Department JOB ADDRESS: PERMIT OWNER'S NAME: PHONE # �U GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ignafure Date Please check applicable subcontractes-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 Date