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11040162CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7995 PUMPKIN CT CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 11040162 OWNER'S NAME: LEE KENNETH 1965 KYLE PARK CT DATE ISSUED: 04/22/2011 OWNER'S PHONE: 4087258266. SAN JOSE, CA 95125 PHONE NO: (408)286-8931 L LICENSED CONTRACTOR'S DECLARATION r— f— � t License Class # (2 CS BUILDING PERMIT INFO: BLDG ELECT PLUMB t . V I / MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I a cense under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE & REPLACE EXISTING FURNACE WITH TITLE 24 (commencing with Section 000) of Division 3 of the Business & Professions ENERGY COMPLIANT 2010 and that my license is in full force and effect. Xre by 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. Sq. Ft Floor Area: Valuation: $3000 1 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 pe it is issued. APN Number: 36202042.00 Occupancy Type: 0 APPLICANT CERTIFICATION [ c rtify 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 I pertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may acc a agai st said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of [h perm �ddition ly, the lican[ understands and will comply onino Municipal Code, Section with all non-p=—Date G �� 9.18. Issued by: �/ - Date: C 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) 1, 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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 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 & 1 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 del' y the Bay Area Air Quality Management District I will ' maint mplia ce with the 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 alt' afety ode cti ns 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 O Ar�h ed a 'J 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 work's 1 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, cost, ?nd expenses which may accrue against said City in consequence of the gr , of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION wit,. _a non-point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36202042.00 DATE ISSUED.......: 04/22/2011 RECEIPT #.........: BS000013272 REFERENCE ID # ...: 11040162 SITE ADDRESS .....: 7995 PUMPKIN CT SUBDIVISION ......: CITY .............. CUPERTINO IMPACT AREA ......: OWNER ............: LEE KENNETH ADDRESS ..........: 7995 PUMPKIN CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 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 ---------- -ADMIN ------------- HOURS ---------- 0.50 ---------- 39.00 ---------- 0.00 ---------- 39.00 ---------- 0.00 1BCBSC VALUATION 3,000.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 3,000.00 0.50 0.00 0.50 0.00 1MFR=<100 UNITS 1.00 126.00 0.00 126.00 0.00 1MPERMITFE 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 ---------- 250.50 ---------- 0.00 ---------- 250.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 250.50 --------------- 250.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #6231 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING c CITY OF CUPERTINO rm__� FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 7995 pumpkin ct. DATE: 04/22/2011 REVIEWED BY: bobs. UNITS APN: BP#: 'VALUATION: 1$3,000 "PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK remove and replace existing furnace with Title 24 energy compliant 2010 SCOPE $0.00 APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $126 PME Plan Check: $0.00 PME Unit Fee: 1 PME Permit Fee: $42.00 F - I TOTALS: $126.00 - Mech. Plan Check 10.0 1 hrs $0.00 FMech. Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs 1 $42.00 NOTF_: These fees are ha.cod an tho nroliminary infarmatinn availahlo and nro nnh? nn octimnfo C'nnfnrt fho non/ fnr nddn 11 info FEE ITEMS (Fee Resolution 09-051 I ff. ? 1.10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item j I Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/017_1 �� =UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 r *Our municilial code requir�s all businesses working in the city to have a City of Cupertin bus ness license. NO BUILDING FINAL OR FINA OCCINSP TION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND LLS BC HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / I am not using any subcontractors: Please check applicable subcontractors and co ture Date the following information: Date 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 Rock Tile Date CUPERTIINO //G� Ultoa� GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org n PT.T TMRTNG \kIvIECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS MEP misc PROJECT ADDRESS tyqqS -bAQ i t\ju AP � / ^ Q /� OWNER NAME-1� Vy' P Oq�� �_ V f /MAIL b STREET ADDRESSME v` �, i INC) © FAX A. CONTACT NAI C.J E-MAa. STREM D SS C1TY• ❑ OWNER ❑ OWNER -BUILD 11 OWN AGENT CTOR ❑CONTRACT C1 ARCHITECT ❑ ENGM R ❑ DEVELOPER ❑ TENANT CO ( ( 0 ( I(�'lJ LICENSE NUMB -37 LICENSE TYPE BUS. LIC # C LIZIA V S ZIP P ARCHii•ECT/ENGINEER N LICENSE NUMBED LIC k 'PLIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 'SE OF or Duplex ❑ Multi -Family URE; El COIIlIIlercial STRDESCRIPTION PROJECT IN WILDLAND URBAN INTERFACE AREA El Yes [I No PROJECT IN FLOOD ZONE El Yes ❑ No OF WORK A _- TOTAL VALUATION: � 1 N f n By my signature below, I certify o eac of the following: am the erty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I a provided i corr t. I a he Desc ' of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati ul n represent s of Cupertino to enter the above -i entified prop for inspection purposes. Signature of Applicant/Agent: Date: MEPMUcApp_2011.doc revised 03/16/11