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10120034 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 906 NEW HAVEN CT CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 10120034 OVVNER'S NAME: DENTINGER FREDIC AND PATRICIA 1965 KYLE PARK CT DATE ISSUED: 12/06/2010 O""YER'S PHONE: 4083660465 SAN JOSE,CA 95125 PHONE NO:(408)286-8931 C NSED CONTRACTOR'S DECLARATION � � (� I BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class !�ic # �� -�� ) � ' � � � MECH� RESIDENTIAL� COMMERCIAL� Contractor �� Date I hereby aftirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE&REPLACE EXISTING FURNACE&A/C AT (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING LOCATIONS FOR BOTH Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following hvo 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:$6500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35611051.00 Occupancy Type: APPLICANT CERTIFICATION 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 puiposes. (We)agree to save indemnify and keep harmless the City of Cupe�tino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may iv gainst said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting this permit. Addi'onally h applicant understands and will comply with all n n-poi oui�ce-re lati s p e Cupertino Municipal Code,Section �--�,7 9.18. �� .� Issued by: �---'......_.�___--_�----- Date:�2=-�.�d Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior[o any roofing material being installed.If a roof is I hereby aftirm that I am exempt from the Contractor's License Law for one of ]nstalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the stnicture 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 consttuct 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 HAZARDOUS MATERIALS DISCLOSURE declarations: 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 912 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)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 deFned by ay a Air Quality Management District I will ainta'n compl nce ' h rti Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall ealt &Safety e c ons 25 25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If,after making this certificate of exemption,I ner ge : ('�� ( (� become subject to the Worker's Compensation provisions of the Labor Code,I must Date: d l LJ forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a consUuction lending agency for the performance of work's I certify that I have read this application and state that the above infonnation is for which this pernut 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, c - and expenses which may acc�ue against said ' in consequence of the pRCHITECT'S DECLARATION ' .ig of 's pernut.Additiona , pli t unde nds and will comply �...�all no po' t source re latio r t pe ino nicipal Code,Section I understand my plans shall be used as public records. 9.18. (�S (� Licensed Professional Signatur Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35611051. 00 DATE ISSUED. . . . . . . : 12/06/2010 RECEIPT #. . . . . • • • • : BS000012158 REFERENCE ID # . • • : 10120034 SITE ADDRESS . . . . . : 906 NEW HAVEN CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DENTINGER FREDIC AND PATRICIA ADDRESS . . . . . . . . . . : 906 NEW HAVEN CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4023 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 6, 500 . 00 1 .00 0. 00 1. 00 0 .00 1BREMAIRHA NO.LTNITS 1. 00 63 .00 0 . 00 63 . 00 0 .00 1BSEISMICR VALUATION 6, 500. 00 0 .65 0 . 00 0. 65 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 1TR.AVDOC FLAT RATE 1 . 00 42 . 00 0. 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 274 .65 0 .00 274 .65 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 . 65 #2497 --------------- TOTAL RECEIPT : 274 .65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 906 new haven ct. DATE: 12/06/2010 REVIEWED BY: bob s. APN: BP#: *VALUATION: $6,500 YPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY 1�3� 1I PENTAMATION FURN/AC OSE: SFD or Duplex �,.�. t,�,� ��tt:y� PERMIT TYPE: wORK re lace existin furnace and a/c at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 16REMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check 0.0 hrs $0.00 ;''`, f'=`� € `� _� - '`=r-�%_',<:�. Mech.Permit Fee: IMPERMIT �.:° �,��>:�i;`e�<°. � 7>.`r: 1��,3�r,�;t�,�� Other Mech.Insp. 0.0 hrs $42.00 �J��' r ;`�_.�_ �°>>>>�� C�„'r{�P�1�� 1�,_,;��- 11�'F�h Its� f`�ce°� t'I�r , _f�-,J� ?:��'� 1<Fe°c_Iria�� 1''.�e NOTE: These ees are based on the relimina in ormation available and are onl an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 09-�51 Ef. '%1;'1�Z FEE QTY/FEE MISC ITEMS ��1;171 (..��Tf:'c:�.- �`�i:'i': .�+21�>j>rr. I z� i t'::' PME Plan Check: $0.00 ��i�'t'Ili'txr I'�i:�{:" >l�?f�Jr.�(. 17i:0�t) �':.;�.,' PME Unit Fee: $189.00 PME Permit Fee: $42.00 C�'E�ti, °�tc`��;rer 1�11� , (a°t�l�t�tEz�; l�a ��it', t . �_ Work Without Permit? � Yes � No $0.00 Jx�t.i?t171t?�,' f't'E'.i: Travel Documentation Fee: ITRf1VDOC $42.00 � Stron�Motion I'ee: IBSEISMICR $0.65 Select an Administrative Item Bldg Stcis Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.65 $0.00 TOTAL FEE; $274.65 Revised: 11/08/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRAC R/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# Z U D � OWNER'S NAME: PHONE# GENERAL CONTRACT R: . � I BUSINESS LICENSE# f ADDRESS: CITY/ZIPCODE: *Our municipal code requir all busi esses working in e city to have a City of Cupertin bus ess license. NO BUILDING FINAL OR FINAL OC ANCY I WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND A SU C O HA E O AINED A C1TY O CU ERTINO BUSINESS LICENSE. � � /� c I am not using any subcontractors: Signature , Da e 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date t G l 2--� �' =�� ClTY OF CITY OF CUPERTINO FURNACE/AC CUPERTiNO PERMIT APPLICATION FORM APN # � � I .n � Date: �� ` � U � Building Address: ti� , „ / �A � �-�' �1/ I�� Owner's Name. �� f � � n ((i� ( � Phone #:�t //D� / �6 ��.� I�1 1� `t �� Contractor: -�i�,j�S� �� C Phone #: j` Z,�,�� / , � � � �f' l r �� S� �I �x#: �73 �-1 � Contractor License#• / � j�ry Cupertino Busin ss License #: (� l ( Contact: ��(� -��p ( � � Phone #: j� L��3/ � ��_� ( .V«_� Fax#: p�� Building Permit Info: Elect [� Plumb �/' Mech Residential Comm cial ❑ Job Description:�� ,� ��L��-� , / S`�� 7F��-� C� /�-( � � S�T/ /�' �C�- � , For Reside tial Inst lations: Attic ❑ 1 St floor� 2"d floor ❑ Adhere to minimum setback re uirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Plannin A roval Re uired ❑ Cost of Project: .�--- Type of Construction (Usage Class): � �� Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Pro'ect Size: Ex ress ❑ Standard ❑ Lar e ❑ Ma'or ❑ Valuation: . ��.� , ,..---� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. �ii Revised O1/07/09