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11020078 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 817 SEPTEMBER DR CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 11020078 OWNER'S NAME: MARK PENER 1965 KYLE PARK CT DATE ISSUED:02/18/2011 n�ER'S PHONE: 4082868931 SAN JOSE,CA 95125 PHONE NO:(408)286-8931 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C.� Lic.# t � REMOVE AND REPLACE FURNACE rr,p � � � Contractor��^(��J 1 I`-1�'�Date � I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby aftirm 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[he performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000 I have and will maintain Worker's Compensation Ins�rance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number•36212004.00 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 hazmless the City of Cupertino against liabilities,judgments, costs,and expenses which may e against said City in consequence of the granting of this permit. Add' onal ,- e applicant understands and will comply Issued by: Date: with all no -point r ula' ns p the Cupertino Municipal Code,Section 9.18. �'J � �� RE-ROOFS: Signature Date �/ All roofs shall be inspected prior to any roofing material being ins[alled.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following hvo reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby aftirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, hould I s quipme� e 'ces which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defi ed by the ay Ar Air a� Management District I performance of the work for which this perrr►it is issued. will maintain complianc with th Cu no nicipa ode,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,Sect' s 2550 , 4. � Section 3700 of the Labor Code,for the performance of the work for which this J � � permit is issued. Owner or authorized age . Date�t 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 Worker's Compensation laws of Califomia. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep hazmless the City of Cupertino against liabilities,judgments, ,ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. �ting of this permit.Additionally,the applicant understands and will comply ..rth all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 817 september dr. DATE: 02/18/2011 REVIEWED BY: bob s. APN: BP#: ''VALUATION: $�2,000 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: w0� remove and re lace furnace at existin location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan C6eck Q,0 hrs $0.00 ��`.��<,`;. P.'�r3:i,c�; ��r��.t'i�doz t'h��<�i< M6Cil.P2ri1]it Fee: IMPERMIT J'?tr� '_. r`'�:rnart F�°c� i�;It��- 1'crt,�i I�,�� Other Mech.Insp. 0.0 hrs $42.00 t�r��,�t�;=��,t��_�t,�r� ��rr',�-t�1;i�c�. tt�,��. t��:cr�. J�uu. 1°�:c=� 7'�trrarb. rn l�. ,r�i°s�- /:e�c�_ r�itz �.�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 jFee Resolt�tior�09-0�1 Ef�. 7;%1.!101 FEE QTY/FEE MISC ITEMS f'I�.ir� C:'tlt�ct�f�<>t: �r��>f�rl. I>(.'I:+:>�, PME Plan Check: $0.00 /'.�t'rrait f��c�c�: .�t��,1. Irt.,��f�'��> PME Unit Fee: $126.00 PME Permit Fee: $42.00 C;r��1s7t�trc�iton Zcr.t� ��c;utts(t��ttl lit't�ieti:1=f=r': Work Without Permit? 0 Yes � No $0.00 PCcrrrrri�l,�7 f�c�<':s: Travel Documentation Fee: �7'�vDoc $42.00 � . � Stron�Motion I�'ee: 1BSEISMICR $0.50 Select an Administrative Item Bld�Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 01/15/2011 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36212004 . 00 DATE ISSUED. . . . . . . : 02/18/2011 RECEIPT # . . . • • • • • . : BS000012747 REFERENCE ID # • • • : 11020078 SITE ADDRESS . . . . . : 817 SEPTEMBER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . MARK PENER ADDRESS . . . . . . . . . . : 817 SEPTEMBER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 2, 000 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 2, 000 . 00 0. 50 0 . 00 0 .50 0 . 00 1MFR=<100 LTNITS 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 : 211 . 50 0 . 00 211.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 211. 50 2696 --------------- TOTAL RECEIPT : 211. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL S' lified Pres ' tive CectiFicate of C liance: 2008 Residential HVAC Altera.tions CF-1R ALT:VAC Cbma.te Zones 1 and 3-7 Manu�a.c;turer: - - - -- --- Model Number: -- - -- -- __ ------_ _ _ �31°�� A�� _ J �D � �o� �--- Site Address: Enforcement Agency: . Petmit No. gl � �' �� `�-� � I�! I �' Equipment Tppe' List Minimum Z Conditioned Duct Insul�ation Thennostat Ef6ciea Floor A=ea requirement ❑Packaged Unit oCOP Served by Ove=40 ft of ducts ❑Setba.ck e oSEER ❑HSPF system Added or rep]aced ('if not akeady Q Indoor Coil oEER oResistance sf in Unconditioned present,must ❑Condensmg Unit , � space be installec� ❑Other �� d � ❑R 6(CZ 1,3-5) 1. Equipment Type: Choose the t being installed;if mo=e than one system,use anothe=CF-1R.ALT- HVAC foi each system. 2, Minimnm F,qw'tpment Effi�iencies: 13 SEER,78%AF[JE,7.7 HSPF for typiCal residential systems. Contractor(Documentation Authar's/Responsyble Desi�ei's Declaration Statement) • I ce�ify that this Ce�tificate of Compliance documentation is accuraxe and complete. • I am elig�ble under Divysion 3 of the Califomia Business and Professions Code to accept respons�b�ity For the design identified on tbis Cerrifica.te of Compliauce • I certify thax the ener�y feaxures and performance specificaxions£or the design identiified on this Cer�ifica.te of Compliance confoma to the requizemeats of Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Cenificaxe of Compliance axe consistent with the information documented an othcr a�plicable compliance fotms,worksheets,calcula.tions, d specifications submitted to the enforcement agen.cy for approval with the ��ca ' . Name: (� S' ture: C Date: Address: �cense No.: Ci /State/ ' Phone No.: Plarming Apptov�aL• Setback from property: ;�; � `�;. CIT7 OF CITY OF CUPERTINO FURNACE/AC C U P E RT I N O PERMIT APPLICATION FORM ��oz�� APN# I Date: � l � I ' Buildi �Address: � � , ' /�, 10 If residential, is ho se an Eichler? Yes ❑ No If yes, needs planning approval. O er's Name: Ph ne � �� } � . � / ntractor: ------ Phone #: 2�, 6�j`� . � - �-1 � - � F�#: �---E� Contractor Licen e#: Cupertino Busi ss License #: �� Contact: �l �� Phone#: d Faa�/e-mail: � vQ �'� Building Permit Info: Elect � Plumb �� Mech Residential Commer ial Job Descri tion: � � , -- p � �� :.� �X 15�� .��r�� For Residential Installations: Attic ❑ 1 St floor� 2nd 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 Constructi (Usage Class): Strapped On Platform ❑ Bonded � New Location ❑ Replacement Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑ Valuation: ��.� J—,�' 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. Revised 12/06/10