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10090204CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10038 JUDY AVE OWNER'S NAME: MATT KIM 4ER'S PHONE: 4085373556 LICENSED CONTRACTOR'S DECLARATION icense Class_ / `Licc.. #� /` ontractor �f' fes/ r A z t�� ( Date hereby affirm that I am licensed under the provisions of Chapter 9 :ommencing with Section 7000) of Division 3 of the Business & Professions :ode and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: have and will maintain a certificate of consent to self -insure for Worker's :ompensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by lection 3700 of the Labor Code, for the performance of the work for which this )etmit is issued. APPLICANT CERTIFICATION /4�T [ certify that I have read this application and state that the above informatio is ;orrect. I agree to comply with all city and county ordinances and state laws relating [o building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. r Signature — Date` U [i OWNER -BUILDER DECLARATION CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 10090204 1965 KYLE PARK CT DATE ISSUED: 09/21/2010 ',SAN JOSE, CA 95125 PHONE NO: (408)286-8931 BLDG r ELECT F PLUMB r 13UILDING PERMIT INFO: MECH r RESIDENTIAL F COMMERCIAL r IOB DESCRIPTION: RMV & REPLACE FURNACE Sq. Ft Floor Area: Valuation: $3200 APN Number: 37511014.00 Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 relatini. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save inify and keep harmless the City of Cupertino against liabilities, judgments, , and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. /lZ) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: —7"'�_�-� "_ �.. Date: y,?� RE -ROOFS: k11 roofs shall be inspected prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection, I agree to remove all new materials for nspection. signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Ow hor' agent:�^ Date:,�&-,/ L/v- CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constriction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional. CITY OF C UPERTINO FEE ESTIMATOR -'BUILDING DIVISION DATE: REVIEWED BY: BP#: *VALUATION: $3,200 nical Permit PLAT CHECK TYPE: Alteration / Addition /Repair 1111� 70PENTAMATION I I'I.001i .fl"l:t PERMIT TYPE: APPLIANCE / EQUIP TYPE Furnace, Forced -Air TOTALS: Mech. Plan Check 0.0 hrs $0.00 E'hfn1 n Mech. Permit Fee: IMPERMIT }�(it.'Ft �, I7f`i Pritr I"c'C', Other Mech. Insp. 0.0 hrs $42.00 '..f"" ; T r''ut��1, Otrer� IIc�c_ Ifasp. NOTE. These fees are based on the preliminary in or FEE ITEMS (Fee Resolution 09-051 Eff. 7/1./10) /,/oir i 'l ecA l' ec: .SPrppi" Int. Fce PME Plan Check: Perrnit F"e. Stpp/. I»sp I -11'c PME Unit Fee: PME Permit Fee: (','c)rzstrrrrtion Tax A(,ouslicul Iicvicw I"tV. Work Without Permit? 0 Yes 0 No rStds mentation Fee: ITRAVDOC on Fee: ommission Fee_ IBCBSC SUBTOTALS:` 'ion ,mailable and are FEF: QTY/FE $ ).00 $126.00 $42.00 90.00 $42.00 $0.50 $1.00 $211.50 Revised: 9/14/2010 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS PBUSINESS VI I t +r OWNER'S NAME: �Cct�C � �V( NE # U GENERAL CONTRACTOR: L ENSE # ADDRESS: Y/ZIPCODE: *Our municipal code requires all businesses working in :he city to have a City of Cupertino business license TlL THE NO BUILDING FINAL OR FINAL OCCUPANCYTRACTORS INSPECTION(S) OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SU BUSINESS LICENSE. ) .•�'/��; I am not using any subcontractors: Signature Date Please check applicable subcontractors and complt to the following information: SUBCONTRACTOR I BUSINE` 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 r ate CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blh: Lot: APN 37511014.00 DATE ISSUED.......: 09,'21/2010 RECEIPT #.........: BSo00011525 REFERENCE ID # 10090204 SITE ADDRESS .....: 10038 JUDY AVE SUBDIVISION ....... CITY CU ?ERTINO IMPACT AREA ....... METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 322.00 --------------- 322.00 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING REFERENCE NUMBER -------------------- #2173 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 304 OWNER ............. MArT KIM ELECTRICAL 501 FINAL ELECTRICAL ENERGY ADDRESS ..........: 1038 JUDY AVE FINAL PLUMBING ENERGY 503 FINAL CITY/STATE/ZIP ...: CUPERTINO, CA 95014 FINAL BUILDING ENERGY 505 RECEIVED FROM ....: ATLAS-TRILLO ELECTRICAL 507 FINAL PLUMBING CONTRACTOR .......: TRILLO, STEVE LIC # 4269 MECHANICAL 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 3,200.00 1.00 0.00 1.00 0.00 0.00 1BSEISMICR VALUATION 3,200.00 0.50 0.00 0.50 126.00 0.00 1MFR=<100 UNITS 1.00 126.00 0.00 0.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 ---------- -----42_00 ------0_00 ---------- TOTAL PERMIT 211.50 0.00 211.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 322.00 --------------- 322.00 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING REFERENCE NUMBER -------------------- #2173 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CITY OF (-7UPERTINO Lzl�md ]i " FURNj�CE/AC CUPERTINO PERMIT APPLICATION FORM APN # Date: n ( r -0 Building Address: ` � .� �.� e, _ t ✓C Phone #: �� - _ 3�j (v Owner's Name: t � �J : Phone*, �> �3 _US ( (v �'0., ( /� /� a- � '�✓l � U A 1 - - Fax V Contractor License #: Cupertino Business License #: Phone #: Contact: �� C ( Fax #: Build g ermit Info: Elect ❑ Plumb ❑ Mech Comore ial Residentia�K- Job Descripti c C/ For Residential Installations: 2' floor ❑ Attic ❑ 1St floor ❑ Adhere to minimum setback re uirement For Commercial Installat n . Replacement same weight Additional weight (structural calcs) ❑ Structural Calculations req red for new installation ❑ ❑ New installation Planning Approval Required Type of Construction (Usage Class): Cost f Project: "3 V U Uzi Strapped On atform Bonded New Location Replacement Project Size: Express Standard Large[] Major ❑ 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. Revised 01/07/09