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10090203CITY OF CUPERTIN O BUILDING PERMIT I BUILDING ADDRESS: 10038 JUDY AVE OWNER'S NAME: MATT KIM IS PHONE: 4085373556 LICENSED CONTRACTOR'S DECLARATION cense Class /� �C!�I C LI Lic. # C 1 3 f C Contractor C, S L)n` Date a& 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 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. 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. � 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 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. J Signature Date LJ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, 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 pen -nit 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 CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 10090203 1965 KYLE PARK CT DATE ISSUED: 09/21/2010 SAN JOSE, CA 95125 PHONE NO: (408)286-8931 BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REMV & REPLACE WATER HEATER Sq. Ft Floor Area: Valuation: $3200 APN Number: 37511014.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued byY'� L%'2'�I-'Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 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(x) 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 permit is issued. Health & Safety Code, Sections 25505,255-3-3, and 25534. 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 ner au rorize Ownt: Compensation laws of California. If, after making this certificate of exemption, I Date: become subject to the Worker's Compensation provisions of the Labor Code, I mus forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) Lender's Name 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 upon the above mentioned property for inspection purposes. (We) agree to save -rmify 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. Signature Dat Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional �, CITY OF CUPERTINO TTT T0T1rA4 A T111D U 11TT1.nTNf_ nIVIRInN APPLIANCE I EQUIP TYPE I FEE ID Water Heater I 1PRWHEATR TOTALS: r r.r,- Plumb. Plan Check 0.0 hrs $0.00 r h"" /'!an ADDRESS: DATE: REVIEWED BY: Ctz r P<:rri; F- 0"h - Ak h 1Y��h. `VALUATION: $3,200 Clrher t 7,,, . Inst APN: BP#: Phimb, I cc, *PERMIT TYPE: Plumbing Permit PLAI4 CHECK TYPE: Alteration / Addition / Repair PENTAMATION PRWHEATR PRIMARY SFD or Duplex PERMIT TYPE: .,. , USE: WORK SCOPE PME Unit Fee: APPLIANCE I EQUIP TYPE I FEE ID Water Heater I 1PRWHEATR TOTALS: .—I - ___.r _ ..r.. of;s.nfo rnwart the Dent for addn'1 info. NOTE: These fnes are based on the prelinanaty in ormareon (Fee Resolution 09-051 Eff 7%7i101 F r, 1,11"1 E t h, c k F Plumb. Plan Check 0.0 hrs $0.00 r h"" /'!an t�'cil. I'<,�rl1t t 1-t��' F Plurib. Permit Fee: IPPERMIT Ctz r P<:rri; F- 0"h - Ak h 1Y��h. Other Plumb Insp. 0.0 hrs $42.00 Clrher t 7,,, . Inst A, (h In,lp 1,cc Phimb, I cc, $ 3.00 .—I - ___.r _ ..r.. of;s.nfo rnwart the Dent for addn'1 info. NOTE: These fnes are based on the prelinanaty in ormareon (Fee Resolution 09-051 Eff 7%7i101 ivuuuble FEE uriu urc U,g. QTY/FEEMISC y - - - -- ITEMS FFEEITEIMYS ec F= PME Plan Check: $ 3.00 Permit Fcc=: Srppi" Ittsp PME Unit Fee: $25.00 PME Permit Fee: $42.00 C oll.�Iiwctioll Trr:v ,�c;utrstt{;crt rtr'`°r`{',i�• 'c'c'. Work Without Permit? 0 Yes No $ 0.00 Ij%7t11'lP77�Y f' E'f':5: Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee:` 0.50 ` Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 51.00 SUBTOTALS; $1'10.50 $0.00 TOTAL FEE: $110.50 RCvlavu. d/ ,- ,-- . , 5 ITEMS OF 10 CITY OF --UPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37511014.00 DATE ISSUED.......: 09/21/2010 RECEIPT #......... BS000011525 REFERENCE ID # ...: 10090203 SITE ADDRESS .....: 10038 JUDY AVE SUBDIVISION ...... CITY CUFERTINO IMPACT AREA ...... OWNER MATT KIM ADDRESS 1OC38 JUDY AVE CITY/STATE/ZIP ...: CUFERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ATLAS-TRILLO CONTRACTOR .......: TRILLO, STEVE LIC # 4269 COMPANY ATLAS-TRILLO HVAC ADDRESS 19E5 KYLE PARK CT CITY/STATE/ZIP ...: SAI\ JOSE, CA 95125 TELEPHONE ........: (4C8)286-8931 FEE ID UNIT QUANTITY IMOUNT PD -TO -DT THIS REC -------------------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 3,200.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 3,200.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRWHEATR UNITS 1.00 25.00 0.00 25.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- ---------- 0.00 TOTAL PERMIT ---------- 110.50 ---------- 0.00 110.50 0.00 VOICE ID DESCRIPTION VOICE -------- ID ---------------------------- DESCRIPTION -------- ---------------------------- 518 WATER HEATER 1. UseLow/No-VOG Paint ' IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes IAQ/Health pts y=yes 3. Use Low/lb VOG Adhesives : IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes ;► Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde G IAQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes 7. Seal d EqmW ftWeboaM or MOF 4 IAQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish I Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim i Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl f ) IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: 1_401 1301 57 Total Points Project Received: 0 0 0 nd V� G:data/progs/greE nbuildingguidelines/remodelers/greenpointsfina12.12.04protected.xls Ll CITY OF C'UPERTINO WATER HEATER PERMIT APPLICATION FORM t)ate : 4) 1000, Building Address: Owner's Name: Phone #: Contractor: vt n C �L V Cupertino Business License #: UA(-- Revised EL Contact: rnone f+: / G �L-�/(i L Fax #: Building Permit Info: r---, I = ►�-.a a 131ag U U I — Residential Commercial ❑ Job Description: ra Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ ReptiicemenyQ Valuation (cost of 32U� project): Project Size."Express Standard ❑ Large ❑ Major ❑ 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. r Green Building Points achieved: Revised 03/10/10