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10030155CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20073 NORTHCREST SQ CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 10030155 OWNER'S NAME: FRESCURA BERT L 1965 KYLE PARK CT DATE ISSUED: 03/26/2010 VER'S PHONE: 4082576052 SAN JOSE, CA 95125 PHONE NO: (408)286-8931 LICENSED CONTRACTOR'S DECLARATION Licenselass ic. # � f---� BUILDING PERMIT INFO: BLDG r- ELECT I— PLUMB X Contract r Date MECH RESIDENTIAL COMMERCIAL I hereby affirm tha I m icensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE &REPLACE EXISTING FURNACE (commencing with S ion 7000) of Division 3 of the Business & Professions Code and that my lice se 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 Sq. Ft Floor Area: Valuation: $1800 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. APN Number: 31638072.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which mV -accrue against said City in consequence of the granting f this permit. iti he applicant understands and will comply with all n-po our re lation a Cupertino Municipal Code, S tion Issued by Date 9.18. Date Signature RE -ROOFS: LJ OWNER -BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self -insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will m'tain complian I e upertino Municipal Code, Chapter 9.12 and the permit is issued. 117 -7th &Safety de cc 25505, 25533, and 25534. 1 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 ne or th e a t 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 must J 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 APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes. (We) agree to save unify and keep harm ity of Cupertino against liabilities, judgments, DECLARATION anexpen hi against said City in consequence of theARCHITECT'S gra�iting f this it. Athe applicant understands and will comply I understand my plans shall be used as public records. 4,e with all n n-po per the Cupertino Municipal Code, Section 9.18. It /��Licensed Professional Signature Date �A CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31638072.00 DATE ISSUED.......: 03/26/2010 RECEIPT #......... BS000010040 REFERENCE ID # ... 10030155 SITE ADDRESS .....: 20073 NORTHCREST SQ SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: FRESCURA BERT L ADDRESS ..........: 10100 PHAR LAP DR CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1112 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 ---------- 1,800.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 1,800.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MRRAA UNITS 1.00 63.00 0.00 63.00 0.00 1PPERMITFE 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 ---------- 232.50 ---------- 0.00 ---------- 232.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 232.50 --------------- 232.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #2328 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM Q -7 APN # ✓� I i - -3Q Date: Lii Building Address: W K _ q(S01 �k Ower's N�ame:- fke�' C/""I Phone #: `-�� Contractor: A -i -L �y� ` r . � L Phone #: ! �� 6b T3 1 `Z rpt tAl, Fax #: Contractor License #: Cupertino Business License #: �' Contact: Phone #: I l `�- Kj Fax #: 73q D`1 1 Building Permit Info: Elect [a. �" Plumb Mech Residential ?� Commercial ❑ Job Description:r— n 1 Rei A -UV �I v l� C�� i � S l� 5 I For Residential I stallations: Attic ❑ I" floor [ 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: ❑ Replacement same weight ❑ Additional weight (structural calcs) Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: j Type of Construction (Usage Class): - Strapped El On PlatformEl 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. xevisect uiiuiiuy a CITY Of CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating, cooling, absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BC13SC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating, cooling, ab sorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY Of CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1MRAPPVNT Residential for the install/relocate/ or replacement of ea appliance vent install & not incl in an appl permit. M FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES r 1BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1 MFRN> 100 Furnace Syst > l 00k BTU install or relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1 EPERMITFEE Electric Permit Fee E 0 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B 1. Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y --yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts yryes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Ec)osed ftrdOeboard or MDF 4 IAQ/Health, pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 6 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 5 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 1401 130 57 Total Points Project Received:1 01 01 0 �L G:data/progsigreenbuildngguidelineslremodelerslgreenpointsfinal212.Mprotecied.xls 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: -1077 .. PERMIT # D3 d l SS OWNER'S NAME: PHONE # - GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requirts all businesses working in the city to have a City of Cuper(Igo business ucense. NO BUILDING FINAL OR FINOCCUPANCY INS ON(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTORAN� LL SUBCONTO 4VE OBTAINED A CITY F C PERTINO BUSINESS LICENSE. 3 ( -0 I am not using any subcontractors: S' u re D to Please check applicable subcontractor and complete the following information: Owner / Contractor Signature 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 Owner / Contractor Signature Date