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10020033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10705 GRAPNEL PL CONTRACTOR:ATLAS-TRILLO HVACPERMIT NO: 10020033 OWNER'S NAME: THANH NGUYEN 1965 KYLE PARK CT DATE ISSUED:02/04/2010 :ER'S PHONE: 4087810735 SAN JOSE,CA 95125 PHONE NO:(408)286-8931 LICENSED CONTRACTOR'S RECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Cl s # I.� MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am lensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE (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. Sq.Ft Floor Area: Valuation:$4200 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:32643055.00 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 k4it u ertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,an xpenrue a st ' City in consequence of the granting o this p nderstands and will comply with all no -p ' ns r e C e no Municipal Code,Section Issued by: Date:1—L('-tv 9.18.Signature \ Date—I " - RE-ROOFS: r 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). I 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. 1 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 nne the Bay Area Air Quality Management District I will mainta' com Bance with a Cupertino Municipal Code,Chapter 9.12 and the permit is issued. ealth Ca,4ons 25505,25533,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 wn o th i (� Compensation laws of California. If,after making this certificate of exemption,I Date: l 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. 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 nify and keep harmless the C' o ertino against liabilities,judgments, ARCHITECT'S DECLARATION d expenses whic ay a in said City in consequence of the grantin of this ermit.Ad 11 l ant understands and will comply I understand my plans shall be used as public records. with all on- int s rce regul io s p upertino Municipal Code,Section 9.18. Licensed Professional Signatur i Date �� CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32643055. 00 DATE ISSUED. . . . . . . : 02/04/2010 RECEIPT # . . . . . . . . . BS000009693 REFERENCE ID # . . . : 10020033 SITE ADDRESS . . . . . : 10705 GRAPNEL PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER TFANH NGUYEN ADDRESS 1C705 GRAPNEL PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1319 RECEIVED FROM . . . . : ATLAS TRILLO CONTRACTOR TFILLO, STEVE LIC # 4269 COMPANY A'ILAS-TRILLO HVAC ADDRESS 1565 KYLE PARK CT CITY/STATE/ZIP . . . : SIN JOSE, CA 95125 TELEPHONE . . . . . . . . : (908) 286-8931 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 200 .00 1. 00 0 .00 1. 00 0 . 00 1BSEISMICR VALUATION 4, 200 . 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 AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 232 . 50 #2005 --------------- TOTAL RECEIPT 232 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: 1 Builing Address: D S O ame: �� Phone# i KaA k ? , / 673,5 Contractor: Phone#: 2 „-'� r�` P 1iLID Ab -- Fax#: 7-3 2 c: Contractor LiOnse m�#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect % Plumb ❑L--- Mech Residential Commercial ❑ Jo Description,: For Residential Installations: Attic ❑ 1St floor 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installatio:i ❑ New installation Planning Approval Required ❑ Cost of Project:.. Type of Construction (Usage Class): +d.JQ SCS Strapped ❑ On Platform D Bonded New Location Replacement Project Size: Express D---5fandard ❑ 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. I Revised 01/07/09 CITY OF CUPERTINO FURZwACE/AC CUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Descrip-ion Fee Permit Type Group_ 1MRAPPVNT Residential for the install/relocate/or M replacement cf ea appliance vent install &not incl in an appl permit. FURNACE FURN/AC 1PGASRES Residential fcr ea gas piping system of P 1-4 Outlets IBPGAS For each gas piping system of 5 or P more per outl,,t. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential S,ismic B 1 MECPLNCK Mechanical F Ian Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea fcrced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst> l 00k BTU install or M relocate ea forced-air/gravity type farnace/burn,:r, incl ducts/vents attached to slich appliance over 100,000 Btu/h / I EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M ' IPPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B IBUSLIC Business License B M.In Dar Air Quality and Finishes 1.Use Low/No-V©C Paint 1 IAC-/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IADJHealth pts y=yes 0 3.Use LowND VOC Adhesives 3 IADJHealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 5IAQ/HeaJth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IM/Health pts y=yes 0 7.Seal -or MDF _ 4 IAQJHealth-pts y:-:yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAWealth pts y=yes D 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use f3apidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQIHealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 Total Points Available: 1401 1301 57 Total Points Project Recelved 01 0 G:datalprog dgreenbuildrngguidelines/raMDdelers/greenpointsfinal212.D4proteeted.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Buildin De artment JOB ADDRESS: _ PERMIT # ' 017C)s A OWNER' , NAME: W PHONE # GENERAL CONTRACTOR: F I am not using any subcontractors: KLi � I L moo �- Signature Date 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 3-7// Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock ile x3t���� P-�_ ( O er/Contractor Signature Date