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07110073 CITY OF CUPERTINO S"':.'tLDING DIVISION PERNIIT G�� ` ::. . . ,.,:. , ,::: ,.:> ..:::.::.:: ,:. BUILDING ADDRESS: PERMIT NO. 10597 JOHN WAY ATLAS PRILLO HVAC 07110073 . 'NER'S NAME: PERMIT ISSUE DATE RAMBO WILLIAM L TRUSTEE 1965 KYLE PARK CT 11/13/2007 PHONE: SAMTARY NO. CONTROL NO. ARCHI'IECT/ENGINEER: B[JILDING PERMIT 1NF0 REMVE & REPLACE FURNACE H�nc E�cr PLUMB MECH � O 0 0 � o o UCENSED CON7'RACI'OR'S DECLARATION IOU DCSCTI(7tlOi1 � V� I hcrcpy a(ficm Wat I am liccnscd undcr provisions oC CAapur 9(commencing _�� wi�h Sccdon 700U) of Division 3 of thc Busincss and Profcssions Code, and my liccnsc is '� y in full force and e t� �,v� i Licensc C s ConlncWr � y p Datc ��'' ARCH17EC1'S DECI.ARATlO ��< l undcrstand my plans shall bc wed u public records s � o y Licensed Rufcssiana► y e� OWNER-BUILDER DECLARATION " I t�ercby aRrm �hat 1 am ezcmpt fmm ihc Conuactors Liccnsc Law far thc � p o following rcason. (Scctian 7031.5, Busincss and Profcssians Ca1c: Any ci�y or county y� Pi which rcquires a pc�mit w conswc� altcr. improvc, dcmohsh, or rc�wir any swcture prior w iLc issuancc, also �quims ihc applicant for such permit io filc a signcd su�cment -? < that he is licensed pursuant to �he provisions o[ the Conuactor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation Y F� (commcncing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssions Cadc) or y�� that he ia exempt the�cfrom and the basis for �6e allegcd exempdon. Any violadon of Section 7031.3 by a�ry applicant for a permit subjecu the applican� to a civil penalry of ppN Number Occupaney Type nat mo�e �han fiw hundmd dollars (5500). ❑ I. u owner o[ ttk propucy. or my employcea with wages as their sok compensadon, wiA do �he work and ihe swctme is not intended or offe�ed for sslc (Sec. 7044. Business Re uired Ins ections and Professions Code: The Conuactor's Lieenx Law daes not apply to an ow�r of 9 P propeny who builds or improves thercon, and who doos such work himseltar Uwngh his own employca, provided �hat such improvemen�s ue not intended or olteeed for sale. i[, however, the building or impmvemm� is suid wiihin one year of completion. �he owner- builder wiR have the b�uden o[ proving ida� he did mt build ar improve for purpose of sakJ. ❑ I, u ow�xr o[ che property, am exciwively conuuting with li«nsed wnuactors to constnut the project (Sec. 7044. Business and Profcssions Code:)'fie Conlrxwrs Li- ccnse [aw docs not apply m an ownu of propeny who builds or improves thereon, and , who contrsc�s [or such p�ojecis wiUi a conuactor(s) ticensed pursuant to ihe Contncrols License [�w. I� ( am uempt undu See. . B Ac P C fw this rcason � Date WORKER'S COMPENSAT70N DECLARAITON 16ereby atlicm under penalty o( perjury one of the foilowing declarazians: I hsre and will maintain a Cenifipm of Conaent to xlf-insme tor Workcrs Compen- ' n, u providcd for by Secdon 3700 0[ che labor Code, for �he perfo�mance of the w for which Ihis permit is iuued. ��9..have and will msintain Workcrs CompensaUon Insunnce, u tcquired by Scction �i100 oC thc Labor Codc. Cor the pertormanu of �he worlc for which this pe�mit is issued. My Worker o pensadon Insunnce cs 'cr and Poliry number a�c: Cartier. PoI'�cy No.: � � �R � � CERTIFICA7E OF EXEMPTION FROM WORKERS' COMPENSA710N INSURANCE ' (7Lis scction necd rrot bc completcd it �he pecmit is for onc hundred doilus (S I00) or Icss.) I cenify �ha� in thc perfwmance of �hc work for which �his permit is issucd, l shall not employ any person in any manncr so as w bccomc subject a the Worlcccs' Compensation Laws of Califomia Dalc Applicanl N077CE 7'O APPLICAM: If, aftcr making �his CeniGcate of EzcmpGon, you shauld bccane subjcct �o thc Wortcr's Compcnsation provisions of �Mc La6or Codc, you must � O forthwi�h comply wi�h such provisions or this permit sha0 bc deemcd ecvokcd. Z "'� CONSfItUC170N LENDING ,4GENCY E r�-�. 1 hemby aCfirm Uut there is a conswcdon Icnding agcnry (or thc perfarmar�cc u! . �. the work [or which Utis pertnit is iasued (Sec. 3097, Civ. CJ W� Q L.endcr's Ntinc ' L.cnde�s Address V � 1 cectifY ihat ] have resd this application and sia�c that � abovc informatiun is w �" corten. I sgrtx w comply with all rity and counry onlinances and stue Iaws celadng w � U building consuuction, and hereby suthoria mpresentaGvcs of Uiis ciiy to en�cr upon the � W alave-mcndoned propcny for inspenion purposes a (We) agrce to uve, indcmnify and kecp harmlesc �he City o( Cupertino against „F � liabilitiu, judgmcnls, �t and expenses which may in any way ucruc against said Cily (� z in con C c g ting oC Ihis permi4 Date �"� APPL ANT STANDS AND WILL COMPLY WITH ALL NON-PO1NT Issued by: SOUR R U Re-roofs s��urc o w� o "� TyPe of F:oof HAZARDOUS MATERIALS D[SCLOSURE wll �he applicant or futurc building accupant starc or handlc ha•rardous matcrial dcfined by �he Cupenino Munic'paI Codc. Chaptcr 9.12, md Uu Hcal�h md Safcty k. Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Y� � If a roof s installed without first obtaining an inspection, I agree to remove Will the applicmt or wrc building accupant use eyuipmenl or Jevices which emit ha•rardnus air comaminants u dcfincd by the Bay Area Air Quslity Managcmcnt all new n�aterials for inspection. District? � ❑ Yes ! havc ihe hvardouus ma�erials rcquiremcnLt undcr Chaptcr 6.95 of Uu Glifor- nia Hcalth afc odc, Sccuons 25505, 25533 and 25534.1 undcrsund ihatiCthe 6uilding )� does no h a icnan4 't is my responsi6iliry to naify ihe occupam of the =i. � nlswh� m a�a��arac�r��oro� Signature ofApplicant � Date --�'"" „ �� . All roof coverings to be Class "B" or better Ownc thori�cd agcnl CITY OF CUPERTINO 6 ITEMS OF 18 PERMIZ RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35°19007.00 DATE ISSUED.......: 11/13/2007 RECEIPT #.........: BSC00003227 REFERENCE ID # ...: 07110073 SITE ADDRESS .....: 10_`97 JOHN WAY SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............: RAPIBO WILLIAM L TRUSTEE ADDRESS 10_`�97 JOHN WY CITY/STATE/ZIP ...: CUI'ERTINO CA 95014 RECEIVED FROM ....: ATI�AS-TRILLO CONTR.ACTOR .......: TR=:LLO, STEVE LIC # 4269 COMPANY ..........: ATI�AS-TRILLO HVAC ADDRESS ..........: 19�i5 KYLE PARK CT CITY/STATE/ZIP ...: SAI1 JOSE, CA 95125 TELEPHONE ........: (4i)8)286-8931 FEE ID UNIT QUANTITY .�MOUNT PD-TO-DT THIS REC NEW BAL ------ ---------- ---------- --------- BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 3,000.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT : 172.04 0 00 172.04 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL . �� CITY OF C�UPERTINO � �� ` � �� '�.J�.��.��:/��' .:UPEf�TINO PERMIT APPLICATION FORM APN # — Date: J�.� 3 `0� ,�� y / �� , c� Building Address: j - (� S �j ✓ (J �Yl.. . Owner's N e: Phone #: . I� 2-(�� _�--�------ "2S � - �1' -- � �:ontractor: r � PI "�� l_ �� (� License #(.,� � � � � � � ,� � �, l � Contact: Phone: � Cupertino Business License #: � y';. Building Permit Info: Bldg ❑ Elect ❑ P lumb ❑ Mech ❑ Job Description: �- Residential Commercial ❑ For Residential stallations: Attic � l st floo� 2 floor � '�dhere to min set back requirement ❑ � or Commercial Installations: Replacement same weight ❑ Additional weight (st�uctural calcs) � Structural Calculations required for new installation �� New installation P�anning Approval Required ❑ Cost of Project• / � j � Type of Construction: Occupancy group: � ✓�✓ V C� Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location � Re lacement � Qty. if Fee Grou A plicable Fee ID Fee Description P BENERGY E: iergy BUILDING BREMFURN F� zrnace MECHANICAL BREMACOVER A�C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R ecptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE N[ech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS C�as Pi ing System Fee PLUMBING BUSLIC F�usiness License BUILDING