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11010019 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO:11010019 BUILDING ADDRESS: 10600 LARRY WAY DATE ISSUED:01/03/2011 1965 KYLE PARK CT OWNER'S NAME: NAMBA SHIZUO AND GRACE PHONE NO:(408)286 8931 SAN JOSE,CA 95125 OWNER'S PHONE: 4082622280 CV LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License C MECH I— RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:REMOVE&REPLACING EXISTING FURNACE I hereliy affirm that I am censed under the provisions of Chapter 9 (commencing with Section 000)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 Valuation:$2500 performance of the work for which this permit is issued. rAPN Ft Floor Area: 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 Occupancy Type: Number:31602029.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree comply with all city and county ordinances and state laws relating WITHIN to building construction, PERMIT EXPIRES IF WORK IS NOT STARTED ruction,and hereby authorize representatives of this city to enter 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and 0 penes which ma ag ' t said City in consequence of the granting of s pe d 'ion y,t e plicant understands and will comply - Date:with all no point o r laf ns t u ertino Municipal Code,Section Issued by-,' r' 9.18. Date '�_'L Signature RE-ROOFS: 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 o inspection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Profession Code). HERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 oft e declarations: Californi I have and will maintain a Certificate of Consent to self-insure Code�forkhe s compliancewiththe Cupertino Municipal CodeSections s Chapter 9.12 and the Health&and 25534. 1 will am Compensation,as provided for by Section 3700 of the Labor Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use a or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminan as defined the Bay ea Air Quality Management District I will ma' tains co nce w' th erti o Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this in lla&S ety Se ons 2 ,25533,and 25534. permit is issued. t I certify that in the performance of the work for which this permit is issued,I shall L t not employ any person in any manner so as to become subject to the Worker's O er o u rite nt: ate: 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 provision or this permit shall be deemed revoked. ONSTRUCTION LENDING A of theYerformance of work's I hereby affirm that there is a construction lending agency P 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 contraction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, cr and expenses which may accrue against said City in consequence of the lar shall be used as public records. rg of this permit.Additionally,the applicant understands and will comply I understand my p �,:...all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Date Signature Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1 R-ALT-VAC Climate Zones 1 and 3-7 Manufacturer: �A;►/N Model Numb SiteAddress: d Enforcement Agency: Date: Permit No. Equipment Type' List Minimum 2 Conditioned Duct Insulation Thermostat Efficiency Floor Area requirement ❑Packaged Unit E ❑COP Served by Over 40 ft of ducts ❑Setback ❑Furnace ❑SEER ❑HSPF system Added or replaced (if not already ❑Indoor Coil ❑EER ❑Resistance sf in Unconditioned present,must ❑Condensing Unitspace be installed) ❑Other �� u ❑R 6(CZ 1,3-5) 1. Equipment Type: Ch se the equipment installed,if more than one system,use another CF-1 R-ALT- HVAC for each system 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7 HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility For the design identified on this Certificate of Compliance • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Signature: Com Date: Address: License No.: City/State/Zip: Phone No.: Planning Approval: Setback from property: 8Yo COPV� I CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10600 larry way DATE: 01/03/2011 REVIEWED BY: bobs APN: I BP#: *VALUATION: 1$2,500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex t�1 OC?1.pit°1� : PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: 1 $126.00 Mech.Plan Check hrs $0.00 11)w rig 1' w C�ht"'A l�>�� ri�zft<`hach 0.0 Mech.Permit Fee: IMPERMIT Other Mech.Insp. F-1 L 0.01 hrs $42.00 01hr 'r P r,,2h��'t, )rtr 1 r< Irss{�. 11". h. h"'y. Fec: llhorrh. NOTE: Thesefees are based on the preliminairTv in ormation available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 09-05I Eff. 17%1./101 FEE QTY/FEE MISC ITEMS Plan Check 1,Le<1: Supp/. PC Fee PME Plan Check: $0.00 Permit Fee: .Sttpp/. hisp Fee PME Unit Fee: $126.00 PME Permit Fee: $42.00 (7ons7rttc tIIOn 1a-r .lcntfsl<'rtl Reviell Icyc. Work Without Permit? 0 Yes 0 No $0.00 Planning Travel Documentation Fee: ITRA VDOC $42.00 Stroniz Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 L -- . SUBTOTALS: $211.50 $0.00 TOTAL FEE:` $211.50 Revised: 12/07/2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31602029 .00 DATE ISSUED. . . . . . . : 01/03/2011 RECEIPT #. . . . . . . . . : BS000012383 REFERENCE ID # . . . : 11010019 SITE ADDRESS . . . . . : 10600 LARRY WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NAMBA SHIZUO AND GRACE ADDRESS . . . . . . . . . . : 10600 LARRY WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2057 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 2, 500 . 00 1.00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 2, 500 . 00 0 .50 0 . 00 0 .50 0 . 00 1MFR=<100 UNITS 1.00 126 . 00 0 . 00 126 . 00 0 .00 1MPERMITFE 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 211.50 0 . 00 211.50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 211.50 #2628 --------------- TOTAL RECEIPT 211 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CITY OF CUPER'T`INO [a FI RNACEAC CUPERTINO PERMIT APPLICATION FORM APN# -? 02- _ - 2 ate: d Building Address: ) M Lh VV& C?wiier's Name: 191tiarre-#: D� �6 22 Kq3/ Fax#. Contractor Liicense 3� Cti ino Li€e e Contact: /�'�. Phone#: Fax#: Building Permit Info: Elect Ptumb Mech Residential CD rcial ;Db Description: For ential Installations: 2nd floor Attic El �f oor� Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight [IAdditional weight(structural caics) Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: �-� Type of Construction(Usage Class): Strapped On Platforin Bonded New Location Replacement Project Size: Express lord❑ Lar e❑ 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