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07090148 CITY OF CUPERTINO BUILDING'DIVISION PERMIT S INUORmt TII�IY. PERMIT NO. BUIL�I�VDnSpTEMBER DR ATLAS-TRILLO HVAC 07090148 PERMrr LSSUE DATE OWNER'S NAME: ASHOK KUMAR 1965 KYLE PARK CT 09/21/2007 SANITARY NO. CONTROL NO. _)NE: BUILDING PERMIT INFO ARCHITECT(ENGINEER: R&R FURNACE, ADD A/C BLDG ELECT PLUMB MECH 0 0 ed a LICENSED CONTRACTOR'S DECLARATION Job Description Lu C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z(�� with Section 7000)of Division 3 of the Business and Professions Code,and my license is r a a in full force and eff ZLicense Class Lle• t-0 pare Contractor .� ARCHITECTS DEC L�A(A�N i a< I understand my plans shall he used as public records )yV U.F' Licensed Professional O a OWNER-BUILDER DECLARATION j< I hereby affirm that I am exempt from the Contractor's License Law for the "in O following reason-(Section 7031.5,Business and Professions Code:Any city or county < Q. which requires a permit to construct.alter,improve,demolish,or repair any structure s Z prior to its issuance,also requires the applicant for such permit to file a signed statement .Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q e.H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)lite Contractors li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects,with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date _ - _- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q I have and will maintain a Certificate of Consent to self-insum for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. C]I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workers�C,ompensation Insurance carrier and Policy number am: Carrier.� � �-"+r� Policy No.: CERTIFICATE OF EXEMPTION FROM WO CERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z'' CONSTRUCTION LENDING AGENCY [��►�., I hereby affirm that there is a construction lending agency for the performance of a, the work for which this permit is issued(Sec.3097,Civ.C.) w QLender's Name CL,z Lcndees Address U 0 1 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 rJ U building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granti f this permit. / �. APPLICA E DS AND WILL COMPLY WITH ALL NON-POINT Issued by Date Z SOUR EGU Re-roofs Signa ure of Applicant/Contractor °arc T of R oof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Monte,al Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? 1 All roofs Shall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant or uturc building occupant use equipment or devices which If a roof i�installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr,aterials for inspection. District? ❑Yes 1 have read the hazardou materials requirements under Chapter 6.95 of the Califor- niaHcalth ode,Scctions25505.25533and25534.IunderstandthatifUtcbuildin docs cu tly a reran responsibilily b notify tlrc occupan�of ' req rcme c w ' met psi rssuance of a Certificate oCOccup Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Dare CITY OF CUPERI,INO F N. CElA CUINO PERMIT APPLIC-ATION FORM .PN# Date: // / Building Addre s: Ty Ly2 Y Owner's e: Phone#: Ph 031P: /'� �✓ _ ` T�ICLIZSe(#:� ,� Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect PI umb EZ-- Mech C�1 Job Description: g!R—&jW Residential Commercial For Residential Installations: Attic ❑ 1 st floor ❑ 2nd floor❑ Adhere to min set back requirement For Commercial Installations: ,placement same weight ❑ Additional weight(stnictural calcs) ❑ otructural Calculations required for new installation C� New installation Planning Approval Required ❑ Cost of Proj Type of Construct on: Occupancy group: Strapped On Platform Bonded Sq.Ft. Floor Area: New Location Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En,rgy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER AX- Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL / BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Se_smic Fee Res BUILDING BSEISMICOM Se smic Commercial BUILIDNG EPERMITFEE Elm Permit Issuance ELECTRICAL / MPERMITFEE Mf:ch Permit Issuance MECHANICAL PPERMITFEE Pli mbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Phn Check Fee BUILDING BPGAS Gz s Piping System Fee PLUMBING BUSLIC Bi:siness License BUILDING CITY OF CUPERTINO 8 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36215024 . 00 DATE ISSUED. . . . . . . : 09/21/2007 RECEIPT #. . . . . . . . . : BS000002722 REFERENCE ID # . . . : 07090148 SITE ADDRESS . . . . . : 998 SEPTEMBER DR SUBDIVISION CITY CUPERTINO IMPACT AREA OWNER ASHOK KUMAR ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4141 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 . . . . . . . . : (4C8) 286-8931 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 5, 000. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 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 183 .50 0. 00 183 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 352 . 69 #8985 --------------- TOTAL RECEIPT 352 . 69 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ',UPEkTIN0 Building Department JOB ADDRESS: �^ PERMIT # IV c Y ') -?Z� �f� � Y �1 OWNER'S NAME: L r 1 1i PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and comF lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ o _.signature ate