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09070184CITY OF CUPERTIN D BUILDING PERMIT I WILDING ADDR�SS: 21875 HYANNISPORT DR OWNER'S NAME: KAO, LAWRENCE ER'S PHONE: 4085072464 ❑ LICENSED CONTRACTOR'S DEECL ?ARATION License Class U � Lic. # Contractor /Qi - 2;;LJ /o flAr Date --?-1 % 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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. 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. APPLICANT CERTIFICATION 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non- oint souMcF- gulations per the Cupertino Municipal Code, Section 9.18. Signatur Date U d OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, 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 construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 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. 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 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 provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save i iify and keep harmless the City of Cupertino against liabilities, judgments, ci. , and expenses which may accrue against said City inconsequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date CONTRACTOR: ATLAS- TRILLO HVAC I PERMIT NO: 09070184 965 KYLE PARK CT DATE ISSUED: 07/27/2009 SAN JOSE, CA 95125 PHONE NO: (408)286 -8931 WILDING PERMIT INFO: BLDG ELECT P UMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION:ADD A/C UNIT Sq. Ft Floor Area: Valuation: $3800 ,►PN Number: 35613049.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. issued by` Date: RE- ROOFS: , kIl 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 inspection. 'signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain i ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & +afety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air i ontaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I Icalth & Safety Code, Sections 25505, 25533, and 25534. �)wn rayed- agenk• Date- CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's ;'or which this permit is issued (Sec. 3097, Civ C.) lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professi 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: B1}:: Lot: APN ........: 35(.13049.00 DATE ISSUED.......: 07/27/2009 RECEIPT #.........: BSC100008289 REFERENCE ID # ...: 09070184 SITE ADDRESS .....: 21E;75 HYANNISPORT DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER KAO, LAWRENCE ADDRESS ..........: 21E�75 HYANNISPORT DR CITY /STATE /ZIP ...: CUPERTINO CA, 95014 -4015 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... TR.LLO RENOVATIONS, TR::LLO, STEVE LIC # 4269 ATLAS - TRILLO HVAC 1965 KYLE PARK CT SAP1 JOSE, CA 95125 (408) 286 -8931 FEE ID UNIT QUANTITY INOUNT PD -TO -DT THIS REC - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- 1BCBSC ------- - - - - VALUATION -- ---- - - - - -- 3,800.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 ---- 1.00 0.00 1BSEISMICR VALUATION 3,800.00 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 --------------- - - - -- #4227 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 507 FINAL PLUMBING CITY OF CUPERTINO FUR 4ACE /AC CUPEkTINO PERMIT APP=LICATION FORM APN # Date: Building Address: .� Owner's N Phone #: -5-C - -z -C Contractor: Phone #: 611 Ce A,��f I(VAC Ft #: Contractor License #: Cupertino Business License #: l' Contact: Phone #: Fax #: Building Permit Info: Elect ❑ Plumb ❑ Mech ❑ Residential Commercial Job Descripti n: Axw-".,A / C For Residential I stallations: Attic ❑ 1` floor [] 2nd floor ❑ Adhere to minimum setback requirement bl� For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 35 vv Strapped On Platform 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. Kevisea uiiuiiuy CITY OF CUPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN /AC 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1 MCRAA Commercial Mec:l Repair /alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1 -4 outlets P 1 PGASRES Residential for ea gas piping system of 1 -4 Outlets P 1 BPGAS For each gas piI ing system of 5 or more per outlet. C'omm/Resid P 1 BREMAIRHAN Residential A/C v nits <= l Ok CFM B 1 MRRAA Residential Mech Repair /alt/add M J 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Resident al B 1 EPERMITFEE Electric Permit E 1 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P I 1TRAVDOC Travel Documentation B 1BUSLIC Business License B m. indoor Air uuauty ana mnisnes E Resource pts y =yes 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 LowMo VOC Adhesives 3 IAQ/Health pts y =yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y =yes 5. Use Engineered Sheet Goods with no added Urea z 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 Exposed Particleboard 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 E Resource pts y =yes 2. Use Rapidly Renewable Flooring Materials Resource pts y =yes 3. Use Recycled Content Ceramic Tiles Resource pts y =yes 4. Install Natural Linoleum in Place of Vinyl . i IAQ/Health pts y =yes S. Use Exposed Concrete as Finished Floor Resource pts y =yes 6. Install Recycled Content Carpet with Low VOCs z Resource pts y =yes 0 Total Points Availa le: 1401 130 57 Total Points Project Received: 01 0 0 w cy V1 G: data /progs/greei ibuildngguidelines/ remodelers/ greenpc intsfinaiL12.D4protected.xis rte: CITY OF ,;UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: :z cv P/1, v PERMIT # X07 U(� OWNER'S N PHONE # GENERAL CONTRACTOR: f 6 _ o _ FAX # I am not using any subcontractors: Si;;nature Date Please check ar)nlicable subcontractors and complete the following information: 6 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 Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile .� 6 Owner/ Contractor Signature Date