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09030208 CITY OF CUPERTINO BUILDING DIVISION PERMIT Gfi7}`+TRIi (? � RT��Np PERMIT NO. BUILDING ADDRESS: 22091 HIBISCUS CT ATLAS-TRILLO HVAC 09030208 PERMIT ISSUE DATE OWNER'S NAME: , TTANgCIN RCIRFRlp 141 AMM MAVV T• lclrr, 11-2999 SAN U CONTROL NO. ONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH ADD NEW A/C IN ATTIC Q D D D u o c LICENSED CONTRACTOR'S DECLARATION fob Description ut p 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 y bee/+fie is w in full force and effectC 2 Lle.M ? License Class nt—,n Dam Contractor ARCHITECTS DECLARATION a< I understand my plans shall be used as public records DWO U*.* Licensed Professional L.0< OWNER-BUILDER DECLARATION Y, I hereby affirm that I am exempt from the Contractor's License Law for the a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county t a which requires a permit to construct,alter,improve,demolish,or repair any structure y H prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation ?e that he is licensed pursuant to the provisions of the Contrxtur's License Law(Chapter 9 Sq.Ft.Floor Area E H G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Y. y 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). ❑1,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 Required Inspections and Professions Cade:The Conuactoes 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.If, 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:)The Contractor's 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. ❑1 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: I have and will maintain a Certificate of Consent to self-insure for Workefs Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workefs Compensation I surance carrier and Policy number are: Cartier.askiG ( Policy No.: CERTIFICATE OF CEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E r rte—. I hereby affirm that there is a consuuction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) LL)QLender's Name 04 Lendees Address U C) re I certify that 1 have ad this application and state that the above information is lL H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against ►�-i to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date �V ►-r APPLICANT UNDERST DS D WILL COMPLY WITH ALL NON-POINT Issued by: SOURCEREGUL / '-� e-roof; - Signature-oC t/ or Dateof Roof HAZARDOUS MATERIALS DISCLOSURE Tyle Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which ;it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. -,isrict? ❑Yes No 1 have read the harardou rials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sec' ns 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which m o issuance of a Ccnificate of Occupan� , Signatul a of Applicant Date 33All roof coverings to be Class','."or better Owner or au ori agcm Date CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # .32,(P02- 6Z4 . 00 Date: Building Address: `Z. 2, © W I l 5 CU CT- Owner's Name: �. Phone#: Contractor: Phone#: Ll C),z 1, (D Fax#: t-1 Contractor License#: Cupertino Business License#: Contact: Phone#: Fax#: Building Permit Info: Elect 9 Plumb Mech Residential Commercial ❑ Job Description: o 4-7 -- 14 For Residential Installations: Attic 1St floor [] 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: © CD Type of Construction (Usage Class): 7, 6 0 Strapped On Platform Bon ied PQ New Location Replacement El Project Size: Express and ❑ 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. Revised 01/07/09 CITY OF CUPERTINO -111; `` FURNACE/AC CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rel)air/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,,ibsorption or evaporative cooling system,incl installation of cc,ntrols regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating applismce,refrigeration unit,cooling unil,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Ins:all/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of oa appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standzsds Commission Fee B ALL PERMIT TYPES 1BSEISMIC0 Commercial Seismic B 1MRR.AA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling absorption or evaporative cooling system,incl installation of c:)ntrols regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heator,recessed wall htr, or floor mounted t.nit heater. CITY OF CUPERTINO N FUF24ACE/AC CUPE(�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential fa-the install/relocate/ or M replacement of ea appliance vent install &not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Scismic B 1 MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or M relocate ea fo rced-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 furnace/burner, incl ducts/vents attached to sl-ch appliance over 100,000 Btu/1 / 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Pe.-mit P r 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO FURNACE/AC Cin OF FEE SCHEDULE CUPEfTINO Fee Description Fee Permit Type Quantity Fee ID Grou FURN/AC AIR CONDITIONINGB 1BCAIRHAN Commercial A/C Units <= lOk CFM 1 MCRAA Commercial Mech Repair/alt/add M Cal Bldg Standar ds Commission Fee B ALL PERMIT 1BCBSC TYPES 113SEISMICO Seismic Commercial B 1PGASCOM Commerical for ea as piping System P 1-4 outlets P 1PGASS ResidentialREfor ca gas piping system of 1-4 Outlets 1BPGAS For each gas Piping system of 5 or P more per outlet. Comm/Resid B 1 BREMAIRHAN Residential A/C'units<= lOk CFM / 1MRR.AA Residential Me ch Repair/alt/add M 1 Cal Bldg Standards Commission Fee B ALL PERMIT 1BCBSC TYPES 1BSEISMICR Seismic Resid-ntial B E IEPERMITFEE Electric Perm.t 1MPERMI'TFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P _ 1TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue {.. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r;UPEkTINO Building De artment JOB ADDRESS: PERMIT # CTa -, 0 ,? 0� OWNER'S NAME: L 1 C\ ` C� t-� PHONE # 2 `SG GENERAL CONTRACTOR: 71 LL- Q I FAX # L(O I am not using any subcontractors: —zG Signature Date Please check applicable subcontractors and con. lete the following information: SUBCONTRACTOR BUSI:4ESS 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/Contractor Signature Date