14110090CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7505 PEACH BLOSSOM DR
CONTRACTOR: ATLAS-TRILLO HVAC
PERMIT NO: 14110090
OWNER'S NAME:
SAN JOSE, CA 95125
PHONE NO: (408)286-8931
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
v LICENSED CONTRACTOR'S DECLARATION
REMOVE & REPLACE ALL (E) HVAC DUCT WORK, LIKE
Q�7 2
Ucense Class s,�,, Lic. it - l .'T "i D(L_
FOR
A
Contractor ��C (0 f _Jv4 11(:) Date _ t �{ )
LIKE
I 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.
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area: Valuation: $4000
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
APN Number: 36611130 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 D -Pg ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D OM C ED INSPECTION.
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
7
Issued b Date: 4'
granting of this permit. Additionally, the applicant understands and will comply
with all non -point egulations per the Cupertino Municipal Code, Section
918.
•�
RE -ROOFS:
I
Date e c
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain compliance w
the Health &Safety Code, S 5505, 25533, and 25534.
1 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
Owner or authorized agent: Date: LVLO
permit is issued.
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 Worker's
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date
CITY OF CUPERTINO
�1VU 1Vc'I`111%4 A Illi? — RTTTT .nFNC DIVTCION
[a
ADDRESS: 7505 peach blossom dr
DATE: 11/17/2014
REVIEWED BY: melissa
I
APN: 36611130
BP#:
"VALUATION: 1$4,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
Plan Check:
PENTAMATION 1 RMAP1
PERMIT TYPE: i
USE:
iPME
T71-
WORK
remove & replace all a hvac duct work like for like
PME Unit Fee:
SCOPE
PME Permit Fee:
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Other Appliance/Equip 1 BAPPLOT 1 # $72
TOTALS: $72.00
NOTE: This estimate does not include fees due to other uepartments (Le. rlanning, ruattc vvurA3, I,t.G, ou.tuu.y -., a�l�•• ea y
rantart the Dent for addn'l Info.
FEE ITEMS (Fee Resolution 11-053 Ef. . 7f 11113)
FEE
-
QTY/FEE
MISC ITEMS
Platt C hec.'k Free:
sttl'pi PC.' l`e'e
Plan Check:
$0.00
iPME
T71-
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
C.G1t.Y17'diC/CC�tt Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes •; No
$0.00
Plara ing Fees:
A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong; Motion Fee: IBSEISMICR
$0.52
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$214.52
$0.00 TOTAL FEE:
$214.52
Revised: 10/01/2014