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09010055 CITY OF CUPERTIPQO � � �, BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10740 MTNETTE DE —JID—P PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. ow0 : 408 646-326 BUILDING PERMIT[NFO ARCHIL.CT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 v p pLICENSED CONTRACT OR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 70(10)of Division 3 of the Business and Professions Code.and my license is S EWR LINE RE P LCMNT ;2.2 in full force and eR 2 - L� \ ? License Cl 7 p Date Conlraear_ ARCHITECT'S DECLARATION �tt�CC l understand my plans shall be used as public records 7LuU O in Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure prior Iv its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Y H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 52000 e R— that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 37531039 . 00 0 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 oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law docs not apply to an owner of property who builds or improves thereon,and who does such wort himself or through his own employees,provided that such improvements ate 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.). NITA, ! A-.r 0 1,as owner of the property,am exclusively contracting with licensed contractors to ' construct the project(Sec.7044.Business and Professions Code:)The 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 tenseLaw' 0 I am exempt under Sec B&P C for this Mason 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 Workers Compen- ,on,as provided fon by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued 0 L have and will maintain Worker's Compensation Insurance,as mquircd by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued My Workers C�Co ir and Policy number arc: ' Grier. Policy No.: ITON 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.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z.t" CONSTRUCTION LENDING AGENCY (�►. 1 hereby affirm that there is a construction lending agency for the performance of pCt,7 the work for which this permit is issued(Sec.3097,Civ.C) W ALenohces Name �:)z L-cndees Address U 0 1 certify that I have read this application and state that the above information is L1.H corer.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. L1 t (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 V Z in consequence of the granting of this permit. Date ' APPLICANT UNDE NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R Re-roofs - Sigprplicant/Contractor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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(x)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes �No � 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. trict? 0 Yes Polo I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Codd_Sections 25505.25533 and 25534.1 understand that if the building docs not currenty�h ante a tenant,that it is my responsibility to notify the occupant of the Date u; or to issuance of a Certificate of Occupancy. Signature of Applicant U ) All roof coverings to be Class" `'or better Ow or authorized agent Data CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37531039 . 00 DATE ISSUED. . . . . . . : 01/13/2009 RECEIPT #. . . . . . . . . . BS000006961 REFERENCE ID # . . . : 09010055 SITE ADDRESS 10740 MINETTE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER NI DUAN ADDRESS . . . . . . . . . . : 10740 MINETTE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JUAN L DIAZ CONTRACTOR . . . . . . . : JUAN DIAZ LIC # 30298 COMPANY JD PLUMBING ADDRESS . . . . . . . . . . : 270 UMBARGER RD STE 66 CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : (408) 646-3266 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00 1PRSEWER UNITS 1. 00 20 .40 0 . 00 20 .40 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 103 .48 0 . 00 103 .48 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 103 .48 VISA --------------- TOTAL RECEIPT 103 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN#3-7,�:) ,�� • �� Date: of 113 ) 0 Building Address: �-6 � v Owner's bane: P ne Contrac�r: Phone#: 40$ 646 —3 2-6,6 vl—�( V\CN Fax #: 4r& 360- 6 Contact: Phone#: A o$ (54 6—6-1 3`l Fax #: SIC& 360 --5C7 Contractor License#: V 6 3 2 Cupertino Business License#: 2q Job Description: ��P`O �` y Residential Commercial ❑ Valuation: Z,00C " Project Size: Express Standard Large Major 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. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P _ 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CITY of CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P / 1 TRAVDOC Travel & Documentation Fee B ` 1 BUSLIC Business License B M.Indoor AFir uality and Fmtshes 1.Use Low/ND-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D 3.Use LowlNo VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes J=J=L 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 ! 1 ! N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes D 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D ! ! ! Total Points Available: 1 1401 1301 57 Total Points Project Received: 01 0 0 Q ( t 3 loct I G:data/progs/greenbuildinoguidelines/remodelers/greenpointsfinal2.12.04protectedxls Community Development `-: 10300 Torre Avenue { w„ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 f.',UPEKTINO Buildin De artment JOB ADDRESS: PERMIT # ' D U � OWNER'S NAME: PHONE # �od 646 -3z,516 GENERAL CONTRACTOR: I ,� �c r FAX # aC� 360 6 4� I am not using any subcontractor • ?'I Signature Date Please check applicable subcontractors and complete the followininformation: 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/Contractor Signature Date