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09010110 CITY OF CUPERTINO BUILDING DIVISION PERMIT11�Afw ?R ITI(3N� BUILDING ADDRESS: PERMIT NO. 18700 NEWSOM AVE DRAIN DOCTOR 09010110 OWNER'S NAME: PERMIT ISSUE DATE °HO A CONTROL NO. (408) 370-3082 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1 O p LICENSED CONTRACTOR'S DECLARATION !UF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description with Section 7000)of Division 3 of the Business and Professions Code,and my license is t y in full force and effecL8 REPLC SWR LINE & INSTL PROPTY CLEAN-OUT ;M4 License Class Lic,K O Date Contractor ARCHITECTS DECLARATION ,a U 1 u nd my plans shall be used as public records O y Licensed Professional t 3 OWNER-BUILDER DECLARATION j< 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Cafe:Any city or county m which requires a permit to construct.alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ~3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of $7165 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(5500). 37530005 . 00 p y yp ❑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 and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections 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.). ❑I,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 Contractor's License Law. 0 I am exempt under Sec. B&P C for this reason SANITARY' 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 Worker's Compen- .ton,as provided for by Section 3700 of the Labor Code•for the performance of the work f hi ch this permit is issued. I have and will maintain Workers Compensation Insurance,ss required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insu ce carrier and Policy number am: 7 QQ Carrier. Policy No.: CERTIFICATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 Califumia.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. N CONSTRUCTION LENDING AGENCY .4 1 hereby affirm that there is a construction lending agency for the performance of Yt> the work for which this permit is issued(Sec.3097,Civ.C.) 0i A Lender's Name Z Lendees Address Q 1 certify that I have read this application and state that the above information is 4 0--4 correct.I agree to comply with all city and county ordinances and state laws relating to VU building construction.and hereby authorize representatives of this city to enter upon the w above-mentioned property for inspection purposes. y CA (We)agree to save,indemnify and keep harmless the City of Cupertino against y cn liabilities,judgments,costs and expenses which may in any way scenic against said City Z in consequence of the granting of this permit. r"t APPLICANT UNDERSTANW AN WILL COMPLY WITH ALL N N-POINT Issued by: Date SOURCE REGULA7T - Re-roofs Signature o pplicant/Contractor 6ac HAZARDOUS MATERIALS DISCLOSU E Type of Roof 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)? [-]Yes All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Act? 0 Yes IQs 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whljch et prior to issuance of a Ccrtificat of cnpaney. Signature of Applicant Date ( iK ' All roof coverings to be Class'`'or better Owner or authorized agent atc CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 37530005 . 00 DATE ISSUED. . . . . . . : 01/26/2009 RECEIPT #. . . . . . . . . BS000007041 REFERENCE ID # . . . 09010110 SITE ADDRESS . . . . . : 18700 NEWSOM AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER RAMAN KRISHNAN ADDRESS 18700 NEWSOM AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DRAIN DOCTOR, INC. CONTRACTOR JOHN H. LIM LIC # 24784 COMPANY . . . . . . . . . . : DRAIN DOCTOR ADDRESS 1775 WINCHESTER BLVD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 370-3082 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 165 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 165 . 00 0 . 80 0 . 00 0 . 80 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 .78 0 .00 103 .78 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 103 . 78 #1598 --------------- TOTAL RECEIPT 103 .78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING U 0l0/ r � CITY OF CUPERTINO - REPIPE/SEWER/MAIN SERVICE CUPEi�TINO PERMIT APPLICATION FORM APN # ,�- .. Date: 3 �� 0 () ()- t 11, tJ 1 Z Building�ddress: ov Owner's Name: Q hl A h Pr- A yi 01 n Phone#: Y Z�� 4.3 Contractor: Phone#: �OV -7�1 g7< �fG Y Fax#: Contact: Phone#:403) 7it/,-, / 83 Fax #: Contractor License#: [(� Cupertino Business License#: 3� (--� L/7 Q Job Description: � 'A ce /-/—rLx roff Residential Commercial ❑ Valuation: 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 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO r REPIPE/SEWER/MAIN SERVICE CUPE(,TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC 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 1BPWATER Install/alter Water Pipe P 1BPFIXTURE 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 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P / 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B M.Indoor Air Quality and Finishes MUNIM 1.Use LOWNO-VOC Paint 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowMo 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 p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7•W all Exposed ParftkwdorMDF 4 IAQ/Health. Y=Y is es 0 P B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 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 0 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 1 G:datatprogs/greenbuildmgguidelines/remodelers/greenpointsfina1212.04protected.xls Community Development 04 10300 Torre Avenue RW Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPE�TINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: 1� (,'r►.. PHONE # 7 ?1 GENERAL CONTRACTOR: o+K yti. FAX # I am not using any subcontractors: IZ-2—b Si ature Dat Please check applicable subcontractors and complete the following information: 60 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