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09040005 CITY OF CUPERTINO #u � � : . BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 2o211 suTSIML_DE�- TBp TO P132M1T ISSUE DATE OWNER'S NAME: S A - CONTROL NO. BUILDING PERMIT INFO FRCECTfENG1NNEER: BLDG ELECT PLUMB MECH 0 0 a o -------------- c c LICENSED CONTRACTOR'S DECLARATION Job Description v hereby affirm that I am licensed under provisions oC Chapter 9(commencing z tion7000)oCDivision3ofthcBusinessand of o Code,a ylicenseis C,OPPR REPIPE FRM HSE SHUTOFF THRU—OUT ENTIRE HSE arce and efr j z License Class Lic•# EXCEPT BK F•o Dam Contractor ARCHITECISD IIG "PREMIER PLUMBING AND REPIPE INC. PD FOR BUS LIC I understand my plans shall be used as public records Ir�yv O in Licensed Professional OWNER-BUILDER DECLARATION n.l 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct.alter,improve,demolish,or repair any structure Valuation o"H prior to its issuance.also requires the applicant for such permit to file s signed statementF3692801E . 00 Ft.Floor Area —Z< that he is licensed pursuant to the provisions of the Contractor's Incense Caw(Chapter 9q 750 Y F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 5.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofAPN Number not more than five hundred dollars(5500)• 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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,die 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 Contractors Li- rty mon,and. who contracLaw ts for sucnot h ppy to an owner of rojects with a conttracmr(s)licensedbuilds pursuantt to the Contractors License Law. B&P C for this mason I am exempt under Sec. 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- .ion,as provided for by Section 3700 of the Labor Code,for the performance of the �worit for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need riot 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,1 shall not employ any perso • y marine to become b W rkers'Compensation Laws of Calif r Applicant NOTICE P CANT:If,a[§Ww1his C of Exemption,you should ba subject m the Worker's Compensate revisions of the tabor Code,you mus 'Z, forthwith comply with such provisions or this permit shall be deemed revoked. Z R CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C-) W ALender's Name 0 Lender's Address C)Z I certify that I have read this application and sate that the above information is LL Corect.1 agree to comply with all city and county ordinances and sate laws relating to C.) building construction,and hereby authorize representatives of this city m enter upon the above-mentioned property for inspection purposes. m>4 OWa (We)agree to save,indemnify and keep harmless the City of Cupertino against H aj liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►� APPLICANT UNDERSTANDS D WILL C MPLY ITH ALL -POINT Issued by SOURCE REGULATIONS. Re-roofs Signature of Applic tractor Dao T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant sore 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 Well the applicant or future building occupant use equipment or devices which all new r Iaterials for inspect-ion. iit hazardous air conaminan defined by the Bay Arca Air QualityManagement strict? O Yes ° L e read the hazardous materials requirements under Ch�d' .95 of the Califor- Safety Code.Sections 25505,25533 and 25534.1 undethat if Ute building rently have a tenant,Umar it is my responsibility to nthe occupant of the Date which l prior a rtificaicccu an Signatur,:of Applicant ` All roof coverings to be Class'A"or better orized agent Date i CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # 3o a n r Date: Building Address: ULn Owner's Name: � Phone#: ontractor: ,n Phone#: Fax #: Contact: �-O�p Phone#:,�Q oe? > Fax#: Contractor License#: Cupertino Business License#: Job Description: C V- ?'�� l , p �'�� ct Tkvy-vt 01ki wo G Residential Commercial ❑ Valuatio Pro je Size. Express ❑ StandardLff Large Major❑ Green Building: Please complete relevant portio a of the Green Building Checklist & attach it to t application or if applicable, include in plan set& the sheet index. rc2-), Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 11CPSS sewer/sanitary sewer 1BPREPIPE Commercial rc-pipe per fixture P 1CPRP 1PGASCOM 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 REPIPE/SEWERIMAIN SERVICE CUPEt�TiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group IBCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residentia. P 1PRSEWER Residential building P 1RPSS sewer/sanitary sew s-r / 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P IPCESS Cesspool P IBPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Pi)ing System P 1-4 Outlets 1BPGAS Gas Piping SysteYr 5+ Outlets P IPPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Ch.-ck P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Prc jest Plans See below B. Site 9. Install H.E. Irrigation, (details/sp;c)' L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D.' Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, Note/:pec.) A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11.A 2500 Gal.Tank, (Note/Spec L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A,3 1 point 3. Energy Star Refrigerator, NoteiS ec. A-3 1 point P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 40 points 4 Plan Review Process Work Book Page-12-Revised 3/25/08