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09060003 CITE'OF CUPERTINO h,- BUILDING DIVISION PERMIT � Z 1Y34 -ON ` BUILDING ADDRESS: PERMIT NO. 10074 LIBERTY OAK LN CUPERTINO PLUMBING 09060003 PERMIT ISSUE DATE (408) 253-0618 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH apo LICENSED CONTRACTOR'S DECLARATION Job Description U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'may in full force and ert p — COPPER REPIPE/WATER HEATER v�Z License Class - �� Lic•M �'� 7 a n t- Date /- S Contractor — AiiCHrmcT s DECLARATI13N a U I understand my plans shall he used as public records a tt.y Licensed Professional O< OWNER-BUILDER DECLARATION } 1 hereby affirm that 1 am exempt from the Contractor's License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county K Pi which requires a permit to construct,alter,improve,demolish,or repair any structure y �' prior to its issuance,also requites the applicant for such permit to file a signed statement E_G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation >l- (commencing with section 7000)of Division 3 of the Business and Professions Code)or $5000 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 mom than five hundred dollars($500). 34232046 . 00 ❑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 Code:The Contractor's License Law dries 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.). ❑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. ❑I am exempt under See B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 'have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .m,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I will maintain Worker's Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: ,�1 q Cartier.�',_ tL, Policy No.: S CERTIFICATE OF EXEMPTION FROM WO CERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z 0-4 CONSTRUCTION LENDING AGENCY rA I hereby affirm that there is a construction lending agency for the performance of pf, the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendces Name az Lcnder's Address U 0 1 certify that I have read this application and state that the above information is LL. correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hemby authorim representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against ,may y liabilities,judgments,costs and expenses which may in any way accrue against said City �? �j- U Z in consequence of the granting of this permit. Date 'C -- APPLICANT UNDERSTANDS.AND- /ILL C;,MPLY WITH ALL NON-POINT Issued bi 199BIZEREGULATIONS'. Re-roofs Signature of Applicant/Conyyl�tlor '' Dare �= HAZ RDOUS MATERIALS DISCLOSURE 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(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes CJ�o .. 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 r iaterials for inspection. rict? _ ❑Yes QNti'" 1 have mad the haiardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,255V, d 25534.1 understand that if the building docs not currently have a reticent t1sT i�is my ity to notify the occupant of the requirements_whiehmust be met prior to issy ori icate of Occupancy. Signaturc of Applicant Date yam.. All roof coverings to be Class':q"or better Owner of au .6.d agent ' Date qo(p CDC>3 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APP] JICATION FORM APN# Date: Building Ad r ss. : Contact:1 Phone#: 30 F �7r�n�-- Fax#: Contractor License#: Cupertino Business License#: Job Description: Cs.� Q�-c (��a-�-- � '�.��-v- G�-�•.�-ems Residential Commercial ❑ Valuation: -5. v Project Size: Express Standard Large [] Major El Green Building: Please complete relevant portior 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 Newer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial G,-.s Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF C'UPERTINO REPIPE/SEWERAIN SERVICE (�TJM CUPE INO FEE SC FIEDULE Quantity Fee ID Fee Descriptio a Fee Permit Type Group 1 BCBSC Cal Bldg Standarc s Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary serer 1PRREPIPE Residential re-pip,:per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P / 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas P.ping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets, P / 1PPERMITFEE Plumbing Permit:lee Issuance P 1 PLMBLNCK Plumbing Plan C1 eck P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B M. Indo-Or Air Quality and Finishes 1.Use Lawlf+3o VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes0 3.Use Lowl 4o VOC Adhesives 31AQ/Health pts y=yes 7 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed ParMaboard yr MDF 4 IAQ/Health. pts y=yes 0 8.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 3 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=yesl 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 Total Points Available: 1401 130r____5_7 Total Points Project Received:i 1 01 01 0 G:data/progs/gre:nbuildngguidelines/remodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r,UPEkTINO Building Department JOB ADDRESS: PERMIT# C CY-7 L 04r- OWNER'S 4r- OWNER'S NAME: FAX # 012 I am not using any subcontractors: Signa Date Please check applicable subcontractors and com Dlete the following information: 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