09100006 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19742 BIXBY DR CONTRACTOR:PREMIER PLUMBING AND PERMIT NO:09100006
REPIPE INC
0—NER'S NAME: THOMPSON CHARLES T AND MARGARE 1725 ROGERS AVE STE C DATE ISSUED: 10/01/2009
0 uvNER'S PHONE: 4082570177 SAN JOSE,CA 95112 PHONE NO:(408)903-8184
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f- PLUMB F
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date&--,(--
1 hereb arm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER REPIPE FROM HOUSE SHUT OFF THU-
ffi(commencing with Section 7000)of Division 3 of the Business&Professions OUT ENTIRE
Code and that my license is in full force and effect. HOUSE,NEW 40 GALLON WATER HEATER SAME LOCATION.
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 5700 of the Labor Code,for the
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$6573
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36909018.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section �^
9.18• Issued byc! l Date-A0--,/
i
e� -ature Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,1 shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner-4r autt ' a ent•
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:,1(2 0
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
.mify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36909018 .00
DATE ISSUED. . . . . . . : 10/01/2009
RECEIPT #. . . . . . . . . : BS000008810
REFERENCE ID # . . . : 09100006
SITE ADDRESS . . . . . : 19742 BIXBY DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : THOMPSON CHARLES T AND MARGARE
ADDRESS . . . . . . . . . . : 19742 BIXBY DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3325
RECEIVED FROM . . . . : PREMIER PLUMBING &
CONTRACTOR . . . . . . . : JOSE MENDEZ LIC # 30877
COMPANY . . . . . . . . . . : PREMIER PLUMBING AND REPIPE IN
ADDRESS . . . . . . . . . . : 1725 ROGERS AVE STE C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 903-8184
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 573 . 00 1 . 00 0. 00 1. 00 0 . 00
1BPWATER UNIT 1. 00 42 . 00 0 .00 42 . 00 0 . 00
1BSEISMICR VALUATION 6, 573 . 00 0 .70 0 . 00 0. 70 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00
1PRREPIPE NO OF FIXTURE 9. 00 99 . 00 0 . 00 99. 00 0 .00
1PRWHEATR UNITS 1. 00 25 . 00 0. 00 25. 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 251 . 70 0 . 00 251. 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 251 . 70 #1020
---------------
TOTAL RECEIPT 251.70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTiNO PERMIT APPLICATION FORM
APN# � � �} � 6 Date: 10
Building Address:
192
9- A,�i L
Owner's Name: `1 Phone#:
a C� - Tkobvic)So u
ntractor:
�A– V- Fax#: Liza 69�.
Contact: `_J Phone#: �-
XelFax#:
Contractor License#: 9 P G 3
Cupertino Business License#:
Job Description: C 0 jope'� �'Q `� Q
Residential _ Commercial ❑
Valuation:
S
ProjectMize: Express Standar 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 & thsheet index.
Green BuildingPoints:
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
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
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
1 PRSEWER 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
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
1PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentation Fee B
1 BUSLIC Business License B
(� (L U
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 Project
Plans See below
r
B. Site 9. Install H.E. Irrigation, (details/spec)' 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/Spec. A-4 2 oints
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 oints
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, (Note/Spec. A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 1 40 points
Plan Review Process Work Book Page-12-Revised 3/25/08
Indoor Air Quality and Finishes INPUT Resources Energy [AD/Health
1.Use LowMo-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 Low/t4o 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
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all ExposWP. Ieboardor MDF 4 IAQ/Health. pts y=yes 0
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 B 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
i t t
Total Points Available: 1 1401 130 57
Total Points Project Received: 1 01 01 01
/'G.:da4talprog,/greenbuilcriinggui mes/remodelers/g reenpointsfinal2.12.D4protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Buildin De artment
JOB ADDRESS: PERMIT #Rix 1A 'I _
OWNER'S N PHONE #�
GENERAL CONTRACT V Q1
I am not using any subcontractors: `Q
Signa Date
Please check applicable subco actors and complete 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