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09100060 CITY OF CUPERTINUBUILDING PERMIT BUILDING ADIIRESS: 10100 DE ANZA BLVD CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100060 OWNER'S NAME: ARMADILLO WILLYS DATE ISSUED: 10/09/2009 t IER'S PHONE: 4082527427 , PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f- PLUMB License Class u 672J 7 -1 Contractor Date f� 9 MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION:REMOVE APPRX 45FT ASPHALT,EXCAVATE& I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions REPLACE Code and that my license is in full force and effect. SEWER MAIN(PARTIAL)BACKFILL,NO ASPHALT REPLACE; CEERTIFIED PLUMBING PD FOR BUS LIC 10/09/2009 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: on:$15000 permit is issued. APPLICANT CERTIFICATION APN Number:36901001.00 ancy Type: I certify that I have read this application and state that the above information is t, 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT PRK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may a e ag inst said City in consequence of the WITH 1 F PERMIT ISSUANCE OR granting of this permit. Addit' nally,the applicant understands and will comply 180 DA M T CALLED INSPECTION. with all non-point source r lation er the Cupertino Municipal Code,Section 9.18. (�'y� Issued by: �+ ' '/ 0/91)ate: Signature Date Li OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,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 I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,S ns 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I must Owne or author' ut. / forthwith comply with such provisions or this permit shall be deemed revoked. Date: /0 q/ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save �nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 sou regulations per the Cupertino Municipal Code,Section 9.18. gyp, 1 understand my plans shall be used as public records. Signature Date cr.) ��v / Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36901001. 00 DATE ISSUED. . . . . . . : 10/09/2009 RECEIPT #. . . . . . . . . BS000008874 REFERENCE ID # . . . : 09100060 SITE ADDRESS 10100 DE ANZA BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ARMADILLO WILLYS ADDRESS 10100 DE ANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM CERTIFIED PLUMBING, CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 15, 000 . 00 1 . 00 0 . 00 1 . 00 0 .00 lBSEISMICO VALUATION 15, 000 . 00 3 .15 0 . 00 3 .15 0 . 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0. 00 114 . 00 0 .00 1PCSEWER UNITS 1. 00 21 .00 0 . 00 21. 00 0 .00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 223 .15 0 . 00 223 .15 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 223 . 15 #201295 --------------- TOTAL RECEIPT 223 .15 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: to Owner's Name: Phone#: • W,1A i&I �C( C I c400 2-S -7 t47-7 Contractor: , Phone#: c400 UA3'1700 cz-w-4r � 13i Fax #: 'z"k5- -see I Contact: Phone#: I&A t Pk t Fax#: Contractor License#: Cupertino Business License#: Job Description: Residential ❑ Commercial Valuation: 15-000 - 00 Project Size: Express Q--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 1PGASCOM 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 CITYCUPEf�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 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 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P - 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B INPUT ResouTces Energy •Q M.Indoor Air Quality and Finishes 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/No 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 6lAQ/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 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 1 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 kild Total Points Available:1 1 1401 1301 57 Total Points Project Received: 01 0 0� G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 .�UPEkTIN0 Building Department JOB ADDRESS: PERMIT # kokoo OWNER'S NAME:q��%,-kn1U o PHONE # c4oi�5 ZOOO -7700 GENERAL CONTRACTOR: i FAX # 1-40Z 2-CAS- -5955 I am not using any subcontractors: lole Signature Date Please check applicable subcontractors and complete the following information: 21 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 ��SAN ' BOARD OF DIRECTORS DISTRICT MANAGER•ENGINEER �� r� .P� MARK THOMAS&COMPANY,INC. I J WIW/AM A.BOSWORTI 1 RICHARD K.TAN/�.KA JOHN M.GATTO YCAPS OF CURTIS B.HARRISON DISTRICT COUNSEL- a.5F.AVTCF H/ENDELL H.KF-RR,JR. ATKINSON•FARASYN,LLP. �f'�Br��gN6p'� CHRISTOPHER C.LEE HAROLD S.TOPPEL 20833 STEVENS CREEK SOULEVARD,SUITE 104 CUPERTINO,CALIFORNIA 95014.21134 (408)253.7071 PHONE • (408)253.51173 FAX www.cupertinosanitsrydistrict.c o m File: CuSD—MOP Building Dept. —Cupertino City of Cupertino Attn.: Building Department 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Onsite sewer repaired Name: Armadillo Willys Address: 10100 De Anza Blvd. APN: 369-01-001 Permit No. 09100060 ■ Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the .District. Inspector: Tony Sofres/Roger Santos........... .... Date:...10-27-2009................... Sanitary Sewer Location: cc: Property Owner 51' long 5' deep SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS ANO SURROUNDING UNINCORPORATED AREAS