09100080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10397 MEADOW PL APT A&B CONTRACTOR:AQUATEK PLUMBING INC PERMIT NO:09100080
OWNER'S NAME: JOHN BRUZUS P O BOX 23271 DATE ISSUED: 10/13/2009
ER'S PHONE: 4156151863 SAN JOSE,CA 95153 PHONE NO:(408)295-7767
❑ LICENSED CONTRACTOR'S DECLARATION f— F
/ r-� '"� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C c.# b 1-I S - ) f— I— r-
C� MECH RESIDENTIAL COMMERCIAL
Contractor Date 10_0�^O -1
I hereby affirm t at I a n e e the rovisions of Chapter 9 JOB DESCRIPTION:COPPER RE-PIPE OF BOTH UNITS,APTS.A&B
(commencing with SectionF��t
n of the Business&Professions
Code and that my license d effect.
Ihereby 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 3700 of the Labor Code,for the Sq.Ft Floor Area: Valuation:$12000
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 APN Number:34229020.A&B Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify 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 thi a by
t. Additionally,the applicant understands and will comply Issued i. Date/`t 3 6
with all no oin s rce regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date
N\1 N11
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
L O R-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
% j inspection.
I hereby (firm t I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the stnicture is not intended or offered for sale(Sec.7044,
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally, hoold I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by contaminan s s defined by the Bay Area Air Quality Management District 1 will
Sheri
ce with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this de,Sections 25505,25533,and 25534.
permit is issued.
1 certify that in the performance of the work for which this permit is issued,I shall
an
d
not employ any person in any manner so as to become subject to the Worker's Date: 1
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I mustCONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this pennit shall be deemed revoked. there is a constriction lending agency for the performance of work's
t is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
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 Lender's Address
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
i unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34229020 .A&B
DATE ISSUED. . . . . . . : 10/13/2009
RECEIPT #. . . . . . . . . BS000008898
REFERENCE ID # • . . : 09100080
SITE ADDRESS . . . . . : 10397 MEADOW PL APT A & B
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER JOHN BRUZUS
ADDRESS 10397 MEADOW PL APT A
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AQUATEK PLUMBING IN
CONTRACTOR . . . . . . . : SHEPHERD, JAMES LIC # 21658
COMPANY AQUATEK PLUMBING INC
ADDRESS P O BOX 23271
CITY/STATE/ZIP . . . : SAN JOSE, CA 95153
TELEPHONE (408) 295-7767
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 000. 00 1 . 00 0 .00 1 . 00 0 .00
1BPWATER UNIT 1. 00 42 . 00 0. 00 42 . 00 0 .00
1BPWSVCS WATER SERVICE 1 .00 21 . 00 0 . 00 21. 00 0 . 00
1BSEISMICR VALUATION 12, 000. 00 1.20 0 . 00 1.20 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 149 .20 0 . 00 149.20 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 149 .20 #9496
---------------
TOTAL RECEIPT 149 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
OV o0 00
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: Au k tl
Owner's Name: Phone#:
Phone#:(4 U'" 7 W
Contractor:
\,CilFax#:
,4
Contact: Phone#:
Fax#:
Contractor License#:
Cupertino Business License#:
Job Description:
Residential Commercial E]
Valuation:
Project Size: Express Standard E] Large LJ Major F-1
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 ICPSS
sewer/sanitary sewer
IBPREPIPE Commercial re-pipe per fixture P 1CPRP
IPGASCOM Commercial Gas Piping System P
1-4 Outlets
IBCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
IBSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CITYCUPEi�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
I 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
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
M. ndoor Arir uahty an Fmis es INPUT Resoumes Energy IAD;Health
1.Use Lo*No-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 61AQ/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
S.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 LO 1 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
1 0 1
Total Points Available: ,1 130 57
Total Points Project Received:1 01 01 0
G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls
Community Development
10300 Torre Avenue
td, Cupertino CA 95014
Telephone(408)777-3228
aft OF Fax(408)777-3333
'UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
1 )S9-1 M.P- ,, .o lice. Re- 660d-O
OWNER'S NAME:-Xc)hr 16`OZQ S– PHONE c�)aS '1
GENERAL CONTRACTOR: FAX # ?—CA S 11 FS
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors 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
f Plumbing
Roofing
Septic T
Sheet etall
Sheet R ck/
Til<2
OWne C n acto e Date