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09080025 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19731 BIXBY DR CONTRACTOR:CHARLES PLUMBING PERMIT NO:09080025 OWNER'S NAME: SHAG-HAN LIN 581 SARATOGA AVE DATE ISSUED:08/06/2009 t+ ER'S PHONE: 4082487910 SANTA CLARA,CA 95050 PHONE NO:(408)248-7910 ] ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class j Lic.# y [.f- r r �T[y'��— T-- — MECH RESIDENTIAL COMMERCIAL ContractorK. Lar hate'' I hereby a m that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL ANEW 40G WATER HEATER r (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 3700 of the Labor Code,for the Sq.Ft Floor Area: Valuation:$1000 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:36909047.00 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 this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulation the Cupertino Municipal Code,Section 9.18. 7., Z� G D� Signature Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is LJ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. 1 hereby affirm that 1 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 structure 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 I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. 1 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,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance 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 Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,1 shall Ow nV,or aut e en . not employ any person in any manner so as to become subject to the Worker's N Date: .- Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit 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 nify and keep harmless the City of Cupertino against liabilities,judgments, :rid 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 orlaon-.�5-, Y CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APP]�ICATION FORM APN �� 9 J g 0 V 7 Civ Dater Building Address: 1:9 7 3 1 6!�� Owner's Name: Pyne #: 9 Contractor: Phone #: ©#: Cupertino Business License #: Contractor State License #: c zf 1341 t? Contact: Phone #: Fax M Building Permit Info: Bldg ❑ Elect Plumb Mech [� Residential X Commercial ❑ Job Description: Strapped . On Platform ❑ Bonded ❑ New Location ❑ Replacement r. Valuation (cost of project): 6 Project Size: Express 4Standard ❑ 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 achieved: Revised 01/07/09 CITY OF CUPERTINO .1. -a WATER HEATER CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Descripti c)n Fee Permit Type Group 1 PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission F'ee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee r 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Pernit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B M.Indoor Air Quality and Finishes INPUT Resources Energy IAD/Health 1.Use Low/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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal d ExposedFarticieboard or 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 i 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=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 Ow Total Points Available: 1 1401--- 40 130 57 Total Points Project Recelved: �j 01 0 G:data/progs1greE nbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls k,7-8 Community Development 10300 Torre Avenue 14 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPERTINO Building Department JOB ADDRESS: _ PERMIT# /47 79/ i O' D WNER'S NAME: V PHONE # GENERAL CONTRACTOR: FAX # Io y�iibcontracto 3 a44- Signature Date Please check apphcable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 UC7T4 GV /A c� Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Con actor Signature Date