09080144 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:ABLE PERMIT NO:09080144
BUILDING ADDRESS: 10514 FELTON WAY UNDERGROUND
CONSTRUCTION INC
✓NEB's NAME:
SAN JOSE,CA 95154-4819 PHONE NO:(408)377-9990
❑ LICENSED CONTRACTOR'S'D7ECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB
I.ICCtlge Class L % Lac.# ` MECH+ RESIDENTIAL– COMMERCIAL
Contractor Date
JOB DESCRIPTION: INSTALL PROPERTY LINE CLEAN OUT ON
I hereby affirm that I am licensed under the provisions of Chapter 9 EXISTING SEWER
(commencing with Section 7000)of Division 3 of the Business&Professions LINE
Code and that my license is in full force and effect.
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 3700 of the Labor Code,for the S Ft Floor Area: Valuation:$3900
performance of the work for which this permit is issued. q
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:35918036.00 Occupancy Type:
permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN180 DAYS OF PERMIT ISSUANCE OR
s
I certify that I have read this application and tate that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating; 180 DAYS FROM LAST CALLED INSPECTION.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save Date:
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued by:
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section RE-ROOFS:
S. All roofs shall be inspected prior to any roofing material being installed.If a roof is
` Q installed without first obtaining an inspection,I agree to remove all new materials for
Signature Date �9'`7 ( inspection.
Signature of Applicant: Date:
❑ OWNER-BUILDER DECLARATION
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one A
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensatic n,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
HAZARDOUS MATERIALS DISCLOSURE
Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
I,as owner of the property,am exclusively contracting with licensed contractors t> California Health&Safety Code,Sections 25505,25533,and 25534. I will
constrict the project(Sec.7044,Business&Professions Code). maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
I hereby affirm under penalty of perjury one of the following three material. Additionally,should I use equipment or devices which emit hazardous
declarations: air contaminants as defined by the Bay Area Air Quality Management District 1
I have and will maintain a Certificate of Consent to self-insure for Worker's will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Compensation,as provided for by Section 3700 of the Labor Code,for the
the Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. �
_`%% --
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l shall CONSTRUCTION LENDING AGEN
CY
not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of
Compensation laws of California. If,after making this certificate of exemption,I work's for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I r gust
Lender's Name
forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address
APPLICANT CERTIFICATION
-ertify that I have read this application and state that the above information is
sect.I agree to complywith all city and county ordinances and state laws rel,ting ARCHITECT'S DECLARATION
to building construction,and hereby authorize representatives of this city to entcr I understand my plans shall be used as public records.
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Licensed Professional
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectio 1
9.18.
m Date_---- -- _—---
Community Development
10300 Torre Avenue
i' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"UPEkTINO
Buildi:n De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: Prat -C �, PHONE # 22 - 7Z1O
GENERAL CONTRACTOR: Ge, 4"? ,jr- C-06r FAX #
I am not using any subcontractors:
Si;;nature 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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF 12UPERTINO
REPIPE/SEWEIR/MAIN SERVICE
CUPEi�TINO PERMIT APPLICATION FORM
APN # , CP Date:
Bu��/ LddrG;l�� #of no ��I
-Owner's NamPhone#e:
(SGC LIM k6ir
Contractor: Phone#:
/m k Fax#: X08
Contact: Phone#:t qoe) Zt Sk6 ex"I Wcy ren:h
Fax#:
, ontractor License#: 7 '�
Cupertino Business License#:
Job Description: /1All prop cr J-7 kit
P�i6`1rn;c�7 Sewer 114e, -
Residential W Commercial ❑
uation: -3/ f?,04). 0
Project Size: Express ❑ Standard Large Major LJ
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set 6: the sheet index.
Green Building Points:
Quantity Fee ID Fee Descrip tion Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitar) sewer
1BPREPIPE Commercial r-,-pipe per fixture P 1CPRP
1PGASCOM Commercial (Jas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Star.dards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Com ercial P
Revised 01/07/09
CITY OF C UPERTINO
REPIPE/SEWER�MAIN SERVICE
CITY°fFEE SCHEDULE
CUPERTiNO
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1PRSEWER
J Residential buildingP 1RPSS
sewer/sanitary sewer
:::
JPRREPIPEResidential re-pip,-per fixture P 1RPRP
1BPWSVCS Water Service P ICPWS or
1RPWS
IPPRSEG Private Sewage Disposal System P
W
1 PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
::IIBPFIXTURE Plumbing Fixture P
PGASRES Residential Gas Piping System P
1-4 Outlets
IPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
I
TND )C Travel & Documentation Fee B
Business Licens'
B
M.
Indoor Air uahty an Finishes 0
1 Use ilevMrlNo-VOG Paint 1 I��Q/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 21,ka/Health pts y=yes 0
3.Use Low/N®VOCAdhesives 31.%Q/Health pts y=yes
31lesource is es 0
4.Use Salvaged Materials for Interior Finishes p Y=Y
5.Use Engineered Sheet Goods with no added Urea 6 IAQ/Health is - es 0
Formaldehyde P y-y 0
6.Use Exterior Grade Plywood for Interior Uses 1 'AQMeaith pts y=yes7. 0
SSW a,ENMW pa bdeboard or MDF 4 AQ/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--yes0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes
■ 1 1 1
N.Flooring 0
1.Select FSC Certified Wood Flooring B.resource pts y=yes
0
is y=yes 2.Use Rapidly Renewable Flooring Materials 4 lesource P y-y 0
3.Use Recycled Content Ceramic Tiles 4 3esource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y--yes
4 Resource is es 0
5.Use Exposed Concrete as Finished Floor P Y=y 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yeS 1
■ 1 1
Total Points Available: 140 1301 57
01— 01 0
Total Points Project Received:
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