09080001 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21853 OAKVIEW LN CONTRACTOR:JA PLUMBING PERMIT NO:09080001
OWNER'S NAME: CARTER DONALD&JUDY :,8306 INDUSTRIAL BLVD STE B DATE ISSUED:08/03/2009
FR'S PHONE: 4082530551 l IAYWARD,CA 94545 PHONE NO:(510)266-5125
LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# ! / /y
MECH RESIDENTIAL r— COMMERCIAL r
Contractor Date
1 hereby affi that 1 am licensed under a provisions of Chapter 9 .IOB DESCRIPTION:REMOVING GALVANIZED WATER PIPE&
(commencing with Section 7000)of Division 3 of the Business&Professions CPWITH
COPPER
Code and that my license is in full force and effect. OPPIPE
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
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by liq.Ft Floor Area: Valuation:$3069
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
*,PN Number:32619100.00 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-p t source regulations per e C rtino Municipal Code,Section
9.18• a Issued by: Date:
Signatur I'Aft
Date v ��
11 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:
I 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. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety I have and will maintain Worker's Compensation Insurance,as provided for by Saty 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued, 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,I 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,1 Oner r authorized Ip g
become subject to the Worker's Compensation provisions of the Labor Code,I must o Date: 7 /
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCI'!ON LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.1 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
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
it ify and keep harmless the City of Cupertino against liabilities,judgments,
cz., ind expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
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
REPIPE/SEWE-R/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # 2el? (P/ ?� d C7 o Date:
Building Address:,�)1
ner's NI: Phone
Vo 1^J
Co ,t Phone#• ,
U rn lA VL Fax#:
Contact: Phone
';�)ews Fax#:
Contractor License#: �1 -�
Cupertino Business License#:
Job Description:
veA L
Residential r Commercial ❑
Valuation: *304
0 to
Project Size: Expres 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;,,ewer
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 C UPERTINO
T` REPIPE/SEWERMAIN SERVICE
CUPEf�T1NO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standard;; Commission B ALL PERMIT
Fee TYPES
r 1BSEISMICR Seismic Residentiz.l P
/ 1PRSEWER Residential building P 1RPSS
sewer/sanitary sew er
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1 PCESS 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
1 PLMBINSP Other Plumbing/gas Insp. P
` 1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.Use itaw7No-VOG 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 LowftVOGAdhesives 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 b9osed Particleboard or UDF 41AQ/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 0
N.Flooring
1.Select FSC Certified Wood Flooring I3 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 t Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs I.Resource pts y=yes 0
Total Points Available: 140 130 57
Total Points Project Received: A21
01
01
0
X/
G:data/progs/gref nbuildngguidelinWremodelers/greenpointsfinal2.12.04protected.xls
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
,MkTINO
Building Department
JQ � lli,57S S. 'V�e c,J �►/� PERMIT # cADDRES )
OWNER'S NAME'--6 0 6X4 — PHONE # D
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Si;;nature Date
Please check applicable subcontractors and complete the following information:
60 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/ ontractor Si Date