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09080330 CITY OF CUPERTIP40 BUILDING PERMIT BUILDING ADDRESS: 10367 VISTA KNOLL BLVD CONTRACTOR:VIP PLUMBING AND PERMIT NO:09080330 DRAIN CLEANING OWNER'S NAME: FIRST STATEWIDE REALTY 4020 PAYNE RD DATE ISSUED:08/25/2009 ER'S PHONE: 4082531000 PLEASANTON,CA 94588 PHONE NO:(408)644-2288 ❑ LICENSED CONTRACTOR'S DECLARATION J��9:3 � 'BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# � yi P P�•U�rRiN� Date 06 MECH RESIDENTIAL COMMERCIAL Contractor I hereby affirm that I am licensed under the provisions of hapte 9 JOB DESCRIPTION:REPIPE WATER SYSTEM (commencing with Section 7000)of Division 3 of the Business&Professions 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 f`°k e:; All Compensation,as provided for by Section 3700 of the Labor Code,for theSq.Ft Floor Area: no performance of the work for which this permit is issued. T _, 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:32613 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERM IRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F M 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 perm't. Additionally,the applica nderstands and will comply Is ued b�: Date: with all non-pours rce regulat' ns per the Cu ert no Municipal Code,Section u Z 9.18. i Signature —�Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is b O ER-BUILDER DEC TION installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: I,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) 1,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 1 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 I will maintain compliance with t Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this yealhSafety Code,Sec o s 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall r orized a e not employ any person in any manner so as to become subject to the Worker's Date: f::' 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 mustINSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I here y 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 lift'and keep harmless the City of Cupertino against liabilities,judgments, cc.. 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 Jal, REPIPE/SEWS R./MAIN SERVICE CUPE�TINO PERMIT APPLICATION FORM APN # Date: Cpl -;3 0$ /)-S-/ o9 _ Building Address: _ v 151 '(� V Np LL Z( �� Cu?�� N U C 5 0 ( y Owner' Name: Phone I jLn7l '!S:7% A D-E_ A 00d �_s Contractor: Phone#: 000 04 2 2 9K Fax #: qj 24 q 1-9 4 � Contact: Phone : (j 08 s 06 — os-3 j Fax#: N.5 Contractor License#: 00— 9'�) Cupertino Business License#: Job Description: _ Residential [ Commercial ❑ Valuation: ., p `7d Project Size: Express Standard Large [:I—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 Descripilon 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 Stanc.ards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO .,-CE REPIPE/SEWER/MAIN SERVICE CUPEI�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 HUSS sewer/sanitary sew-r 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water ?ipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Pi,)ing System P 1-4 Outlets 1 BPGAS Gas Piping System. 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Ch:,ck P 1 PLMBINSP Other Plumbing/gas Insp. P r 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B INPUT Rescurces Energy A-DiHealth M.Indoor Air Quality and Finishes 1.Use lowfND-VOG Pant 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowJ�lo VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 2 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde E IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal al EVosedPaf dale oard,orMDF 2 IAG/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 ■ j____ 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 E 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 ! Total Points Available: 1 1401 130 57 Total Points Project Received:1 01 01 0 O / G:data/progs/gr ibuildingguidelines/remodelers/gree intsfinal2.12.04protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Buildfnn De artment JOB ADDRESS: PERMIT # r tozb � vi�( A a.�rUc�� gLv C�� Q�� OWNER'S NAME: PHONE # I� 23-06-> o,5 3 GENERAL CONTRACTOR: V 1 L V F # I am not using any subcontractors: c>G -� C�6 Si;mature ate' Please check applicable subcontractors and ,bm plete the follvwing information: SUBCONTRACTOR B INESS 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