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10110052CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 875 ALDERBROOK LN CONTRACTOR: GREAT AMERICAN PERMIT NO: 10110052 PLUMBING CO INC " "NER'S NAME: MASTERSON WILLIAM J AND ELAINE I P O BOX 26942 I DATE ISSUED: 11/09/2010 v vdNER'S PHONE: 4082526362 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C -34 Li-- #J-'50 16 & 57 Contractor61e4 4?-4qMK46 AAdgnYpate / %q /6 I hereby affirm that I am licensed under the provisions of Chapter 9 (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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( k 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 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 granting of this permit. Additionally, the applicant understands and will comply with all non -goint sour regulations per the Cupertino Municipal Code, Section 1 9.18. 7atur Date/ l V ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 i the above mentioned property for inspection purposes. (We) agree to save .unify 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 with all non -I f t source regulations per the Cupertino Municipal Code, Section 9.18. 1 l%n l` SAN JOSE, CA 95159 I PHONE NO: (408)279 -1515 BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r- MECH r RESIDENTIAL r— COMMERCIAL r— JOB DESCRIPTION: INSTALL PROPERTY LINE CLEAN OUT 4 Sq. Ft Floor Area: APN Number: 36V00( .N V I Occupancy Type: PERMI1'rXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owne or utl d ag u Date: ITCONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36920005.00 DATE ISSUED.......: 11/09/2010 RECEIPT #.........: BS000011952 REFERENCE ID # ...: 10110052 SITE ADDRESS .....: 875 ALDERBROOK LN SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: MASTERSON WILLIAM J AND ELAINE ADDRESS ..........: 875 ALDERBROOK LN CITY /STATE /ZIP ...: CUPERTINO, CA 95014 -4613 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... THE GREAT AMERICAN CORPORATION LIC # 18061 GREAT AMERICAN PLUMBING CO INC P O BOX 26942 SAN JOSE, CA 95159 (408)279 -1515 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---- - - - - -- 1BCBSC ------- - - - - -- VALUATION ---- - - - - -- 1,950.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 1BSEISMICR VALUATION 1,950.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRSEWER UNITS 1.00 21.00 0.00 21.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 TOTAL PERMIT ---- - - - - -- 106.50 ---- - - - - -- 0.00 ---- - - - - -- 106.50 ---- - - - - -- 0.00 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 202 UNDERFLOOR PLUMBING 400 SEWER /LATERAL CITY OF CUPERTINO FM-7 FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 DATE: REVIEWED BY: BP FEES APN: BP #: 1 PRSEWER VALUATION: 1$1,950 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex lex USE: ` t�I: c, = -` r E �� <�` r PENTAMATION 1 RPSS PERMIT TYPE: WORK SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER Li 1 # $21 Perfnit SUP /4' Irts P 1''C( PME Unit Fee: $21.00 PME Permit Fee: $42.00 Ccta�tt °rlc°fion KIx lcovS`lic°"11 Rcvielb' I°ce: Work Without Permit? 0 Yes No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $21.00 Strong Motion Fee: IBSEISMICR NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS {Fee Resolution 09 -051 Elf 7 %7%101 1 !Ck b, P!,71 c ,11 Plumb. Plan Check 0.0 1 hrs $0.00 MISC ITEMS FT: Plumb. Permit Fee: IPPERMIT ?rfrc, !is<y, h.sC3. Other Plumb Insp. 0.0 hrs $42.00 Li -11—i': h'.1' J "'e PME Plan Check: k/, . limp 1 "'i': NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS {Fee Resolution 09 -051 Elf 7 %7%101 FEE QTY/FEE MISC ITEMS c Slf t /11. Jai.' /"cc PME Plan Check: $0.00 Perfnit SUP /4' Irts P 1''C( PME Unit Fee: $21.00 PME Permit Fee: $42.00 Ccta�tt °rlc°fion KIx lcovS`lic°"11 Rcvielb' I°ce: Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106.50 $0.00 TOTAL FEE: $106.50 Revised: 11/08/2010 CITY OF CUPEkT1NO CITY OF CUPERTINO REPIPE /SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN # j �� (� .� -� Dat e: '�j Fee Group Building Address: d i !MV Owner's Name: Phone #: CL � 1CPSS Contractor: Phone #: V 7 C -I S7 GA LUM101 41 Fax #: - 3 Contact: Phone #: 1 PGASCOM Fax #: Contractor License #: % Cupertino Business License #: Job Description: fti57?9 cc ietqpeeny o iw Residential Commercial ❑ Valuation: U Project Size: xpres Standard ❑ Large 0 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 Group Permit Type 1PCSEWER Commercial building sewer /sanitary sewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System 1 -4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 1. Use Low/No -VOC Paint 2. Use Low VOC, Water -Based Wood Finishes 3. Use Low/No VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 6. Use Exterior Grade Plywood for Interior Uses 7. Seal all dosed Partidaboard or M ©F B. Use FSC Certified Materials for Interior Finish 9. Use Finger- Jointed or Recycled- Content Trim 10. Install Whole House Vacuum System N. Flooring 1 IAQ/Health pts y =yes 21AQ/Health pts y =yes 31AQ/Health pts y =yes 3 Resource pts y =yes 61AQ/Health pts y--yes 1 IAQ/Health pts y =yes 41AQ/Health. pts y =yes 4 Resource pts y =yes 1 Resource pts y =yes 3 IAQ/Health pts y =yes 1. Select FSC Certified Wood Flooring 8 Resource pts y =yes 2. Use Rapidly Renewable .Flooring Materials 4 Resource pts y =yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y =yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y =yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y =yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y =yes Total Points Available: Total Points Pro'ect Received: 1401 130 57 0 00 . A 4.- //-tf -/0 l/ G: data /props /greenbuldngguidelines/ n; modelerslgreenpointsfinat212 .04proteoted.xls CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 9501 4 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: PERMIT # D OWNER'S NAME: PHONE # ^ GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: 19 G, CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of uupertino business ncense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcon actors and complete the following information: Owner / Contractor Signature ) 1--e(—/D Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature ) 1--e(—/D Date