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10100166 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11150 BUBB RD CONTRACTOR:MASTERSERV INC PERMIT NO: 10 100 166 OWNER'S NAME: LIZ Y CHO 560 LIBRARY ST DATE ISSUED: 10/22/2010 ER'S PHONE: 6506783511 SAN FERNANDO,CA 91340 PHONE NO:(800)806-7674 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class r 3 re Lic.# S C)0 � MECH I— I—r COMMERCIAL F_ Contractor/`�/y l Q,&4�_Date gP4:Z JOB DESCRIPTION:COPPER RE-PIPE 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 declaration 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. Sq.Ft Floor Area: Valuation:$4690 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. APN Number:36205042.00 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 relati ig PERMIT EXPIRES IF WORK IS NOT STARTED 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply /�)Date:with all non-point source regulati er the Cupertino Municipal Code,Section Issued by• y ( 9.18. c Signatu Date OrI7 CAM RE-ROOFS: [j OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for ons of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensat:on, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors o ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shE II _-1 not employ any person in any manner so as to become subject to the Worker's Owner r ' �_ Compensation laws of California. If,after making this certificate of exemption,I ate: become subject to the Worker's Compensation provisions of the Labor Code,I r lust forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save i nify and keep harmless the City of Cupertino against liabilities,judgment,, ARCHITECT'S DECLARATION c, ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Sectior Licensed Professional 9.18. Signature Date "In or Quality and Finishes �' ��, .:...... .- 1 IAQ/Health pts y-yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes D ' 3IAQ/H"th 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 61AQJHealth pts y--yes 0 6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/Health pts y--yes 0 _ 41AQ/Health pts y=yes D 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes D 1 1 0 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y--yes 0 9; 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 1 Total Points Available] L1401 1301 57 Total Points Project Received] r � 01 01 0 a/pnx s/gneenbuBcOngguiderines/ramodelers/greenpointsfina1212.D4protecfed.xis CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 11150 Bubb Rd. DATE: 10/22/2010 REVIEWED BY: jsg ` APN: f � � 'a-- �j *VALUATION: BP#: $4,690 O*PERMITT'YPE: Plumbing Permit P LAN CHECK TYPE: Alteration /Addition / Repair PRIMARY 7_07",11 PENTAMATION 1 RPRP USE: SFD or Duplex h��c� > f 1.Tl: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $11 TOTALS: $11.00 Plumb.Plan C heck0.0 hrs $0.00 hl-(°( P io F, Permit Fee: IPPERMIT };.r„r ,;";" �;.� ,, Other Plumb l nsp. 0.0 hrs $42.00 Pi” 3 NOTE: Theseees are based on the preliminary in ormation available and are onl an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 09-05I Eff %%X101 TEE QTY/FEE MISC ITEMS P/carr "'hec'4 FO supp1. PC ].CC PME Plan Check: $0.00 Permit Fec: Silp/d, hiss FO-' PME Unit Fee: $11.00 PME Permit Fee: $42.00 C'ora.wilcliml Tax ,lc:arrstr'ccrl Revic li,FCC': Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $96.50 $0.00 TOTAL FEE: $96.50 Revised: 10/17/2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36205042 .00 DATE ISSUED. . . . . . . : 10/22/2010 RECEIPT #. . . . . . . . . BS000011819 REFERENCE ID # . . . : 10100166 SITE ADDRESS 11150 BUBB RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LIZ Y CHO ADDRESS 11150 BUBB RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM MASTERSERV, INC CONTRACTOR GEORGE ANDERSON LIC # 30854 COMPANY MASTERSERV INC ADDRESS 560 LIBRARY ST CITY/STATE/ZIP . . . : SAN FERNANDO, CA, 91340 TELEPHONE (800) 806-7674 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------•• ---------- ------ 1BCBSC VALUATION 4,690.00 1.00 0 . 00 1 .00 0.00 1BSEISMICR VALUATION 4, 690 .00 0.50 0.00 0 .50 0.00 1PPERMITFE FLAT RATE 1.O0 42.00 0. 00 42 .00 0. 00 1PRREPIPE NO OF FIXTURE 1.00 11. 00 0.00 11.00 0. 00 1TRAVDOC FLAT RATE 1.O1) 42.00 0 . 00 42 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 96.50 0 . 00 96 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ------------- -- ------------- CHECK 96. 50 2910 ------------- -- TOTAL RECEIPT 96. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------------------- --- -------- - 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO �Lq� PE/SEW]�R/MAIN SERVICE KEPI "TY°F CUPEkTINC) PERMIT APPLICATION FORM I APN # :::1 Date: S7 V ! �-- Building Address- — t f ) *nt Name: �j 1•• Phone#: s-r r: Phone # S, V- Fax #: C � Contact: -. Phone #: 41 '� �,Ce lqcckjO- �- Fax #: Z�Z Contractor License#: Cu -rtino Business License#: Job Description: P Residential Commercial ❑ Valuation: Project Size: Express Standard Large Major Green Building: Please complete relevant porlion 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 Grou 1PCSEWER Commercia; building P 1CPSS sewer/sanitzry sewer 1BPREPIPE Commercia.. re-pipe per fixture P 1CPRP 1PGASCOM Commercia'L Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission, B ALL PERMIT TYPES Fee 1BSEISMICOM Seismic Commercial P Revised 01/07/09