10100011 CITY OF CUPERTI vO BUILDING PERMIT
BUILDING ADDRESS: 10145 MCLAREN PL CONTRACTOR:ZABEL CONSTRUCTION PERMIT NO: 10100011
OWNER'S NAME: JACK&ROSEMARY EARL 1658 YORK ST DATE ISSUED: 10/01/2010
VNER'S PHONE: 6509171333 SAN JOSE,CA 95124 PHONE NO:(650)465-7239
((LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# "7G,21 d }� COPPER REPIPE,REPLACE WATER HEATER
Contractor Ce
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. Sq.Ft Floor Area: Valuation:$7000
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:31621051.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relatin; WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 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 permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point souyc regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one(f
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensatio►,
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Ci ertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 05, 33,and 2 /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:�o—/ Y
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I mu;t I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 relatir g
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
;ndemnify and keep harmless the City of Cupertino against liabilities,judgments,
fs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
anting 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
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 1014s— o,14e-Lc.41c PERMIT# O
OWNER'S NAME: Jack 1 C;XI A, PHONE#
GENERAL CONTRACTOR: J# �. .,,,�:..� BUSINESS LICENSE #
ADDRESSCITY/ZIPCODE: O
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
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 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
F—. Tlle
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $7,000
xPERMIT TYPE: Plumbing Permit PLA N CHECK TYPE: Alteration /Addition / Repair
PRIMARY Tull'=s f_ PENTAMATION 1 RPRP
USE: SFD or Duplex 11 t1c�it :;� ?_.�: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $11
Water Heater 1PRWHEATR 1 # $25
Fixture or Trap 1BPFIXTURE 9 # $72
TOTALS: $108.00
1."c'h, Plumb.Plan Check 0.0 hrs $0.00 h;cPi, C`fF,cl<
I1" I-crml!F Plumb.Permit Fee: IPPERMIT
; Other Plumb Inst. 0.0 hrs
NOTE: Theset or addn'l in-fees are based on the preliminaryin ormation available and are onlyan estimate. Contact the De o.
FEE ITEMS(Fee Resolution 09-051 E[f %'l./l0j FEE QTY/FEE MISC ITEMS
flair C hcca Fk-(.
S1/pp/. PC f c>c
F 'A
PME Plan Check: $).00
Pctr-rrtit 1�i>c�
S17 pl, hop I cc
PME Unit Fee: $103.00
PME Permit Fee: $42.00
t"011,cWlWfiOH 7(7A1 r
lcozi_ilicol h'c vice '
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: $0.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 11.00
SUBTOTALS: $193.70 $0.001 TOTAL FEE: $193.70
Revised: 9/29/2010
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot:
APN . . . . . . . . : 31621051. 00
DATE ISSUED. . . . . . . : 10/01/2010
RECEIPT # . . . . . . . . . : BS000011614
REFERENCE ID # . . . : 10:.00011
SITE ADDRESS . . . . . : 10:_45 MCLAREN PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER JACK & ROSEMARY EARL
ADDRESS . . . . . . . . . . : 10145 MCLAREN PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ROBERT ZABEL
CONTRACTOR . . . . . . . : ROBERT ZABEL LIC # 32066
COMPANY ZABEL CONSTRUCTION
ADDRESS 1658 YORK ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (650) 465-7239
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 7, 000 . 00 1 . 00 0 . 00 1 . 00 0. 00
1BPFIXTURE NO OF FIXTURE 9. 00 72 . 00 0 .00 72 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00
1PRREPIPE NO OF FIXTURE 1 . 00 11. 00 0 . 00 11 . 00 0 . 00
1PRWHEATR UNITS 1 . 00 25 . 00 0 . 00 25 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 193 . 00 0 . 00 193 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 193 . 00 VISA
---------------
TOTAL RECEIPT 193 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
M.lnciDDr Air Quality abd Finisnes
1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes.3. p
1 � 1 - _ 3IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ/Health pts y--yes D
B.Use Exterior Grade PlywoodfDF Interior Uses 1 IAQ/Health pts y--yes p
41AQ/Health.pts y=yes p
B.Use FSC Certified Materials for Interior Finish�- 4 Resource pts y=yes 0
9.Use Fnger-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes p
N.Flooring
1.Select FSC Certified Wood Fooring _ B Resource pts y-yes p "
_ 4 Resource pts y=yes 0
3.Use Recycled Gontent Ceramic Tiles 4 Resource pts y--yes p
4.Install Natural Linoleum in Place of Vinyl .5 IAQ/Health pts y=yes D
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 p
Total Points Available: -140 . 1301 57
Total Points Project Received: r Of 01 0
G da4dprDiWgre 3nbuildingguide6ne remodeleralgreenpointsfina121204protecfedAs
CITY OF CUPERTINO
REPIPE/SEWERIMAITiSERVICE
CUPEkT1NO PERMIT APP] JICATION FORM
APN ## Date:
l9 - '3v 0
Building Address:
Owner's Name: Phone#:
a,CA421-1s e_w.z�. u / 1.6-o �1/7 r 3:33
Contractor: tt_ Phone#: 6-1-0 H b . '�-72.39
Z�-t7C� �.,%M S f'Cn F ax #: /Z_ f"/S
Contact: Phone#: �y-'v yq6:3-- 7��9
36�4 -241n Fax #:
Contractor License#: �76 z-o9 6
Cupertino Business License#:
Job Description:
off*ay
Residential [ f Commercial ❑
Valuation: 7
Project Size: xpress Standard E 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
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission, B ALL PERTMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09