10090176 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22182 BITTER OAK ST C�NTRACTOR:WATER QUALITY PERMIT NO: 10090176
PLUMBING
OWNER'S NAME: MONA SCHOROW
1160 ALMADEN RD DATE ISSUED:09/17/2010
C
S.kN JOSE,CA 95123 PHONE NO:(408)267-9330
ER'S PHONE: 4083144390
J:)B DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
❑ LICENSED CONTRACTOR'S DECLARATION COPPER RE-PIPE,REPLACE FIXTURES/TRAP(I3)QTY.
License Class Lic.# 1
Contractorf tSPl1 n QRU_M�\�Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions Valuation:$6000
Code and that my license is in full force and effect. 1,q.Ft Floor Area:
I hereby affirm under penalty of perjury one of the following two declarations: Occupancy Type:
1. I have and will maintain a certificate of consent to self-insure for Worker's ,CPN Number:32651047.00
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by STARTED
Section 3700 of the Labor Code,for the performance of the work for which this PERMIT EXPIIF WORK IS
PERMIT I S DANCE OR
permit is issued. WITHIN 180 D
APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION.
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 �--7 _._------- Date:
to building construction,and hereby authorize representatives of this city to enter Issued by:
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 RE-ROOFS:
granting of this permit. Additionally,the appy t understands and will comply with All roofs shall be inspected prior to any roofing material being installed.If a roof is
all non-point source regulatio s er the Cope i Municipal Code,Section 9.18. installed without first obtaining an inspection,I agree to remove all new materials for
Datc)4� inspection.
Signat a Date:
Signature of Applicant:
L OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: HAZARDOUS MATERIALS DISCLOSURE
�. 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 I have read the hazardous materials requirements under Chapter 6.95 of the
sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
2. [ as owner of the roe am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
property,rtY. y g
construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations: 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
t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Health&Safety Code,Se
Compensation,as provided for by Section 3700 of the Labor Code,forte
Se.ctions 25 5,25533,and 25534.
performance of the work for which this permit is issued. Owner or horized n .
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Date:—Ii-2) D
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. CONSTRUCTION LENDING AGENCY
3. 1 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 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.)
Compensation laws of California. If,after making this certificate of exemption,I Lender's Name
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 Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 Licensed Professional
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
i- ' -mify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply will
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date___
CITY OF CJPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32651047. 00
DATE ISSUED. . . . . . . : 09/17/2010
RECEIPT #. . . . . . . . . BS000011494
REFERENCE ID # . . . : 10090176
SITE ADDRESS 22182 BITTER OAK ST
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MON-T. SCHOROW
ADDRESS . . . . . . . . . . : 221E2 BITTER OAK ST
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MARTY SATALINO JR
CONTRACTOR . . . . . . . : SATI.LINO, MARTY LIC # 21526
COMPANY . . . . . . . . . . : WATER QUALITY PLUMBING
ADDRESS . . . . . . . . . . : 1860 ALMADEN RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 267-9330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- -------
1BCBSC VALUATION 6, 000 .00 1. 00 0 .00 1 .00 0.00
1BPFIXTURE NO OF FIXTURE 12 . 00 96 . 00 0 .00 96 . 00 0. 00
1BSEISMICR VALUATION 6, 000 .00 0.60 0 .00 0 .60 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
1TRAVDOC FLAT RATE 1.00 42. 00 0 .00 42 .00 0 .00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 192.60 0 .00 192 . 60 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 192. 60 AE
---------------
TOTAL RECEIPT 192. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
.Moor it Quality anWnss
1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
...-- 31AQMealth pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Piywood.for Interior Uses 1 IAQ/Health pts y=yes 0
41AQ/Health.pts y=yes p
B.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 yeses p
1 i !
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0
! 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 D
Total Points Avails le: 1 1401 130 57
Total Points Project Received: 0 0 Q
G:data/pmgs i n:enbuildngguidelines/namodelers/gre pointsfina121204protectedx1s
CITY OF CUPERTINO
REPIPE/SEWF, SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # ' r f /, G ! Date:
Building aAddress:
\R T7TKL opv 1 .
Owner's Name: Phone #:
0 - 1-+
Contractor: Phone#: C�
- i Fax #: ,�P,2Lc
Contact: Phone#:
-'� Fax #:
Contractor License#: '_-:�
Cupertino Business License #: 1.
Job Description:
O��1.� QLD r. _ �� _ ,�- Z- o 3
Residential Commercial ❑
Valuation:
Project Size: Expres Standar Large Major
Green Building: Please complete relevant portio:z 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 sewer
1BPREPIPE Commercial rc-pipe per fixture P 1CPRP
1PGASCOM 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