10090127 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20886 JOLLYMAN LN CONTRACTOR:SMART PLUMBERS& PERMIT NO: 10090127
ROOTERS
YER'S NAME: CHENG-LUNG CHEN 2112 SANTA CRUZ AVE DATE ISSUED:09/16/2010
O VANER'S PHONE: 4082532322 SANTA CLARA,CA 95051 PHONE NO:(408)247-2400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB�
License Class Lic.#
�- MECH RESIDENTIAL COMMERCIAL
Contractor / Date
I hereby affirm that I a licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL A NEW 9S LINE FOR COOKTOP 98'WITH 3/4"
(commencing with Section 7000)of Division 3 of the Business&Professions PIPE
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 Sq.Ft Floor Area: Valuation:$1975
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:35925044.00 Occupancy Type:
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 constriction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source lations per the Cupertino Municipal Code,Section 7
9.18. Issued by: �-"'- --_-._._,... Date: -1 --/A
afire Date g�� ko-
I
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's 1100
Compensation laws of California. If,after making this certificate of exemption,I Owner authorized nt:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:= � (�
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
.mify 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 ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
M.Indoor Akir Quality and Finishes
IAN& ,..�;. ..... . . _ - 1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Fishes 2 IAQ/Health pts y=yes p
31AQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
1 1
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/Health pts y=yes p
Obo
4IAQ/Health pts y=yes p
8.Use FSC Certified Materials for Iriteriar Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes p
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
N.Flooring
1.Select FSC Certified Wood Fiooring 8 Resource pts y--yes 0
'ilse 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 p
' 1 1 1
Total Points Available: 140 130L 57
Total Points Project Received: r 01 0 0
G;data/progslga enbulidngguiderinesfmmodelerslgreenpointsfina1212Uprotectedxis
/.c cq c) -2 7
CITY OF C'UPERTINO
an REPIPE/SEWEBJMAIN SERVICE
CUPEI�TINO PERMIT APPL_[CATION FORM
APN # Date:
,351?
Building Address:
P ne #:
Owner's Name:
Contractor: Phone
G(�w` '�' Fax #:
Contact: Phone#: �)
/ — Fax #:
Contractor License#: S�
Cupertino Business License#:
Job Description:
ZittOlj of
Residential ( Commercial ❑
Valuation:
Project Size: Express Standard 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
Grou
1PCSEWER Commercial building P 1CPSS
sewer/sanitary ,ewer
1BPREPIPE Commercial re-pipe per fixture P =1CPR-P
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Stancards Commission_. B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09