10080003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10438 VISTA DR CONTRACTOR:NEW STRUCTURE PERMIT NO: 10080003
PLUMBING INC
BIER'S NAME: MIKE ARO PO E OX 111143 DATE ISSUED:08/02/2010
OWNER'S PHONE: 4089791477 CAN PBELL,CA 95011 PHONE NO:(408)364-2143
❑ LICENSED CONTRACTOR'S DECLARATION BUIDING PERMIT INFO: BLDG r ELECT r PLUMB F
License Class
Z' Q MECH r— RESIDENTIAL r- COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER RE-PIPE INCLUDES 9 FIXTURES �36
(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:$5800
1 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:31633073.00 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 relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, g0 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additio ally,the applicant understands and will comply l
with all non-point source r tions per a pertino Municipal Code,Section Issued by �'�` Date'
9.18.
iture Date - 0
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All ro As 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 one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signa ure of Applicant: Date:
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 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 havr 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 Califr ruia 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. Safet3 Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Addit onally,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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code tions 25505,25533,and 25534.
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 Owner or a
Compensation laws of California. If,after making this certificate of exemption,I Date:
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. CONSTRUCTION LENDING AGENCY
I herel y 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 huilding construction,and hereby authorize representatives of this city to enter Lender's Address
he 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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I unde stand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CU'ERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: I TATE: REVIEWED BY:
APN: BP#: *VALUATION: $5,800
PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration /Addition / Repair
PRIMARY APPLICATION 1 RPRP
USE: SFD or Duplex TYPE:
xW
xa
3c
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Re-Pipe Interior 1PRREPIF'E 1 $11
Fixture or Trap 1BPFIXTURE 9 $72
TOTALS: $83.00
Plumb.Plan Check 0.0 hrs $0.00 '
Plumb.F ermit Fee: IPPERMIT 1'<'
Other Plumb Insp. 0.0 1 hrs 1 $42.00
NOTE: These fees are based on the preliminatry in ormation avail able and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 09-051 Ftf T"i-09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.0C
PME Unit Fee: $83.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.0)
Select an Administrative Item
t31d< Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $168.00 $0.00 TOTAL FEE: $168.00
Revised: 7/27/2010
CITY OF C JPERTINO
ITEM 1 OF 1 PERMIT :ZECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 3163;;073 . 00
DATE ISSUED. . . . . . . : 08/0:/2010
RECEIPT #. . . . . . . . . : BS000011050
REFERENCE ID # . . . : 1008C003
SITE ADDRESS 1043E VISTA DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER MIKE ARO
ADDRESS . . . . . . . . . . 10438 VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM LEON FRIDLIB
CONTRACTOR FRIDLIB LEON LIC # 26052
COMPANY NEW S'PRUCTURE PLUMBING INC
ADDRESS PO BOX 111143
CITY/STATE/ZIP . . . : CAMPB:;LL, CA 95011
TELEPHONE (408) :364-2143
FEE ID UNIT ---- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- --- ------
----------
---------- ----------
BCBSC VALUATION 5, 800. 00 1 . 00 1. 00 0. 00 0. 00
1BPFIXTURE NO OF FIXTURE 9. 00 72 . 00 72 . 00 0. 00
1PGASRES OUTLETS 1. 00 63 . 000 .00
1PPERMITFE FLAT RATE 0 . 00 63 . 00 0 .00
1. 00 42 . 00 42. 00 0. 00 0. 00
1PRREPIPE NO OF FIXTURE 1 .00 11 . 00 11. 00
1TRAVDOC FLAT RATE 0. 00 0. 00
1. 00 42 .00 42 . 00 0. 00 0 . 00
231. 00 168.00 63 . 00 0. 00
TOTAL PERMIT : ----------
METHOD-OF-PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CREDIT CARD 63 . 00 VISA
---------------
TOTAL RECEIPT 63 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ---------------------------- ____________
---
301 ROUGH PLUMBING -------------
507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWER/ 4AIN SERVICE
CUPEY OF
PERMIT APPLICATION FORM
Date:
Building Address: ��
G� rl�C ��2l Cid
Phe
o #:
Owner's e: e
Contractor: Phone#:
Contact: Phone#:
Q
ze �� (4 Fax#:
O
Contractor License
Cupertino Business License#:
Job Description:
Residential Commercial ❑
Valuation: s—
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
Group
1PCSEWER Commercial buildi lg P 1CPSS
sewer/sanitary sew er _
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standard, Commission. B ALL PERMIT
TYPES
Fee
1 BSEISMICOM Seismic Commerc,al P
Revised 01/07/09
M.Indoor Air Quality and Finishes
_ 1 IAQ/-Isalth pts y-
-yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/lealth pts y--yes,0
31AQ/-lealth 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 61AQ/Aealth pts y=yes p
6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/-lealth pts y=yes 0
Mi
_ _ _ 4IAQ/-lealth.pts y=yes 0
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 D
10.Install Whole House Vacuum System 3 IAQ'Health pts y=yes 0
1 ! 1
N.Flooring
1.Select FSC Certified Wood Flooring - -- 6 Resot rce pts y=yes -0=--_ ----
3 - 9> IV* 4 Resot rce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 RBSDL rce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ&ealth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 ReSDI roe pts y=yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resot roe pts y=yes 0
Total Points Available: 301 57
Total Points Pro'ect Received: 01 0 0�
G:data/progs/greenbullcgngg sidelines/remodelers/greenpointsfina1212D4protectedxls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRAC OR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: ,�' a PHONE# O8
GENERAL CONTRACTOR: La✓ ,� SINESS LICENSE#
ADDRESS: ITY/ZIPCODE:
"Our municipal code requires all businesses w king in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECCION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRA TORS HAVE OB AINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signai ure 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
Tile -T
Owner/Contractor Signature Date