10070188 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22162 BITTER OAK ST CONTRACTOR:WATER QUALITY PERMIT NO: 10070188
PLU\IBING
r'-"NER'S NAME: JO CHRISTIE 1860 ALMADEN RD DATE ISSUED:07/28/2010
V vVNER'S PHONE: 4084665483 SAN JOSE,CA 95123 PHONE NO:(408)267-9330
❑ LICENSED CONTRACTOR'S DECLARATIONF
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.#
MECH r- RESIDENTIAL r COMMERCIAL F
Contracto( nj �,plk R8iPDate I-]
I hereby affirm that I am licensed under the provisions of Chapter 9 JOIc DESCRIPTION:COPPER RE-PIPE
(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.lit Floor Area: Valuation:$6000
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. \ APP Number:32651049.00 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, t80 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 � `� �
with all non-point source regulations per the pertino Municipal Code,Section Issued bye" '�'�- L -- Date:7—'c=E1 LU
9.18.
c rat aDate
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All r 3ofs 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 insp,xtion.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Sign iture 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 ha ie 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 Cali Fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the com 3liance 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 Add itionally,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 Cu 'no Municipal Code,Chapter 9.12 and the
Hea th&Safety dei�+�t:Sections 25 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 wi r or
Compensation laws of California. If,after making this certificate of exemption,I e:
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 her-,by 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
-u the above mentioned property for inspection purposes.(We)agree to save
:mrrify 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 unc.erstand 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 CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: TDATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$6,000
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex APPLICATION 1 RPFIX
USE: r = TYPE:
x W
as
00
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Fixture or Trap 1BPFIXTURE 6 $48
Re-Pipe Interior 1 PRREPIPE 1 $11
TOTALS: F $59.00
Plumb.Plan Check 0.0 hrs $0.00 .
Plumb.Permit Fee: IPPERMIT <
Other Plumb Insp. 0.0 1 hrs 1 $42.00 f�r,
NOTE: Thesefees are based on the preliminary i40 rmation avaihtble and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 0.9-051 Elf 7///09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $59.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bld ., Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $144.00 $0.00 TOTAL FEE: $144.00
Revised: 7/27/2010
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: T-D%,TE: REVIEWED BY:
APN: BP#: *VALUATION: 1$6,000
`PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex APPLICATION 1 RPFIX
USE: TYPE:
xW
cc
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Fixture or Trap 1BPFIXTURF 6 $48
Re-Pipe Interior 1PRREPIPE 1 $11
TOTALS: $59.00
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Per nit Fee: IPPERMIT
FTOther Plumb Insp. 0.0 hrs $42.00 '
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info,
FEE ITEMS (Fee Resolution 09-051 L f.' 7.7.'(L9) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $59.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (E) No $0.00
J
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bld<,,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $144.00 $0.00 TOTAL FEE: $144.00
Revised: 7/27/2010
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN#'� fL �f Date: I l�
Building Address:
Owner's Name- Phone#
1 ` �
Contractor: Phone#: '°' e
Fax #: Q'
Contact: Phone#:
Fax #:
Contractor Licdhse
Cupertino Business License#: ` -kS—Z(.o
Job Description:
Residential Commercial ❑
Valuation: (-'CO(D-It2a
Project Size: Express Standar 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 sewer
1BPREPIPE Commercial re-pipe Ier 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
M.Indoor Air Quality and Finishes
1 MHealth pts y--yes p
2.Use Low VOC,Water-Based Wood Finishes 21AQ/lealth pts y=yes p
. 3lAQ/�ealth s es p
Pt Y=Y
4.Use Salvaged Materials for Interior Finishes 3 Resource pts yges D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ/Aealth pts y=yes p
6.Use Exterior Grade Plywood.for Interior Uses 1 IM-lealth pts y--yes p
41AQ/Aealth pts y--yes 0
B.Use FSC Certified Materials for Iriterior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ,Health pts y=yes p
� i 1
N.Flooring
1.Select FSC Certified Wood Flooring _ - B Resol roe pts y=yes - - 0 =-- --- —– --
Z +1 4ResoLrce pts y=yes p
3.Use Recycled Content Ceramic Tiles 4 ReSot Me pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl .5 IAW salth pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 ReSOI rce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 R2soL rce pts y=yes 0
Total Points Avai able: 140 1301 57
t
Total Points Project Received: 0 01 7q
G_data/prngslgreenbwldinggsideBnes/nunodelerslgreenpointsfinal272D4protectedxls