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10070150
CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 19489 ROSEMARIE PL CONTRACTOR: '-7-,,11- tj ro I )1 i/, PERMIT NO: 10070150 OWNER'S NAME: MAITRI INC L 1��c'_ DATE ISSUED:07/21/2010 NER'S PHONE: 4084368393 , PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr r L BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class c Lic.# 7 (1-72 Z MECH r- RESIDENTIAL I- COMMERCIAL� Contractor 7Z4+1 PLLIr41?i X1J_C Date _7-Z l-t 0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DUPLEX(UNITS 1,2,3,4);REPIPING 4 FLEX BUILDING,28 (commencing with Section 7000)of Division 3 of the Business&Professions FIXTURES 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5500 permit is issued. APPLICANT CERTIFICATION APN Number:37501008.00 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 construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. "7.-�,I-j b Issued by: Dater Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one 01 All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,ImusOwner or audurized a ent:-----._., -7-�, forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating; for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name u^^n the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c,., s,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 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional J CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 3-,501008 .00 DATE ISSUED. . . . . . . : 0-,/21/2010 RECEIPT #. . . . . . . . . BE000010933 REFERENCE ID # . . . : 1C070150 SITE ADDRESS . . . . . : 1S489 ROSEMARIE PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER M7,ITRI INC ADDRESS 151489 ROSEMARIE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MLITRI CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 500 . 00 1 . 00 0 .00 1. 00 0 .00 1BUSLIC FLAT RATE 1. 00 114 . 00 0. 00 114 . 00 0 .00 1PPERMITFE FLAT RATE 1. 00 42 ..00 0 .00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 28 . 00 308 . 00 0 .00 308. 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 507 . 00 0 .00 507. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 507 .00 #2468 --------------- TOTAL RECEIPT 507 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: EVALUATION: 1$5,500 -� *PERMIT TYPE: Plumbing Permit PL 1,N CHECK TYPE: Alteration /Addition / Repair PRIMARY . APPLICATION USE: SFD or Duplex �� 1;,t�t� ; .fTYPE: � a 00 3U APPLIANCE/EQUIP TYPE CAPACITY F]:E ID QTY BP FEES Re-Pipe Interior 1PRREPIPE 28 $308 TOTALS: $308.00 Plumb.Plan Check 0.0 hrs $0.00 ti � _- Ph mb.Permit Fee: I PPERMIT Other Plumb Insp. 0.0 hrs $42.00r> NOTE: These fees are based on the preliminary information,available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 09-051 E f 7;'1;7).9) FEE QTY/FEE MISC ITEMS 1' �iivpi, P( "" PME Plan Check: $0.00 PME Unit Fee: $308.00 PME Permit Fee: $z 2.00 1 ii l;t)o 1` 'w't L Travel Documentation Fee: ITRAVDOC $42.00 Select an Administrative Item I31di4 Stds Commission Fee: IBCBSC ;51.00 SUBTOTALS: $313.00 $0.00 TOTAL FEE: $393.00 Revised: 6/30/2010 CITY OF CUPERTINO S 'R/MAIN SERVICE S REPIPE/SEWE CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: 0 '7 Building Address: 1, ( Ii40i-� Uq Owner's Name: Phone#: Contractor: Phone#: 4 K 3 L Fax#: -j) 6 Contact: Phone#: Fax#: Contractor License#: Ct Cupertino Business License#: Job Description: A- U1 2- Residential Commercial ❑ Valuation: Project Size: Express E'Standard E] Large 7 Major F] 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 IPCSEWER Commercial biilding P ICPSS sewer/sanitary sewer IBPREPIPE Commercial rc-pipe per fixture P 1CPRP 1PGASCOM Commercial Cas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Stanlards Commission B ALL PERMIT Fee TYPES IBSEISMICOM Seismic Commercial P Revised 01/07/09 NPUT Resources M.Indoor Air Quality and Finishes 1.use tDwwvoc parol 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use LowlNo VOC Adhesives 3 IAQ/Health 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/Health pts y=yes 0 6.Use Exterior Grade Plywood-for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all ExposedP;abdaboaidwWF 4IAQ/Health pts y=yes 0 8.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 y=yes 0 . 1 i 1 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials f Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles t 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 0 1 1 1 Total Points Available: 1 1401 1301 57 Total Points Project Received:1 1 01 01 0 G:data/progs/gaenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xis Building Department City Of Cupertino is 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: <I Lt �'`i ce LrwA Z( G �G % �� PERMIT# OWNER'S NAME: MA i TO,I -n-")_ . PHONE# 4t5- 74- © 2-5-L GENERAL CONTRACTOR: T-,/f ,)a BUSINESS LICENSE# 7 7 ?Z-7 ADDRESS: Z 1!0 Oftl,(M Z V -;F. CITY/ZIPCODE: 5T j Z *Our municipal code requires all businesses working i» 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. _ -7 -"Z 140 I am not using any subcontractors: S gnatur 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 Owner/Contractor Signature Date