10060173 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19060 BARNHART AVE CONTRACTOR:SMART PLUMBERS& PERMIT NO: 10060173
ROC ETERS
nWNER'S NAME: VICKI A&GARY P BERCHEM 2112 SANTA CRUZ AVE DATE ISSUED:06/28/2010
vNER'S PHONE: 4082558153 S"TA CLARA,CA 95051 PHONE NO:(408)247-2400
LICEN/SED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB
License Class Com- 0 Lic.# 6(4:E6 o—OL
MECH RESIDENTIAL COMMERCIAL
Contractor�C�xp�i7l(�vw ate
JOE DESCRIPTION:REPLACE SECTION OF MAIN SEWER PIPE ABOUT 8'&
I hereby affirm that I am licensed under the provisions of Chapter 9 INS]ALL A CITY CLEAN OUT
(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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.lit Floor Area: Valu ion:$2200
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. WA
APPLICANT CERTIFICATION API` Number:37537 0 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 13'ERMIUMPIRES 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. Addition lly,the applicant understands and will comply
with all non-point sou�regions per the Cupertino Municipal Code,Section _
9.18. Issued + �'"�- Date: 6,20^ 16
7
Signature Date
�J —
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All r)ofs 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: inspf ction.
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, Sign iture 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 ha-e read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cali ornia 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 Safe:y 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 Add tionally,should I use equipment or devices which emit hazardous air
permit is issued. cont iminants as defined by the Bay Area Air Quality Management District I will
mair tain 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&Safe Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Own er or uthorized ag
become subject to the Worker's Compensation provisions of the Labor Code,I must Dater
forthwith comply with such provisions or this permit shall be deemed revoked. G
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I her;by 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 a hich 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
^n 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,
c,.,.,ts,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
with all non-point source regulations per the Cupertino Municipal Code,Section I and erstand my plans shall be used as public records.
9.18.
Lice,rsed Professional
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: '..jot:
APN . . . . . . . . : 37537036 . 00
DATE ISSUED. . . . . . . : 06/28,2010
RECEIPT #. . . . . . . . . : BS000010720
REFERENCE ID # . . . : 10060/73
SITE ADDRESS . . . . . : 19060 BARNHART AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPER`CINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : VICKI A & GARY P BERCHEM
ADDRESS . . . . . . . . . . : 19060 BARNHART AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MIKE 19 RA
CONTRACTOR . . . . . . . : JIN L:�',E LIC # 31236
COMPANY . . . . . . . . . . : SMART PLUMBERS & ROOTERS
ADDRESS . . . . . . . . . . : 2112 SANTA CRUZ AVE
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051
TELEPHONE . . . . . . . . : (408) 247-2400
FEE ID UNIT QUANTITY AMO'JNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 2, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRSEWER UNITS 1. 00 21 . 00 0 . 00 21. 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 106 . 00 0 .00 106 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- - -------------------
CREDIT CARD 106 . 00 VISA
---------------
TOTAL RECEIPT 106 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWERPMAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # �I-) Date:
-7v �, � �� ,
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Building Address:
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Owner's Name: Phone#:
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Contractor: Phone#:41-4)r.57�01 Roy
-ki Fax #:
Contact: Phone
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` � k� Fax#:
Contractor License#:
Cupertino Business License#: /
Job Description:
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Residential Ccmmercial ❑
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
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards C—ommission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
-� CITY OF CUPERTINO
REPIPE/SEWER/1VLAIN SERVICE
CUPEr�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
I 1 PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
1PRREPIPE Residential re-pipe pei- fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1 RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1 BPWATER Install/alter Water Pips; P
1BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentati,)n Fee B
1BUSLIC Business License B
M.In Dor Air Quality and Finis es
1.Use LowJNo-VOC Paint 1 IA,)JHealth pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAI)JHealth pts y=yes p
3.Use Low,'No VOC Adhesives 3 IAI YHealth pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 RE source pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AI)JHealth pts y=yes p
6.Use Exterior Grade Plywood for Interior Uses 1 IAI�JHealth pts y=yes p
7.Seal all Exposed Particleboard or MDF 4 IA(VHealth. pts y=yes p
8.Use FSC Certified Materials for Interior Finish 4 RE source pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 RE source pts y=yes 0
10.Install Whole House Vacuum System 3 IA)/Health pts y=yes p
imkm
1 D
N.FIDDring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 ResDurce 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 IAC/Health pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Res3urce pts y=yes 0
® 1 1 1
Total Points Available: 11401 13-01----5-71
Total Points Project Received: 01 01 0
G:data/progs/greenbuildr gguidelines/remod erslgreenp.intsfina12.12.04,,.I ted.xls
Building Department
City Of Cupertino
La 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUB(:ONTRACTOR LIST 77
JOB ADDRESS: 19-V-k _ ,�,1/7� PERMIT#
OWNER'S NAME: PHONE # —
GENERAL CONTRACTOR: a�(144AC!dBUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in 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 SUBCONT C'CORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: � �o
Signature Date
Please check applicable subcontractors and complete i he following information:
SUBCONTRACTOR BUSINESS 74AME 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
6 —plc
caner/ ontractor Signature Date