10060048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10171 S DE ANZA BLVD CONTRACTOR:DRAIN DOCTOR PERMIT NO: 10060048
OWNER'S NAME: DIDDAMS STORE 48)ALDO AVE DATE ISSUED:06/09/2010
OWNER'S PHONE: 4089972711 SP NTA CLARA,CA 95054 PHONE NO:(408)370-3082
lie LICENSED CONTRACTOR'S DECLARATION JC B DESCRIPTION: RESIDENTIAL COMMERCIAL
�L
License Class �— Lie.# G LJ 3 SO If4STALL COMM WATER HEATER&VENTING CHANGED
FROM
Contractor r•�'•i n � ti' �Nl_ Date 162 SINGLE WALL TO DOUBLE EXISTING PENITRATION
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)6T1fivWdri_3 ofTh—eBusiness&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:$1376
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 APN Number:35910015.10171 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify 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 Is;:ued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section _
9.18.
/� RE-ROOFS:
Signature Date V _ I-rc/ Al roofs shall be inspected prior to any roofing material being installed.If a roof is
in tailed without first obtaining an inspection,I agree to remove all new materials for
in:pection.
❑ OWNER-BUILDER DECLARATION
Si;;nature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I I ave read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by th--Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this O,vner or authorized agent:_`� - i Date: 5
permit is issued.
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I F ereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lt rider's Name
APPLICANT CERTIFICATION Lt rider's Address
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
--ion the above mentioned property for inspection purposes.(We)agree to save
lemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
,:osts,and expenses which may accrue against said City in consequence of the I t nderstand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Li.ensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
OWATER [EATER
CUPEkTINO PERMIT APPLICATION FORM
APN# _ ' Date:
Building Address:
Pe A ii c13-61 V
Owner's Name: Phone #: 103 _eT ei.-i - Z 7 11
l Ao se-
Contractor: Phone #: f2d A?X
kr-, M D41C-J-; r Fax #:
Cupertino Business License #: Contractor State License #:
13 Y5-60
Contact: Phone #:
Fax #: 9'oo --c ;z - o-s-
Building Permit Info:
Bldg Q-- Elect Plurab Mech [--
Residential ❑ Commercial
Job Description: ; Vem Ae .�
Strapped ❑ On Platform 0 Bonded ❑ New Location ❑ Replacement t
Valuation (cost of project): J( 1 .-3
611-11y
Project Size: Express ff 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 achieved:
Revised 03/10/10
CITY OF CUPERTINO
•' WATER H=EATER
PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICOM Seismic Commercial B
1PCSWHTR Commercial Soler B PCSWHTR
Thermal Water Iltr
1 PRWHEATR Residential Watc r B PRWHEATR
HeaterNent
1PRSWHTR Residential Solar B PRSWHTR
Thermal Water Iltr
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permi: P
1 TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
INPUT RLSOUTCeS Energy IAQ!Heafth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQhiealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/I lealth pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/I iealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resc urce pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/liealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/liealth pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/I iealth. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resc urce pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resc urce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 ReSOI rce pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resot rce 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/Flealth 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 01 01 0
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