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10060013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7652 WEST HILL LN CONTRACTOR:JA PLUMBING PERMIT NO: 10060013 OWNER'S NAME: LEWIS&CAROL KIDD 28306 INDUSTRIAL BLVD STE B DATE ISSUED:06/03/2010 OWNER'S PHONE: 4084460508 H,�YWARD,CA 94545 PHONE NO:(510)266-5125 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class 6 Lic.# et q PEX RE-PIPE THROUGH OUT HOUSE Contractor f Date 0_3)/0 I hereby affirm that I am licensed under the provisions of Chapter 9 (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. Sc.Ft Floor Area: Valuation:$4459 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 AI'N Number:36227022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 the2 granting of this permit. Additionally,the applicant understands and will comply Is sued by: Date: 3 with all non-point source regulations per the Cupe ino Municipal Code,Section _ 9.18. /y RE-ROOFS: Signature Date b( l V Al I 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Si;nature of Applicant: Date: 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I 1 ave read the hazardous materials requirements under Chapter 6.95 of the C.lifornia 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 m:iterial. 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, apter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by th-Health&Safety Code,Sections 25505,25 d 25534 Section 3700 of the Labor Code,for the performance of the work for which this l /to permit is issued. O,vner or authorized agent: Date: ` l 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 t 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. we rk's for which this permit is issued(Sec.3097,Civ C.) Lc nder's Name APPLICANT CERTIFICATION Lc nder'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 -non the above mentioned property for inspection purposes.(We)agree to save ;mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ...,sts,and expenses which may accrue against said City in consequence of the I understand 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: -`7 JC W oe7+ �� 1 ��1 e PERMIT# co OWNER'S NAME: J,,ewtCa1.4 PHONE# GENERAL CONTRACTOR: 3'j� v b�' BUSINESS LICENSE# W ADDRESS: v t14riC?l v L- •� CITY/ZIPCODE: Ca *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCSUBCONT INSPECTION(S) WILL BE OBTAINED A CITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND AL BUSINESS LICENSE. 61 t I am not using any subcontractors: _ Date Signature Please check applicable subcontractors and complete i he 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 ho Owner/Contractor Si ature Date CITY OF CU.PERTINO REPIPE/SEWER/1`IAIN SERVICE CUPEI�T1NO PERMIT APPLICATION FORM pUUC0 1 3. Date APN # : � C�2 ��02-2 .00 , /(C) Building Address: r C1130 t- Owner's Name: Phone#: �1 I � (1-1041) ��` C'c Phone#:C; lc, ) 7 6 Contractor: Fax #: Contact: Phone#:gl 0� ref`Qgtjao ttP�tilut,�� t'` - Fax#: Contractor License#: 1 Cupertino Business License#: Job Description: Pe x (fir'l +Il P lnv�'SC Residential L K Cc mmercial ❑ 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 Grou 1PCSEWER Commercial buildi ig P 1CPSS sewer/sanitary sewer 1BPREP5E Commercial re-pipe per fixture P 1CPRP 1PGASC6M Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standard Commission B ALL PERMIT TYPES Fee 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY of CITY OF CL;PERTINO REPIPE/SEWER/ 4AIN SERVICE FEE SCHEDULE CUPERT NO Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES f 1BSEISMICR Seismic Residential P S 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BP WATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Pipi Zg System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fey. Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B INPUT Resoumes EnergyAU M.Indoor Air Quality and Finishes 1.Use LowMo-VOC Paint 1 IAD/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IP 0/Health pts y=yes 0 3.Use LowlNo VOC Adhesives 3 IP Q/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 R;source pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IPQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IP D/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 R:source pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 R;source pts y=yes 0 10.Install Whole House Vacuum System 3 kQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 8 Re3ource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Re3ource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Re Source pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IA THealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Re30urce pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Re source pts y=yes 0 1 ! 1 Total Points Available: 1 1401 130 57 Total Points Project Received: C 0 0 0 v &data/progs/greenbuil Gngguidelines/remodelers/greenpointsfinal2.12.04protected.xls CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: ]got: APN 36227()22 . 00 DATE ISSUED. . . . . . . : 06/03,'2010 RECEIPT #. . . . . . . . . BS000010548 REFERENCE ID # 10060013 SITE ADDRESS 7652 'BEST HILL LN SUBDIVISION . . . . . . CITY CUPER'TINO IMPACT AREA . . . . . . OWNER LEWIS & CAROL KIDD ADDRESS 7652 REST HILL LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5057 RECEIVED FROM . . . . : FERNANDO HERNANDEZ CONTRACTOR NIGEL EDWARDS LIC # 30554 COMPANY JA PLUMBING ADDRESS 28306 INDUSTRIAL BLVD STE B CITY/STATE/ZIP HAYWPRD, CA 94545 TELEPHONE (510) 266-5125 FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ -------- 1BCBSC VALUATION 4,459 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 4,459 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 000 . 00 -----42_ -- 00 - 0_00 TOTAL PERMIT 127 . 50 0 . 00 127 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------ CREDIT CARD 127 . 50 '1IISA --------------- TOTAL RECEIPT 127 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING