10050197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10761 JOHNSON AVE
r270
RACTOR:JD PLUMBING PERMIT NO: 10050197
^WNER'S NAME: CYRUS MIRBAHA
MBARGER RD STE 66 DATE ISSUED:05/26/2010
,,WNER'S PHONE: 4083144039
OSE,CA 95111 PHONE NO:(408)646-3266
❑ LICENSED CONTRACTOR'S
�DECLARATION
JOB T ESCRIPTION: RESIDENTIAL COMMERCIAL
—'7�i Lic.# {' Z SEV VER LINE REPLACEMENT FROM HOUSE TO
License Class _ PROPERTY LINE
Contractor Date &BUILDING PLUS CITY CLEANOUTS
I hereby that I am licensed under the p visions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
TAR,Y
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 Valuation:$32000
performance of the work for which this permit is issued. Sq.F:Floor Area:
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 APN Number:37531058.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in
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 Issu:d by: ate:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. RE-ROOFS:
vqignature Date U Z 6 All r)ofs 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
inspi:ction.
❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1,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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70441 Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
Cal fornia 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: He:Ith&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 mai erial. 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
the Health&Safety Code,Sections 255
I have and will maintain Worker's Compensation Insurance,as provided for by
O�ner or authorized age Date: (U
,an
Section 3700 of the Labor Code,for the performance of the work for which this _.---— d 25534.
S+ Z�
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hi:reby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. Le rder's Name
APPLICANT CERTIFICATION Lender'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 ARCHITECT'S DECLARATION
lemnify and keep harmless the City of Cupertino against liabilities,judgments,
posts,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.
Date 04Z 6-
1(0
Signature- _
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: (0 6
PERMIT#
OWNER'S NAME: C V jt c'V PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: 'L-7c) CITY/ZIPCODE:
*Our municipal code requires al businesses workin in the city to have a City of Cupertino business license.
EDULED UNTIL THE
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S)
HAVE OBTAINED AHCITY OF CUPERTINO
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS
BUSINESS LICENSE. �5f2611 Q
I am not using any subcontractors: Date
JSignatu re
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
CITY OF CUPE 2TINO
PERMIT RECEIPT OPERATOR: SylviaM
5 ITEMS OF 5 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37531058 . 00
DATE ISSUED. . . . . . . : 05/26/2010
RECEIPT # . . . . . . . . . BS000010493
REFERENCE ID # 10050157
SITE ADDRESS 10761 L--OHNSON AVE
SUBDIVISION . . . . . . .
CITY CUPERT=:NO
IMPACT AREA . . . . . .
OWNER CYRUS 11IRBAHA
ADDRESS 10761 JOHNSON AVE
CITY/STATE/ZIP CUPERTCNO, CA 95014
RECEIVED FROM JUANLUABING DIAZ LIC # 30298
CONTRACTOR . . . . . .
COMPANY JD PLU`4BING
ADDRESS 270 UMBARGER RD STE 66
CITY/STATE/ZIP SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 646-3266
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- NEW BAL
----
---------- -------------
----------
------ ----------
-----
1BCBSC VALUATION 32, 000 . 00 2 . 00 0 .00
2 . 00 0 . 00
1BSEISMICR VALUATION 32, 000 .00 3 .20 0 . 00 3 .20 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
0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 ---- 42 . 00 ------
TOTAL PERMIT
:.10 .20 0 . 00 110 .20 0 . 00
METHOD OF PAYMENT AMOUNT -- REFERENCE NUMBER
----------
-
CREDIT CARD 110 .20 9:38561
---------------
TOTAL RECEIPT 110 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
_ -------- -----------------------
-- --------
___
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUP
ERTINO C60d
REPIPE/SEWER/MAIN SERVICE
CITY
TING PERMIT APPLICATION FORM
Date:
APN # S- 2- to
Building Address:
W-7 61 Phone#:
Owner's Name: 4(& 3 1A —40 3
Phone#: Ac$ 64 6– 3 Z 6
Contractor: Fax#: o? `-56CJ " `16 C1 6
Phone#:
Contact: 4_.�
Fax#:
Contractor License#: S
Cupertino Business License#: a vS� o
Job Description:
1
Residential }— Commercial ❑
Valuation: 3 ZUv
Project Size: Expre 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
x.
Green Buildin Points:
rt4!1PCSEWER
ee ID Fee Description Fee Permit Type
Grou
Commercial building P 1CPSS
sewer/sanitary sewer
re-
Commercial i e per fixture P ICPRP
1BPREPIPE p p
1PGASCOM Commercial Gas Pi3ing System P –
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
REPIPE/SEWERIMAIN SERVICE
"n°fFEE SCHEDULE
CUPEf�TINO
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
I Fee TYPES
1BSEISMICR Seismic Residential P
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 Disposa: System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping;system P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
/ 1 PPERMITFEE Plumbing Permit Fee Is 3uance P
1 1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp- P
1 TRAVDOC Travel & Documentation Fee B_
I
1BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.Use L -VOC Pa" 1 IAQ/F ealth pts y=yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/I-ealth pts y=yes. 0
3.Use Low/No VOC Adhesives 3 IAQ/F ealth pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resoirce pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Flealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Flealth pts y=yes 0
7.Seal All P used Partidebmd or WF 41AQ/F lealth pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Rescurce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Rescurce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/dealth pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 ReSOLroe pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 R8SDL roe pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 ReSOL roe pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/F ealth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 ReSOL roe pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 ReSOL roe pts y=yes 0
1 1 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 0 0 0
O
G:datatprogs/greenbuilding;uidelineslremodelers/greenpointsfinal2.12.D4protected.xis