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10050190 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8113 PARK VILLA CIR CONTRACTOR:STERLING GENERAL PERMIT NO: 10050190 CONS"RUCTION NER'S NAME: DAVID CHIN 1727 CELL AVE DATE ISSUED:05/26/2010 OWNER'S PHONE: 4088711372 CAMPBELL,CA 95008 PHONE NO:(408)871-1372 LICENSED CONTRACTOR'S DECLARATION JOB D ESCRIPTION: RESIDENTIAL COMMERCIAL C 22 ��g REPAIRING SUPPLY LINE UNDER SLAB License Class J Lic.# a A ' ' i✓ Date Contractor 0 ,. I hereby affirm that I am h ensed under the provisions of Chapter 9 'n. (commencing with Section 7000)of Division 3 of the Business&Professions 1 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:$7000 performance of the work for which this permit is issued. Sq.FI Floor Area: 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 Vumber:35610062.00 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 Issui d by: Date: 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: nature/� `^' Date 7 All rc Hofs 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 inspection. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: 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) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I ha ie 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: Heath&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 mat-rial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air(ontaminants 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 lth&Safe i he caSafety Code,Sections 25505,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by t � Section 3700 of the Labor Code,for the performance of the work for which this Ow rer or authorized agent: Date: V 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 he"eby 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.)Ler der's Name APPLICANT CERTIFICATION Ler der'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 building construction,and hereby authorize representatives of this city to enter in the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ..idemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I ul.derstand 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 Lic nsed Professional 9.18. Signature Date CITY OF CUPERTINO SM� REPIPE/SEWER/MAIN SERVICE CUPE(�TINO PERMIT APPLICATION FORM v � � v APN # t r I U O(rpo� . DO Building Address: �/a 90k i //1 �c� C� c� � NOj((71 , Owner's Name: Pho e#: L)A�e 11N Contractor: _ Phone#: Fax #: Contact: Phone#: Fax#: Contractor License#: 700/9/ Cupertino Business License#: 9 z Job Descri o�n. Residential [ Corunercial ❑ Valuation: �- Q Project Size: Express Standard Large major Green Building: Please complete relevant portion of th a 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 1 PGASCOM Commercial Gas Pip:ng 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 CUPE RTINO REPIPE/SEWER/MAIN SERVICE CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1BCBSC Cal-Bldg Standards Convnission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fi dure P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal 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+ Cutlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P 1 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel &Documentatiui Fee B I 1BUSLIC Business License B •! .Indoor Air QuaI4 and Finishes 1.Use 1Ow1No-VOC PairA 1 IAQ/He dth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO/He filth pts y--yes 0 3.Use Low/No VOC Adhesives 3 IAQ/He filth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resour;e 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.deal all Exposed ParOolaboard©r MIDIF 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resowce pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resow ce pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/H;alth pts y=yes 0 1 i 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resourc a pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource 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/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: 145T 1301 57 Total Points Project Received: 0 0 0 CL G:datalprogs/greenbuildnggi idelin49d ler eenpointsfinal2.12.D4protected.xls CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lc-t: APN 356100E2 . 00 DATE ISSUED. . . . . . . : 05/26/:.010 RECEIPT # . . . . . . . . . BS0000-.0487 REFERENCE ID # 100501 +0 SITE ADDRESS 8113 PARK VILLA CIR SUBDIVISION . . . . . . . CITY CUPERT:=NO IMPACT AREA . . . . . . OWNER DAVID CHIN ADDRESS . . . . . . : 8113 PARK VILLA CIR CITY/STATE/ZIP CUPERTENO CA, 95014-4044 RECEIVED FROM STERLING GEN CONST CONTRACTOR PATRICK WEHNER LIC # 22979 COMPANY STERLING GENERAL CONSTRUCTION ADDRESS 1727 DELL AVE CITY/STATE/ZIP CAMPBELL, CA 95008 TELEPHONE (408) 871-1372 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 .00 1. 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1BSEISMICR VALUATION 7, 000 . 00 0 . 70 0 .00 0 .70 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1.00 42 . 00 0 . 00 42 . 00 0_00 ----- ----- TOTAL PERMIT 127.70 0 . 00 127 . 70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 127 . 70 21111 --------------- TOTAL RECEIPT 127 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- 301 ROUGH PLUMBING 507 FINAL PLUMBING