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10050196 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18771 TUGGLE AVE CONTRACTOR:JD PLUMBING PERMIT NO: 10050196 OWNER'S NAME: KHATAMI FEREIDOON AND MEHRZAD S TRU 271)UMBARGER RD STE 66 DATE ISSUED:05/26/2010 J1'NER'S PHONE: 4085904887 SAN JOSE,CA 95111 PHONE NO:(408)646-3266 ❑ LICENSED CONTRACTOR'S DECLARATION K B DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class _.7 6- Lic.# O -(63-2_ S KWER LINE REPLACEMENT FROM HOUSE TO PROPERTY LINE Contractor ..�4 0^ Date Z6 ' &BUILDING PLUS CITY CLEANOUT I hereby affirm that I am licensed unde 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. Sq.Ft Floor Area: Valuation:$2800 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:37527024.00 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 granting of this permit. Additionally,the applicant understands and will comply Is sued b . Date: �Z�lr1 with all non-point source re tia r the Cupertino Municipal Code,Section 9.18. /,�/ / RE-ROOFS: Signatur Date ( '--tom All roofs shall be inspected prior to any roofing material being installed.If a roof is in:,talled 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) 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 Have 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 in iintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H!alth&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 in iterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the ai-contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. w 11 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ini ,ilLd 25534. Section 3700 of the Labor Code,for the performance of the work for which this ____ ---� 0151261( Owner or author' cut:-- _ Date: 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 I iereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w)rk's for which this permit is issued(Sec.3097,Civ C.) L:nder's Name APPLICANT CERTIFICATION L order's Address 1 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 emnify 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 iinderstand my plans shall be used as public records. granting of this permit.Additional) ,the applicant understands and will comply with all non-point source ions per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature %" Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: (F-7 `7 PERMIT# )r� OWNER'SNAME: /� ��^yct _ h� PHOC49- 32C GENERAL CONTRACTOR:1 �,_,,M��- BUSINESS LICENSE# ADDRESS: Z vn-�-�jur `1( CITY/ZIPCODE: q5(I I *Our municipal code requires a businesses wor ing 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 SUBCONTRAC'CORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �-- �- I am not using any subcontractors: -7 y 5 26 1 Signat are Date 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 CUP13RTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: LDt: APN 37527024 . 00 DATE ISSUED. . . . . . . : 05/26/2010 RECEIPT #. . . . . . . . . BS000010492 REFERENCE ID # . . . : 10050196 SITE ADDRESS 18771 TUGGLE AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KHATANI FEREIDOON AND MEHRZAD ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : JD PLLMBING CONTRACTOR JUAN EIAZ LIC # 30298 COMPANY JD PLCMBING ADDRESS 270 Ub:BARGER RD STE 66 CITY/STATE/ZIP . . . : SAN JC,SE, CA 95111 TELEPHONE (408) 646-3266 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---- 1BCBSC VALUATION 2, 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 800 . 00 0 .50 0 . 00 0 . 50 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 -06 . 50 0 . 00 106 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CREDIT CARD 106 . 50 9:37718 --------------- TOTAL RECEIPT 106 .50 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/SEWER/P4AIN SERVICE D CUPEkTINO PERMIT APPLICATION FORM APN# —"] , W-4 1 Date: S �25- /® Building Address: Owner's Name: Phone ��ct .-,k s Sip Contractor: Phone#: _ 616—3`Z6-6 Fax#: 3G0— 9C 6 Contact: Phone#: u 2 Fax#: Contractor License#: gcj G 3-Z Cupertino Business License#: rr Job Description: SC _,c e�cccc + /a„'` G S� e c,i 4-1 (Ak 0 �,��1� v�-� —�- c d -��! C�(b air c- Residential Commercial ❑ Valuation: SOP._ 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 iheet 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 Piping 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 CUPJLTRTINO REPIPE/SEWER/NUUN SERVICE CITY OF FEE SCHEDULE CUPEt�TINO Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per axture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Dispo& System P 1 PCESS Cesspool P 1 BPWATER 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 / 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Ir,sp. P 1 TRAVDOC Travel & Documentat.on Fee B 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.Use LowWVOC Pala 1 IACJHealth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IACJHealth pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAO/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Re3ource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61A(JHealth pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes 7.Sea!all Psrticleboand or MDF 4 IAO/Health pts y=yes 0 S.Use FSC Certified Materials for Interior Finish 4 Re3ource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IA)/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource 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 IAC/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: 14-01-1301 57 Total Points Pro'ect Received: S 0 0 0 110-011, G:data/progs/greenbuildi igguidelines/remodelers/greenpointsfinal2.12.04proteated.xls