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10040088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7851 BELKNAP DR CONTRACTOR:SAN JOSE PLUMBING INC PERMIT NO: 10040088 OWNER'S NAME: LOUIE LIU 1732 HILLSDALE AVE DATE ISSUED:04/13/2010 'NER'S PHONE: 4086851096 SAN JOSE,CA 95124 PHONE NO:(408)296-1820 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB License Clas Lic.# MECH RESIDENTIAL COMMERCIAL Contractor lag J0 -elJOB DESCRIPTION:COPPER REPIPE FROM FOUNDATION VALVE THROUGH I hereby affirm that I am licensed under the provisions o C pte 9 (commencing with Section 7000)of Division 3 of the Business&Professions HOUSE 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$6925 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36208033.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section , j, 7�C a 9.18. Issued by.. Date: l' Signa tur Date � 3 a u OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 exempt' n r authorized agent: f become subject to the Worker's Compensation provisions of the Labor Code,I mut Date: / forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional re SignatuDate G 4 C./ CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36208033 . 00 DATE ISSUED. . . . . . . : 04/13/2010 RECEIPT #. . . . . . . . . BS000010176 REFERENCE ID # . . . : 10040088 SITE ADDRESS 7851 BELKNAP DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LOUIE LIU ADDRESS . . . . . . . . . . : 7851 BELKNAP DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM DAVID PLEMONS CONTRACTOR GARZA, KEVIN N LIC # 14200 COMPANY SAN JOSE PLUMBING INC ADDRESS 1732 HILLSDALE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE (408) 296-1820 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ----- 1BCBSC VALUATION 6, 925 . 00 1 . 00 0 . 00 1 . 00 0. 00 1BPREPIPE NO OF FIXTURE 1. 00 6 . 00 0 . 00 6 . 00 0 . 00 1BPWATER UNIT 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 6, 925 . 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 133 . 70 0 .00 133 .70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 133 . 70 VISA --------------- TOTAL RECEIPT 133 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO , REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: i C Building Address: Owner's Name: Phone#: P • S a Contractor: Phone#: Q Fax#: 6 Contact: l Phone#: Xco 1,^-" 'LJ Fax#: 4100 k Contrac icense#: Z Cupertino Business License#: Job Description: 4e, o �� Residential]] Commercial ❑ Valuation: n�' �R� Project Size: Express H Standar 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 Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group r 1BCBSC Cal Bldg Standards Commission B ALL PERMIT I Fee TYPES r 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P IRPSS sewer/sanitary sewer IPRREPIPE Residential re-pipe per fixture P (! RPRP 1BPWSVCS Water Service P 1CPWS or IRPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P IBPWATER 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 IPPERMITFEE Plumbing Permit Fee Issuance P IPLMBLNCK Plumbing Plan Check P IPLMBINSP Other Plumbing/gas Insp. P I TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B INFUT Rescwces Energy IAD/Health .In oor it ua fty an mrs es 1..ihse -VM Pant 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowtMVMAl"im 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes_ 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. _ NDF- 4IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource 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 IAQ/Health pts y=yes 0 1 i 1 N.Flooring —1.Select-FSC CertifiedWood Flooring------- - 8 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 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 ! Total Points Avai a le: 1 1401- 40 130 57 Total Points Project Received: 01 0 0 i G:da rugs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Buildin De artment JOBADDRESS: PERMIT # OWNER'S NAME: PHONE # Q GENERAL CONTRACTOR: FAX# I am not using any subcontract rs: Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Aatener Contractor Signature