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10040024 rOWNECITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:WATER QUALITY PERMIT NO: 10040024 R DRESS: 22085 LINDA VISTA PL PLUMBMG 1860 ALMADEN RD DATE ISSUED:04/05/2010 ME: NEAR JAMES E AND NANCY T PHONE NO:(408)267-9330 ONE: 4088577437SAN JOSE,CA 95123 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 1:. .341 Lic.# "s V MECH RESIDENTIAL COMMERCIAL Contractor � �� Date ��'� JOB DESCRIPTION:COPPER REPIPE&MAIN WATER SERVICE 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 Valuation:$7400 performance of the work for which this permit is issued. Sq.Ft 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 Number:35608014.00 Occupancy Type: permit is issued. 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point sourceAgulations per the Cupertino Municipal Code,Section Issued by: 9.18. ure :! Dat RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Date: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the I in Worker's California Health&Safety Code,Sections 25505 25533, nd2 and the 25534. 1 it ma I have and will maintain a Certificate of ConHealth&tain declarations: sent to self-insure for Work compliance with the Cupertino Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should Isto a orer handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Sal 11 Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall /f a ent: not employ any person in any manner so as to become subject to the Worker's Own g Date%U 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 % forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating f '-gilding construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save iuuemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION sequence of the costs,and expenses which may accrue against said City in con granting of this permit.Ad,i •onally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source r ulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Da Signature �a�� CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608014 . 00 DATE ISSUED. . . . . . . : 04/05/2010 RECEIPT #. . . . . . . . . BS000010100 REFERENCE ID # 10040024 SITE ADDRESS 22085 LINDA VISTA PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER NEAR JAMES E AND NANCY T ADDRESS 22085 LINDA VISTA PL CITY/STATE/ZIP CUPERTINO CA, CA 95014-4022 RECEIVED FROM . . . . : WATER QUALITY PLUMB CONTRACTOR SATALINO, MARTY LIC # 21526 COMPANY WATER QUALITY PLUMBING ADDRESS 1860 ALMADEN RD CITY/STATE/ZIP SAN JOSE, CA 95123 TELEPHONE (408) 267-9330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW BAL ---------- ------------- ---------- ---------- ---------- ---- 1BCBSC VALUATION 7,400 . 00 1. 00 0 .00 1 . 00 0 . 0 1BPWATER UNIT 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 21. 00 0 . 00 21 . 00 0 . 00 1BSEISMICR VALUATION 7,400 .00 0 . 80 0 . 00 0 . 80 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1. 00 11 . 00 0 . 00 11 . 00 0 . 00 1 . 00 42 . 00 0 .00 42 . 00 -- -- 0 . 00 1TRAVDOC FLAT RATE ---------- ---------- ---------- TOTAL PERMIT : 159 . 80 0 .00 159 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ----- CHECK 159 . 80 #17563 --------------- TOTAL RECEIPT 159. 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - _ -507 FINAL PLUMBING ------ ---------------------- -------- _ 301 ROUGH PLUMBING i CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEtOF �TINO PERMIT APPLICATION FORM Date: _ r PN# Luilding Address: Phone#: Owner's Name: _ :� 5� J M 3 Phone#: t Contrac Fax#: Phone Contact: m,�� 5�,—��,�-z-� Fax#: Contractor License#: C� Cupertino Business License#: / Job Description: RA V31 r— Residential [ Commercial ❑ Valuation: -710v 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: Fee Permit Type Fee Description Quantity Fee ID p Grou 1PCSEWER Commercial building P ICPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets ALL PERMIT 1BCBSC Cal Bldg Standards Commission B TYPES Fee IBSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group r 1 BCBSC 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 IBPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P I PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P I1 TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B M.Indoor Air QuallitY and MnIsFe-S 0 1.Use LowlNo-VOC Paint 1 IACMBalth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IALUHealth pts Y=yes 0 3.Use LowM VOC Adhesives 3 IAQ/Health pts Y--Yes 3 Resource is Mes 0 4.Use Salvaged Materials for Interior Finishes p 5.Use Engineered Sheet Goods with no added Urea 6 IAQ/Health pts y=yes 0 Formaldehyde 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts Y=yes 0 7.Seal aH Eiosed PWWObOard or MDF 4 IAQ/Health.pts Y=Yes 4 Resource is — es 0 B.Use FSC Certified Materials for Interior Finish p y_Y D 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 1 1 1 N.Flooring 0 1.Select FSC Certified Wood Flooring B Resource pts y=yes 4 Resource pts y=yes 0 2 Use Rapidly Renewable Flooring pgateriais 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 4 Resource pts y=yes D 5.Use Exposed Concrete as Finished Floor 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y=YeS 1 1 1 Total Points Available: 140 130 57 01 01 0 Total Points Project Received: c� -�� :dafalpr sJ reenbuilicbngguide slremo eters!reen ointsfina121204pro1eoted.xis