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10040167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7890 ROBINDELL WAY CONTRACTOR:DISCOUNT PLUMBING& EDATE NO: 10040167 ROOTER NER'S NAME: GARY L CARMINE 1330 VALOTA RD SUED:04/28/2010 OWNER'S PHONE: 6503338105REDWOOD,CA 94061 O:(650)333-8105 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB r License Class CLic.# 10 5 MECH f— RESIDENTIAL COMMERCIAL Contractor b,5(�U► >�UIK �S Date y�_3 — �y JOB DESCRIPTION: INSTALL CITY CLEAN OUT I hereby affirm that I am licensed under the provisions of Chapter 9 rte, (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 y� Compensation,as provided for by Section 3700 of the Labor Code,for the a ation: performance of the work for $1200 which this permit is issued. Sq.Ft Floor Area: ��, I have and will maintain Worker's Compensation Insurance,as provided for by e e Section 3700 of the Labor Code,for the performance of the work for which this `" occupancy T e APN Number:36219027.00 p y YP ` 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 -2 - !� 2 ---� _.--- __..._-- -- with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date: r 9.18. ature ��Z Date =10 RE-ROOFS: 13installedDECLARATION 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: I,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 I,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 I have read the hazardous materials requirements under Chapter 6.95 of the declarations: sent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Concompliance with the Cupertino Municipal Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should InCode,Chapter toe ohandlehazardous and & 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&Safety Code,Sections 255059 25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shall '1 not employ any person in any manner so as to become subject to the Worker's Ow n�f�or,.authorized eryt _ Date: Compensation laws of California. If,after "( ` —��0 making this certificate of exemption,In ` //// become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 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 to building construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature � L` -2 Date 20 �d CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36219027 . 00 DATE ISSUED. . . . . . . : 04/28/2010 RECEIPT # . . . . . . . . . BS000010284 REFERENCE ID # 10040167 SITE ADDRESS 7890 ROBINDELL WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER GARY L CARMINE ADDRESS 7890 ROBINDELL WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM ORCE NAUMOVSKI CONTRACTOR ORCE NAVMOVSKI LIC # 24887 COMPANY DISCOUNT PLUMBING & ROOTER ADDRESS 1330 VALOTA RD CITY/STATE/ZIP REDWOOD, CA 94061 TELEPHONE (650) 333-8105 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---- 00 1BCBSC VALUATION 1, 200 . 00 1 . 00 0 . 00 1 . 00 0 • 1BSEISMICR VALUATION 1, 200 . 00 0 . 50 0 . 00 0 .50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 . 00 1PRSEWER UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 ---- -0_00 ---------- ---------- ---------- TOTAL PERMIT 211. 50 0 .00 211 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ------ CHECK 211 . 50 #6378 --------------- TOTAL RECEIPT 211 . 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/MAIN SERVICE CUPEY TING PERMIT APPLICATION FORM Date: , APN # i� ( 1� �J � ()�-1 Building Address: V Ac)6Nbo%1. ( �� Phone#: Owner's Name: � � �j ��Q _- -3-T3_ g(Q S" ( Phone#: Contractor: I J �L Fax #: >Wc t v`. UI'�'i bin G�^� _ Phone#: Contact: ,ni11 f " � 6 --3 -,a Fax#: �d ra Contractor License#: 51-3 r �- Cupertino Business License#: Job Description: � T�y C D() Residential Commercial ❑ Valuation: 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 Green Building Points: Fee Permit Type Fee Description Quantity Fee ID p Grou 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 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO r; `' REPIPE/SEWER/MAIN SERVICE CITY OF FEE SCHEDULE CUPEI�TINO Quantity Fe:elD Fee Description Fee Permit Type Grou 1BCBSC Cal Bldg Standards Commission B ALL PERMIT l Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer Residential re-pipe per fixture =:I-R- IPRREPIPE 1PRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG 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+Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B .Indoor Air Quality and Finisnes 0 1 t�se LOMNo-VOC p 1 IAQ/Health pts y=yes Y=Y 0 P 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health is es 0 3 Use LOWM VOG Adhesi►res 31AQ/Health pts y=yes 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea 6 IAQ/HeattOt P Y-y is es 0 Formaldehyde p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes7. 0 SealaU. edp- ebwdorNDF 41AQ/Health. pts y=yes 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 00 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 N.Flooring - ----- - 8 Resource-pts ---�- -- - _1.SelectFSCCertified-Wood.Flooring-_-__--- - --- P Y-ye 0 Renewable Fluorin Materials 4 Resource pts y=yes 0 2.Use Rapidly 9 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 51AQ/Health is Y=Yes 0 4.Install Natural Linoleum in Place of Vinyl P y-y D 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 140 Total oin s Available: �% 130[—' 57 p 0 0 Total Points Project Received: G:datalprogslgreenbuildingguidelineslremodelers/greenpointsfinal2.12.04protected.xls Building Department City Of Cupertino 10300 Torre Avenue Is' Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t 1 PERMIT# OWNER'S NAME: EYL AY /v PHONE# GENERAL CONTRACTOR: w v r Koo USINESS LICENSE# Z �� ADDRESS: 5` 0 V �'�, CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S)CTOS HAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL UNTIL THE SUBCONTRAr BUSINESS LICENSE. q� ,(fy y — 2 8—to I am not using any subcontractors: Signature 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 E Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature