10030047 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10541 GASCOINGE DR CONTRACTOR:SAN JOSE PLUMBING PERMIT NO: 10030047
INC
`)WNER'S NAME: JULIE JOYCE 1732 HILLSDALE AVE DATE ISSUED:03/09/2010
OWNER'S PHONE: 4088294139 SAN JOSE,CA 95124 PHONE NO:(408)296-1820
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALL]
1 r'
License Cl 5 Li,.# COPPER RE-PIPE
Contracto '' Date
I hereby affirm that I am licensed under tlfe provisions of C dapter 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:$5500
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:37528005.00 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 \ Date: U
granting of this permit. Additionally,the applicant understands and will comply Issued by: U
with all non-point source regulations per the Cupertino Municipal Code,S ction
9.18.
_
Signatu e Date / RE-ROOFS: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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature 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
1,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)
1,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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&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 material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safe;2F
`` 50 ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authori
age Datf 0
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 hereby 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.)
Lender's Name
APPLICANT CERTIFICATION Lender'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
to building construction,and hereby authorize representatives of this city to enter
yon the above mentioned property for inspection purposes.(We)agree to save
lemnify 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 I understand 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 Licensed Professional
9.18.
Signa re / Date-3/19�io
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37528005 . 00
DATE ISSUED. . . . . . . : 03/09/2010
RECEIPT #. . . . . . . . . BS000009897
REFERENCE ID # . . . : 10030047
SITE ADDRESS 10541 GASCOINGE DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . .
OWNER JULIE JOYCE
ADDRESS 10541 GASCOIGNE DR
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM . . . . : DAVID PLENONS
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 5, 500 .00 1. 00 0 . 00 1 . 00 0 . 00
1BPWATER UNIT 1 .00 42 . 00 0 . 00 42 . 00 0 . 00
1BSEISMICR VALUATION 5, 500 . 00 0 .60 0 . 00 0 . 60 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 . 60 0 . 00 127 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 127. 60 visa
---------------
TOTAL RECEIPT 127 . 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -----------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
507 FINAL PLUMBING
CITY OF CUPERTINO
RE
PIPE/SEWER/MAIN SERVICE
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN#
CSU 3 �`-�
Date:
3 --752 � 005
Building Address: , / � Q 0�/ �---
Owner's Nam ,- :]�,'Y rPhone#
17TIr
Y
Contractor: Phone#:
=Q 63h Fax #: Q O �7
Contact: Phone#:
/a v Fax #: V 4 d
Contr for License#:
Cupertino Business License#:
Job Description:
Residential Js� Commercial ❑
Valuation: � �
O
Project Size: Express LJ 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:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1 BPREPIPE Commercial re-pipe per fixture P 1CPRP
1 PGASCOM 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
C'n°fFEE SCHEDULE
CUPEkTINO
Quantity Fee ID Fee Description Fee Permit Type
Grou
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
IP 1RPSS
1PRSEWER Residential building
sewer/sanitary sewer
P:TIBPWSVCS
REPIPE Residential re-pipe per fixture P 1RPRP
Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
C.
1 BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
IBPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
M.Indoor Air QuaI4 and Finishes
1.Use LowMo-VOC Paint 1 IAQIHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D
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 IAOMealth pts y=yes 0
7.Seal as Exposed Partioleboard or MDF 4 IAQ/Health.pts y=yes 0
B.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 1 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 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: 1 1401 1301 57
Total Points Project Received: 01 0 0
n
G:data/progs/greenbuil guidelines/remodelers/greenpointsfinal212 Mprotected.xls