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10030076 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10298 MANN DR CONTRACTOR:MELLO PIPELINES INC PERMIT NO: 10030076 OWNER'S NAME: LUTHRA MANEV 260 E MCGLINCY LN DATE ISSUED:03/12/2010 4ER'S PHONE: 4083389563 CAMPBELL,CA 95008 PHONE NO:(408)377-6103 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ) Lic.# MECH r RESIDENTIAL COMMERCIAL Contractor j�� O l ` '��`�s Date S ` /1--— /d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONNECT HOUSE TO CITY SEWER.REPLACE WATER (commencing with Section 7000)of Division 3 of the Business&Professions PIPE FROM HOUSE TO METER 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: X%Ik3000 permit is issued. APPLICANT CERTIFICATION APN Number:32,64500 ' Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT MIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. r� Issued by:�.-��- Date: Signature Date `3- /� -/o Li OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or au o izedt_ forthwith comply with such provisions or this permit shall be deemed revoked. l/ Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save -mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date S'�� Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32645001 . 00 DATE ISSUED. . . . . . . : 03/12/2010 RECEIPT # . . . . . . . . . : BS000009931 REFERENCE ID # . . . : 10030076 SITE ADDRESS . . . . . : 10298 MANN DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . LUTHRA MANEV ADDRESS . . . . . . . . . . : 10298 MANN DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1153 RECEIVED FROM . . . . : MELLO PIPELINES, IN CONTRACTOR . . . . . . . : MELLO, TONY LIC # 8168 COMPANY . . . . . . . . . . : MELLO PIPELINES INC ADDRESS . . . . . . . . . . : 260 E MCGLINCY LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 377-6103 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 .00 1. 00 0 . 00 1 . 00 0. 00 1BPWSVCS WATER SERVICE 1. 00 21. 00 0 . 00 21 . 00 0 . 00 1BSEISMICR VALUATION 3, 000 . 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 127 . 50 0 . 00 127 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127. 50 #11015 --------------- TOTAL RECEIPT 127 . 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 CUPEkTINO PERMIT APPLICATION FORM APN # e' "' �. LI �'�- ;�-, c- I Date: � 2� � Building Address: Owner's Name: Phone#: Contractor: ,� Phone#: L1 0-g-- 3 )'YIsZ Pipe S1 /i1/ L Fax#: �/a - 3 7 -� 6 S`3 Contact: l L Phone#:yQ _ .7 US- Fax#: YO-&- -3-7-2-61S-3 Contractor License#: -7 Cupertino Business License#: / Job Description: C O/f f-,�e c7 in o v L-�-r l /,q C,v W -Te 2 �r,p�. C2 -- Residential ;K Commercial ❑ Valuation: -�, J O�D Project Size: Expres 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 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 CUPERTINO = ' f REPIPE/SEWER/MAIN SERVICE CUPEI\TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group f 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P IPCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P IPGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P I PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B IBUSLIC Business License B . nLaioor it ua rty an ims es 1.Use Low/No-VOC Paint 1 IAQ/Health 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 D 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 p 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all EVosed Partiolaboard or MDF 4 IAQ/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 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes D Z Use Rapidly Ranewab4a.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: 1401 1301 571 1 Total Points Project Received: 01 0 0 0 G:datalprogs/greenbuilrfingguidelines/remodelers/greenpointsfina1212A4protected.xis ` Community Development ` 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIT1f OF Fax(408)777-3333 :UPERTINO Building Department JOB ADDRESS: PERMIT # - - -� /0 yYt w,✓'ry t�2 . , �. OWNER'S NAME: PHONE # 3`7 7- G t o 3 GENERAL CONTRACTOR: yl,x-q l\o Pipe I „�z s FAX # 401-- `3-7.-2-G i 5-3 I am not using any subcontractors: Signature Date Please check ap licable 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date