10010034 CITY OF CUPERTINO BUILDING PERMIT
PERMIT NO: 10010034
CT CONTRACTOR:CUPERTINO PLUMBING
BUILDING ADDRESS: 22680 SILVER OAK 00 DELL AVE STE C DATE ISSUED:01/07/2010
13
OWNER'S NAME: RICE RUTH A PHONE NO:(408)253-0618
CAMPBELL,CA 95008
NER'S PHONE: 4082537550
BUILDING PERMIT INFO: BLDG ELECT PLUMB
[] LICENSED CONTRACTOR'S DECLARATION �,
F COMMERCIAL�
License Class 1 Lic.#
U� MECH RESIDENTIAL
P1 b Date r +� DESCRIPTION:COPPER RE-PIPE
Contractor ��` P� _ JOB
I hereby affirm that I am licensed under the 7000)of n 3 of the Business&Professions
Code a
(commencing with
hl censetis in full force and effect.
Code and t Y
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate Section
consent to self-insure for on 3700 of the Labor Code,for the
Compensation,as provided for by Sec Valuation:$4000
Sq.Ft Floor Area:
performance of the work for which this pensation Insurance,as provided for by
I have and will maintain Workers Comp Occupancy Type:
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34249021.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information state laws relating IT EXPIRES IF WOE IS NOT STARTED
I ce fy PERM
correct.I agree to comply with all city and county ordinances an IN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives
epres n atives(we)agree to savof this city to ter WITH INSPECTION.
upon the above mentioned property for inspection,P judgments, 180 DAYS FROM LAST CALLED
indemnify and keep harmless the City of Cupertino sa d C ty nntconsequence of the
costs,and expenses which may accrue agar -- - Date://'-
ranting of this permit. Additionally,the applicant understands and will comply ,-- �,;T��,..�f_.._�..,�_--
g Issued by:
with all non-point source regulations r the Cupertino Municipal Code,Section
18. . .
9. Date
SigtatU're ''`� RE-ROOFS:
roof
material being installed.If a roof is
All roofs shall be inspected prior to any g
� OWNE
R-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials or
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. Date:
the following two reasons: Signature of Applicant:
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,
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
affirm under penalty of perjury one of the following three
b I have read the hazardous materials requireme 5 x25533,and 25534.der Chapter 91 will maintain
5 of the
I hereby h&Safety Code,Sections 2550 ,
declarations: Chapter 9.12 and the Health&
I have and
will maintain a Certificate of Consent to self-insure for Worker's compliance l ance�with the Cupertino Municipal Code, le hazardous material.
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or hand
for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
performance of the work provided for by the Bay Area Air Quality Management District I will
contaminants as defined by
I have and will maintain Worker's Compensation Insurance,as p Chapter 9.12 and the
Labor Code,for the performance of the work for which this maintain compliance with the Cupertino 5505,25533,and 25534e,
Section 3700 of the Lab Health&Safety Code,Section
permit is issued. _
I certify that in the performance of the work for which this permit is issued,I shall ent:,..� '
7 Imanner so as to become subject to the Workers r777
r' gg Date:not employ any person in anynsation laws of California. If,after making this certificate of exemption,ICompe
Worker's Compensation provisions of the Labor Code,I must ONSTRUCTION LENDING AGENCY
become subject to the C
forthwith comply with such provisions or this permit shall be deemed revoked. that there is a construction lending agency for the performance of work's
I hereby affirm
APPLICANT CERT IF
KATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above informationlaws relating Lender's Name
correct.I agree to comply with all city and county ordinances anstate
oe to c tion,and hereby authorize representatives of this cit to o save Lender's Address
to building c purposes.(We)agree
upon the above mentioned property for inspection pure judgments,
unify and keep harmless the City of Cupertino against liabilities,judg ARCHITECT'S DECLARATIO
and expenses which may accrue against said understands and will comply I understand my ity in consequence of the plans shall be used as public records.
granting of this permit.Additionally,the app
with all non-point sourcere$. �lons per the Cupertino Municipal Code,Section Licensed Professional
9.18. 6 - 0
Date
Signature
CITY OF CUPERTINO
RECEIPT OPERATOR: patg
PERMIT R COPY # 1
5 ITEMS OF 5
Rng: Sub: Blk: Lot:
Sec: Twp: ; 34249021. 00
APN • " " "
01/07/2010
DATE ISSUED: : : : : : : : BS000009516
RECEIPT # ; 10010034
REFERENCE ID # • • -
SITE ADDRESS 22680 SILVER OAK CT
SUBDIVISION
CITY • . • . • • . • CUPERTINO
IMPACT AREA . . . . . . •
. . . . . . . . . . . . RICE RUTH A
OWNER
. . . . • . • • • , . 22680 SILVER O 095014-5635
ADDRESS ; CUPERTINO CA, CA
CITY/STATE/ZIP • • •
IA
CEIVED FROM FRANK L gARANK L LIC # 612
C ;
CONTRACTOR • " ; CARDIA,CUPERTINO PLUMBING
COMPANY • " " 1300 DELL AVE STE C
ADDRESS • • • • • . . CAMPBELL, CA 95008
CITY/STATE/ZIP (408) 253-0618
TELEPHONE . . . . . . . . (408) 25
REC NEW BAL
QUANTITY AMOUNT -PD_TO_DT_ ----------
Q ___--__ 1 . 00 0 . 00
FEE IDSIT___-- ---------- --- 1.00 0 .00 0 0 . 00
-------- 4, 000 .00 0 .00 0 .5
1BCBSC VALUATION 0 .50 42 .00 0 . 00
4, 000 .00 42 . 00 0 .00 0 .00
1BSEISMICR VA1 .001 ,00 0 .00 99 .00 0 .00
1PPERMITFE FLAT 9 .00 99 . 00 0 .00 42 . 00 -
1PRREPIPE NO OF FIXTURE 1 .00 42 .00 _--__-- ---------
1TRAVDOC FLAT RATE _-_----- --- 0 .00 1.84 .50 0 . 00
184 .50
TOTAL PERMIT :
AMOUNTREFERENCE_NUMBER
METHOD OF PAYMENT ---_______ ------
----- 184 .50 VISA
CREDIT CARD ---------------
184 . 50
TOTAL RECEIPT : VOICE ID DESCRIPTION- -_
VOICE ID DESCRIPTION_________ --- --- -------
___--- ----__---- 507 FINAL PLUMBING
301 ROUGH PLUMBING
CITY OF C
REPIPE/SEWER/MAIN SERVICE
CITY Of APPLICATION FORMCUpE TINOPERMIT
�,
Date:
APN#,
Building Address:
Phone# -7550
�5
Owners Name: a
t�-
cue.- Phone#: 2--i5
Cont actor: Fax#:
Phone#: j L) 3 l
Contact:
Fax#:
Contractor License#: c,
Cupertino Business License#:
Job Description:
Commercial El
Valuation:
tandard ❑ Large Major
Project Size: Express of to the
Green Building
' the Green Building Checklist & attach ><t
: Please complete relevant portion
a lication or if applicable, include in plan set& the sheet index.
PP
Green Buildin Points: mit Type
Fee Per yp
Fee ID Fee Description Grou
Quantity
P
1CPSS
1
PCSEWER Commercial building
sewer/sanitary sewer P iCPRP
1 BPREP
IPE Commercial re-pipe per fixture
1PG
ASCOM Commercial Gas Piping System P
1-4 outlets . ALL PERMIT
1 BCBSC
Cal Bldg Standards Commission TYPES
Fee P
1BS
EISMICOM Seismic Commercial
Revised 01/07/09
CITY OF
CUPERTINO
RFPPE/sEwEFjmA1N SERVICE
F FEE SCHEDULE
cuPEINo
Fee Permit Type
Fee Description Grou
Quantity Fee ID �B L PERMIT
Cal Bldg Standards Commission TYPES
1BCBSC Fee
P
MICR Seismic Residential
1 1BSEIS 1RPSS
lbuildingP
PRSEWER Residential
1
sewer/sanita sewer P 1RPRP
Residential re-pipe per fixture
IP PIPE P 1CpWs or
'ce RPWS
1BPWSVCS Water Serve 1
p stem P
1 PPRSEWG
Private Sewage Disposal Sy
P
1PCESS Cesspool
TER Install/alter Water Pipe
P
1 BPW A
P
1 PFIXTURE Plumbing Fixture
P
ES Residential Gas Piping System
stem
1PGASR
1-4 Outlets 5+ Outlets P
Gas Piping System
1BPGAS P f
TFEE Plumbing Permit Fee Issuance
1PPERMI P
1PLMBLNCI{ Plumbing Plan Check
Insp. P
1 PLM
,BIN SP Other Plumbing/gas
Travel &Documentation Fee
B
1TRAVDOC
CB
1
BUSLIC Business License
Islas
Indoor Air QuallitY an Finishes 0
1 IAQ/Health pts y=yeS 0
1.lase toA°-VOC P2 IAQIHealth pts y=yes.
2.Use Low VOC,Water-Based Wood Finishes 0
31AQIHealth pts y=yes
3.Use LDW/W VOC Ac s 3 Resource pts y=yeS 0
4.Use Salvaged Materials for Interior Finishes
5.Use Engineered Sheet Goods with no added Urea 0
6lAQIHealth pts y=yeS 0
Formaldehyde ts y=yeslth/Heap
6.Use Exterior Grade Plywood'for Interior Uses 1 IAQ0
F 41AQ/Health. pts y=yes
7.Sealq ' �T. . 0
4 Resource pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 1 Resource pts y—yes
9.Use Finger-Jointed or Recycled-Content Trim Y=Yes
3 IAQ/Health pts y=yes
10.Install Whole House Vacuum System 1 ` 01
N.Flooring 0
8 Resource pts y=yes
1.Select FSC Certified Wood Flooring 4 Resource pts y=yeS 0
2.Use Rapi($y Renewable Fboring Materials 0
4 Resource pts y=yeS 0
3.Use Recycled Gontent Ceramic Tiles Health is =yes
51AQ! p Y
4.Install Natural Linoleum in Place of Vinyl 7[ 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes
0
1
Available
--�--- 140 130 57
1
Total Points _ ...-
01 OT 0
Total Points Project Re'Clce' .
G:datalprogs/greenbuildingguidelines/remodelers/greenpointstina12.12.D4protected.xis
Community Development
10300 Torre Avenue
Cupertino CA 95028
3
�,. Telephone(408)777
Fax(408)777-3333
W
CIT1f YOF
XPEkTINO
ul in
1
D
e artment
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B
PERMIT #
JOB ADDRESS: �-�-
/ 2e-�.. .......... PHO # Z 7.
OWNERS NAME: t�"- ��ci► r FAX#
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ENERAL CONTRACTOR: O
Ole
Date
am not using any subcontractors: Signature I gn
rn Tf llowin information:
icable subcontractors and coete the o
BUSINESS LICENSE #
Please check a l BUSINESS NAME
SUBCONTRACTOR
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
Date
SijgnaOwner/ContractorTe