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10010146 _ CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:MR.ROOTER PLUMBING PERMIT NO: 10010146 BUILDING ADDRESS: 20083 WHEATON DR DATE ISSUED:01/27/2010 2179 STONE AVE#13 OWNER'S NAME: HINMERS KENNETH J AND RAE M TR PHONE NO:(408)271-2822 SAN JOSE,CA 95125 INER'S PHONE: 4082535012 , r— TRACTOR'S DECLARATION LDING PERMIT INFO: BLDG ELECT PLUMB ❑ LICENSED CON � BUI <; �,, ,� f% � NTIAL COMMERCIAL License Class �-- Lic.# MECH RESIDE �A_ Contractor —t JOB DESCRIPTION:REPLACE APPRX 39'OF 4"WASTEPIPE FM PROPERTY I hereby affirm that I am licensed under the provisions sions of Chapter 9 LINE TO BLDG,INCLUDE CITY CLEANOUT ON HOUSE (commencing with Section 7000)of Divand effect.fthe Business&Professions CLEANOUT**SEE NOTE** Code and that my license is in full force I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to the Labor Code,for the f-insure for Worker's Compensation,as provided for by Section 3700 0 !0% performance of the work for which this permit is issued. provided for b I have and will maintain Worker's Compensation nce Insurance, wok for which this s Section 3700 of the Labor Code,for the pValuation:$4412 Sq.Ft:Flooir a: permit is issued. "� APPLICANT CERTIFICATION 56.00 Occupancy Type: I certifythat I have read this application and state that the above information is relatingAPN Number: correcI agree to comply with all city and county ordinances and state la 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 EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the WITHIN 180 INSPECTION. granting of this permit. Additionally,the applicant understands and will comply re ations er the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED IN with all non-poinf source p 9.18. > 1-,2-7- � _ --- , Signature ` >> Date Issued bp,- Date: ,_, OWNER-BURA ILDER DECLATION 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: with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials or I,as owner of the property,or my employees w g inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Business&Professions Code) T�ignature of Applicant: 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 theLaborCode,for the Worker's materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 oft I have read the hazardous ma q and in ance of the work for which this permit is issued. California Health&Safety Code,Sections 25505 2533, 9 12 25534. 534. 1and the ill Health&a�n perform provided for b I have and will maintain Worker's Compensation Insurance,as p y compliance with the Cupertino Municipal Code,Chapter re or e hazardous Section 3700 of the Labor Safety Code,Section 25532(a)Code,for the performance of the work for which this should I stoevices whclh emit hazardous air material. permit is issued. Additionally,should I use equipment or which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Manag Chapter Dist act I will I certify that in the performance of the work for wh P maintain compliance with the Cupertino Municipal he not employ any person in any manner so as to become subject to the Worker's Health&Safety Codi;Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I �, f: ub ect to the Worker's Compensation provisions of the Labor Code,I must Ow a �- ho ed agent: f .-- becomes je Dater '-� 1 with such provisions or this permit shall be deemed revoked. forthwith comply _ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY that I have read this application and state that the above information relating I hereby affirm that there is a construction lending agency for the performance of work's I certify correct.I agree to comply with all city and county ordinances and state laws r g 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 'Pmnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address s,and expenses which may accrue against said City in consequence of the 6,anting of this permt.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section records. 9.18. % I understand my plans shall be used as public Date � ~�4.�"��� ignature Licensed Professional CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 6 ITEMS OF 6 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31623056 . 00 DATE ISSUED. . . . . . . 01/ 07 RECEIPT # . . . . . . . . . : BS0000096 REFERENCE ID # 10010146 SITE ADDRESS 20083 WHEATON DR SUBDIVISION . . . . . . : CUPERTINO CITY . . . . . . . . . . . . . IMPACT AREA . . . . . . • OWNER . . . . . . . . . . . . : HINMERS KENNETH J AND RAE M TR ADDRESS . . . . . . . . • • : 20083 WHEATON DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-233 RECEIVED FROM . . . . : FRANCISCO ORELLANA# 23496 CONTRACTOR . . . . . . . : VERNON HAL L LIC COMPANY . . . . . . . . . . : MR. ROOTER PLUMBING ADDRESS . . . . . . . . . . : 2179 STONE AVE #13 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 271-2822 QUANTITY AMOUNT PD-TO-DT THIS_REC_ -_NEW_BAL- FEE ID UNIT QUAN - 1. 00 ---------- --- ______ -------- ---------- 0 .00 1 . 00 0 . 00 1BCBSC VALUATION 0 . 50 0 .00 4, 412 . 00 1. 00 0 .50 0 . 00 1BSEISMICR VALUATION 41412 . 00 0 . 00 114 .00 0 . 00 1 . 00 114 . 00 42 . 00 0 . 00 1BUSLIC FLAT RATE 1 .00 42 . 00 0 . 00 0 .00 1PPERMITFE FLAT RATE 21 . 00 0 .00 21 . 00 1 . 00 4200 0 .00 0 . 00 . 1PRSEWER UNITS 1 . 00 42 . 00 _-__--_- 1TRAVDOC FLAT RATE ------ --- ---------- ---------- 0 . 00 220 . 50 0 .00 220 . 50 TOTAL PERMIT : AMOUNT F PAYMENT NT REFERENCE NUMBER METHOD O _________ --------------- ------------- 220 . 50 MC CREDIT CARD TOTAL RECEIPT 220 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --- _---_--_ ---------------------------- -------- ------------------------- 202 UNDERFLOOR PLUMBING 106 SEWER & WATER 3 400 SEWER/LATERAL 01 ROUGH PLUMBING 507 FINAL PLUMBING l 00 �0 CITY OF CUPERTINO `LREPIPE/SENMR/MAIN SERVICE ciTY OF FORM CUPEt�TINoPERMIT APPLICATION APN # Date: Building Address: don- J4 Name: Pone#: Owned, 'Al AA, -i�� one#: cq 0 Co t Fax#: +` L) Phone Contact: Fax#: n Contractor License#: 86 17 t�VI I �� n Cupertino Business License#: Job Description: r. 14 Residential Commercial El Valuation: c �! �,4 • Size: Express Standar Large El Major❑ Project Si p • to relevant portion of the Green Building Checklist & attach it to the Green Building. Please complete p application or if applicable, include in plan set & the sheet index. Green Buildin Points: • e Description Fee Permit Type Quantity Fee ID Fe p Grou 1 PCSEWER 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 ALL PERMIT 1BCBSC Cal Bldg Standards Commission B TYPES Fee 1 BSEISMICOM Seismic Commercial -------- P Revised 01/07/09 CITY OF CUPERTINO SERVICE REPIPE/SEWERIMAIN C IOF E SCHEDULE IVY CUPERTIN O FE • Fee Permit Type Fee ID Fee DescriptionQuantity Grou rds Commission. B ALL PERMIT 1 BCBSC Cal Bldg Standards TYPES Fee P 1BSEISMICR Seismic Residential 1PRSEWER Residential building P 1RPSS / sewer/sanitary sewer P 1RPRP 1 pRREpIpE Residential re-pipe per fixture P 1CPWS or 1BPWSVCS Water Service IRPWS 1PPRSEWG Private Sewage Disposal System P P 1PCESS Cesspool 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P Travel &Documentation Fee B 1TRAVDOC . . 1 BUSLIC Business License B M.Indoor Air Quality and Finishes 0 1 IAQ/Health pts y=yes 0 1.Use ' 2 IAQIHealth pts y=yes 2.Use Low VOC,Water-Based Wood Finishes 0 31AQ/Health pts y=yes 3.Use L ^ 0 3 Resource pts y=yes 4.Use Salvaged Materials for Interior Finishes 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 61AQ/Health pts y=yes 0 1 IAQ/Health pts y=yes 6.Use Exterior Grade Plywood for Interior Uses 4 IAQ/Health.pts y—yes ye Saw- 1 F 0 �r 0 �" B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yesResource is y-yeS 0 9.Use Finger-Jointed or Recycled-Content Trim 1 p 0 3 IAQ/Health pts y=yes 10.Install Whole House Vacuum System ! ! ! 0 - N.Flooring 0 8 Resource pts y=yes 1.Select FSC Certified Wood Flooring 4 Resource pts y=yes 0 2.Use Rapid Rwewable FloDhng Materials 0 3,USe ReGYCIed 4 Resource pts y=yes 0 Content Ceramic Tiles � eS Natural Linoleum in Place of Vinyl 51ATHnIth ptS Y-y 4.Install N 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOGs 4 Resource pts y=yes ! ! 0 Total P oints Available: 140 130 57 01 01 0 Total Points Project Received: ding elines/remodelers/greenpointsfinal2.1/6�r otected.xfsG:data/4progree uiiotected.xfs / >"f Community Development 10300 Torre Avenue Cupertino CA 95014 777-3228 Telephone(408) Fax(408)777-3333 CITY OF SUPE ITIN0 rtment Buildin De a PERMIT # OB ADDRESS: _ PHONE # OWNERS N AX# GENERAL CONTRACTOR: I am not using any subcontractors: Date Signature subcontractors and co rete the following inf oi-matron: Please check applicable subco E BUSINESS LICENSE # SUBCONTRACTOR CTOR BUSINESS NAM 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 r " = J�2 Date Owner/Contracto Signature