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09090135I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20378 CLAY ST IDETERMINED CONTC BD - TO BE I PERMIT NO: 09090135 I kNER'SNAME: MARTIN WON & LIANA CRABTREE OWNER'S PHONE: 4084992236 C�_ LICENSED CONTRACTOR'S DECLARATION License Class____ Lic. # 76 To` Contractor Q Date I hereby affirm that I am licensed under the provisions of Chapter 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. 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 permit is issued. APPLICANT CERTIFICATION I certify that 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cup rtm Municipal Code, Section 9.18. nature/Date 7 / ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three 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 permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that ', 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 building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save -demnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date DATE ISSUED: 09/18/2009 PHONE NO: r- r- r BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH r— RESIDENTIAL COMMERCIAL JOB DESCRIPTION: INSTALL NEW WATER LINE FROM METER BOX TO THE HOUSE Sq. Ft Floor Area: I Valuation: $3000 APN Number: 36938027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sect4 tiions 25505, 25533, and 2553 Owner or authorized agen�y� �- Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's .ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional .4 C1TY OF TPEkTINO JOB ADDRESS: -2o3-7f C-1dV OWNER'S NAME: GENERAL CONTRACTOR: wh\ Buildin s�• Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 De artment PERMIT # 6?c PHONE # �,O'W^ FAX # I am not using any subcontractors: Z�' Signature ,• , , __t__ _, __L .. ..—A ,.lo+o +1,c f,1111,cA7+r,Q infn. gfinn' (?a i55' 519q— 2236 ct-- l& T Date Please L1LCL a 1t%.cavic---- 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 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36938027.00 DATE ISSUED.......: 09/18/2009 RECEIPT #......... BS000008715 REFERENCE ID # ...: 09090135 SITE ADDRESS 20378 CLAY ST SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER MARTIN WON & LIANA CRABTREE ADDRESS 20378 CLAY ST CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4403 RECEIVED FROM TIMOTHY FACCIOLLA CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE 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 1BPWATER UNIT 1.00 42.00 0.00 42.00 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 1TRAVDOC FLAT RATE 1.00 42.00 0.00 ---------- 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 148.50 0.00 148.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 148.50 --------------- 148.50 REFERENCE NUMBER -------------------- 1040 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 301 ROUGH PLUMBING 507 FINAL PLUMBING am --.-w CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN # %o faw O Z-1- DU Date: 91(1 l Building Address:.�..� . Z,D � 7<� CIG y S s <4, - aro C-1, �SDi Owner's Name: /11aV+kA wore Phone #: qof- 41gq-2236 Contractor: rIt oe I t �t\ Idem Phone #: G SO— 2 0'6_ 27 Ig o6 Fax #: �-o;�- 9773 - qS Contact: CC \, Phone #: 65'o — -20`C- 2`7�f Commercial re -pipe per fixture Fax #: ` o i— 97 3_ 6 W 9 Contractor License #: W If 0%6 Cupertino Business License #: Commercial Gas Piping System 1-4 Outlets Job Description: Woe o� �@ � �� '� �r Residential Commercial ❑ Valuation: B Project Size: Express ❑ StandardK 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. P Green Building Points: Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CITY Of FEE SCHEDULE CU PEkTINO Quantity Q Fee ID Fee Description Fee Permit Type Grou 113CBSC 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 f 1RPWS 1 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P / ( 1 BPWATER InstalUalter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P / / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B 1. Use LeWlSlo-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use LowWo VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for interior Uses 1 IAQ/Heaith pts y=yes 7. Seal aD,F.posed Partideboard or MDF 41AQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 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 Total Points Available:1 1401 1301 57 Total Points Project Received: 0 0 0 G:data/progsgreenbuildingguidelines/remodelers/greenpointsfinal2.12.o4protected.xls