09090011 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS! 910 OLD TOWN CT CONTRACTOR:CUPERTINO PERMIT NO:09090011
PLUMBING
NER'S NAME: HENRY ZHAO 1300 DELL AVE STE C DATE ISSUED:09/02/2009
"WNER'S PHONE: 4082194385 CAMPBELL,CA. 95008 PHONE NO:(408)253-0618
❑ LICENSED CONTRACTOR'S DECLARATION r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ t' •__. Lic.# v5 __ F_
�"` �t MECH RESIDENTIAL COMMERCIAL
Contractor C�(1d�r� �u-ry Date__/_�
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COPPER REPIPE/WATER MAIN
(commencing with Section 7000)of Division 3 of the Business&Professions
Cade and that my license is in full force and effect.
1 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 nA ov
Compensation,as provided for by Section 3700 of the Labor Code,for the M&
performance of the work for which this permit is issued. Sq.Ft Floora: !In
0
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
APN Number:35611040.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the ahpve 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 hanrless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in cc;nsequence of the �� _ —��
granting of this permit. Additionally,the applicant undcrsta=ids and will comply issue �--sem Date:
with a�-point regul w`!) the Cupertino Municipal Code,Section
�
d RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. if a root'is
installed without first obtaining an inspection I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of.Applicant: __ Date:
I irer:•by affirm that 1 arm 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!heir sole compensation,
w,l:do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions rode)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec 7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Saftty Code,Sections 25505,25533,and 2.5534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain complianze with the Cupertino Municipal Code,Chapter 9.12 and th
declarations: Health&Safety Code,Section 25532ta)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 er devices which emit hazardous
Compensation,as piovid,.d for by Section 371)0 of the Labor Code,for the air contaminants as defined by the Bay A-ea Air Quality Management District I
pertorrnance of the wo:k for which this permit is issued. will maintain compliance with the Co sin ici pl Code,Chapter 9 12 and
I!rave and will maintain:Yorker's Compensation Insurance,as provided for by the Health&Safety Co a 550 25534.
Stiction 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: _na.e:
permit.s issued.
I certify that in the Performance of the work for which this permit is issued..I shal!
not e-nploy anV person in any manner so as to become subje;,t to the Worker's
Compensation laws of California. if after making this certi!icate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must !hereby affirm that.there is a consiruction lendinb agency for the performance of
forth•.+ith comply with su.h provisions or this permit shall be deemed revoked. work's for which this peanit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address___
I certriv that I have read this application and state that the above information is
correct. I agree to comply with ail city and county ordinances and state laws relating
in building construction,and hereby authorize representatives of this city to enter
•1 the above mentioned property for inspection purposes.(We)agree to save
_.:cnnify and keep hanrless 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 Mun;cipal Code,Section L',ensed Professicnal_.
9.18 1
Signature_ __ _ Date__ 11
Community Development
10300 Torre Avenue
S,�j! Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
7UPEkTINO
Buildin De artment
JOB
�ADDRESS: PERMIT#
j
OWNER'S NAME: Ac-v PHONE # 2-19 - 3 95
GENERAL CONTRACTO : ell-6 FAX #
I am not using any subcontractors: ^ 2 0S
e Date
Please check applicable 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
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35611040 . 00
DATE ISSUED. . . . . . . : 09/02/2009
RECEIPT #. . . . . . . . . BS000008586
REFERENCE ID # 09090011
SITE ADDRESS 910 OLD TOWN CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER HENRY ZHAO
ADDRESS 910 OLDTOWN CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4024
RECEIVED FROM FRANK CARDIA
CONTRACTOR CARDIA, FRANK L LIC # 612
COMPANY CUPERTINO PLUMBING
ADDRESS 1300 DELL AVE STE C
CITY/STATE/ZIP CAMPBELL, CA 95008
TELEPHONE (408) 253-0618
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- ------
1BCBSC VALUATION 5, 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 5, 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 106 .50 0 . 00 106 . 50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------------
CREDIT CARD 106 .50 me
---------------
TOTAL RECEIPT 106 . 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
aN, REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # t no Date: 9
Building Address:
o w,n '
Owner's Name: Phone#: P
Contract r: n Phone#:
►.� i'��r•�� Fax #:
Contact: Phone#: �� -5 L/ l
4�'r6`'"r`ec — Fax#:
Contractor License#: c,Q
Cupertino Business License#:
Job Description:
ce-5
Residential Qtr Commercial ❑
Valuation: Ci c2:5--
Project Size: Express 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
1 BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
" REPIPE/SEWER/MAIN SERVICE
CUPEfZTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1 PRSEWER 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
1PCESS Cesspool P
1 BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1 PGASRES 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
1 PLMBINSP Other Plumbing/gas Insp. P
1 TRAVDOC Travel & Documentation Fee B
1 BUSLIC Business License B
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal.Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans -1 _, 1 point
TOTAL POINTS1 40 points
Plan Review Process Work Book Page-12-Revised 3/25/08
M. n oor Air uallty and Finishes
1.Use tow/No-VOG 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 Adhe&es 3IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7,Seal all tFgposWPAftdebowd 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 i i
N.Flooring
1.Select FSC Certified Wood Flooring 8 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: 140 130 57
Total Points Project Received: 01 01 0
G:data/progs/greenbuildingguidelines/remodelers/greenpoinisfinal2.12.04protected.zls