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09110041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10132 DEEPROSE PL CONTRACTOR:CUPERTINO PLUMBING PERMIT NO:09110041 OWNER'S NAME: GARELICK DAVID W AND ROBERTA G 1300 DELL AVE STE C DATE ISSUED: 11/09/2009 ER'S PHONE: 4084463656 CAMPBELL,CA 95008 PHONE NO:(408)253-0618 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (— C.. Lic.# (_o04205 MECH RESIDENTIAL COMMERCIAL Contractor •2c c � 0(t •�i Date �� !'-U`f I hereby affirm thpnC at I am licensed under he provisions of Chapter 9 JOB DESCRIPTION:COPPER RE-PIPE (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 Sq.Ft Floor Area: Valuation:$6000 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 APN Number:36905020.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above 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 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 Issued - Date:/ with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. G -U7 Signature .�� Date •,��5 //- RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is L OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the stricture is not intended or offered for sale(Sec.7044, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to constrict the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall wfier or authorized a.,ge1 , P c 'y,.... te: Ute_ 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 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.) APPLICANT CERTIFICATION Lender's Name 1 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION i nify and keep harmless the City of Cupertino against liabilities,judgments, 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 Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36905020 . 00 DATE ISSUED. . . . . . . : 11/09/2009 RECEIPT #. . . . . . . . . BS000009145 REFERENCE ID # 09110041 SITE ADDRESS . . . . . : 10132 DEEPROSE PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER GARELICK DAVID W AND ROBERTA G ADDRESS 10132 DEEPROSE PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3335 RECEIVED FROM . . . . : CUPERTINO PLUMBING 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 6, 000 . 00 1. 00 0 .00 1 . 00 0 . 00 1BPFIXTURE NO OF FIXTURE 1.00 8 . 00 0 . 00 8 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 .00 0 .00 42 . 00 0 . 00 1BSEISMICR VALUATION 6, 000. 00 0 .60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 11 . 00 121 . 00 0. 00 121 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 256 . 60 0 . 00 256 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 256 .60 VISA --------------- TOTAL RECEIPT 256 .60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # � � . �J Date: BI bf Address: Owner's Name: Phone#: ADS.,z�. �� r�� 44� 3�5� Contractor: Phone#: ( S-- Z 5 � cj(, t 8 �v .— Fax#. Contact: Phone#: 4(o fj a p -(:L r1 Fax#: Contractor License#: T�� Cupertino Business License#: Job Description: ' C &fT Residential E!. Commercial ❑ Valuation: (�, 6 00 Project Size: Express ff Standard 0 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 1PGASCOM 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 s REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group I 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES I 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer j 1PRREPIPE Residential re-pipe per fixture P 1RPRP I 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P / 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES 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 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.LbbL' r11WVOC Pain, 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*VOC A011190 s 3 IAQ/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 0 6.Use Exterior Grade Plywood for interior Uses 1 IAQ/Health pts y=yes 0 7,S*9dhP adX 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts yryes 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 0 2.Use Rapoly 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 i i 1 Total Points Avail 1 1401 130 57 Total Points Project Received:1 1 01 01 0 G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue x ; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEI�TINO Building Department JOB ADDRESS: PERMIT # 3L�, �� '1 e;/: OWNER'S NAME: .fit GG c l'e_\.O-- PHONE # /Y — .3 S GENERAL CONTRACTOR: FAX # I am not using any subcontractor . _Si ature�' Date Please check applicable subcontractorslann compTete 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