09110078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1117 KENTWOOD AVE CONTRACTOR:JA PLUMBING PERMIT NO:091 10078
OWNER'S NAME: MARK ZHANG 28306 INDUSTRIAL BLVD STE B DATE ISSUED: 11/13/2009
^WNER'S PHONE: 4083508168 HAYWARD,CA 94545 PHONE NO:(510)266-5125,
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License CIC
v Lic.#
COOPER RE-PIPE FORM METER TO WHOLE HOUSE
WITH
Contractor Y� J Date ( 0 WATER HEATER
I hereby affirm that I am licensed under t provisions f 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. Sq.Ft Floor Area: Valuation:$4600
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 APN Number:35931006.00 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 Issued by: Date:
granting of this permi4Adduilonal/licant understands andwill complywith all non-poi a' Cupertino Municipal Code,Section
9.18. RE-ROOFS:
Signatur, Date l� 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.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am 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 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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the ertino Municipa C e,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se t' "ns 505,255 ,a 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ' Date:
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANTCERTIFICATION Lender's Address
1 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
's,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
sting 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: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35931006 . 00
DATE ISSUED. . . . . . . : 11/13/2009
RECEIPT # . . . . . . . . . BS000009191
REFERENCE ID # . . . : 09110078
SITE ADDRESS 1117 KENTWOOD AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . MARK ZHANG
ADDRESS 1117 KENTWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5807
RECEIVED FROM . . . . : JA PLUMBING
CONTRACTOR NIGEL EDWARDS LIC # 30554
COMPANY JA PLUMBING
ADDRESS . . . . . . . . . . : 28306 INDUSTRIAL BLVD STE B
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE (510) 266-5125
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --------
1BCBSC VALUATION 4, 600 . 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 4, 600 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRWHEATR UNITS 1 . 00 25 . 00 0 . 00 25 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 173 .50 0 . 00 173 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 173 .50 5193
---------------
TOTAL RECEIPT 173 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aM
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRES PERMIT #
co
OWNER' NAME: PHONE if 1-/u
GENERAL CONTRACTO FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
' r REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
0910
APN # 3 1 CO(r.�U Date:
Building Address:
Owner's Name: Phone#:adj)3570- 4 r-
Contractor: Phone ,�
v Fax #:tr /d
YYt/ r �Q /
Contact: r Phonet--�r/—,,)? 6 6
Fax #:
Contractor License#:
Cupertino Business License#:
Job Description:
Residential Commercial ❑
Valuation: ; ] / ,1,.z )
Project Size: Express 1 Standard ❑ Large Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include mi 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
REPIPE/SEWER/MAIN SERVICE
CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
LL
1 BCBSC Cal Bldg Standards Commission B ALL TYPES PERMIT
IT
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
IBPWSVCS Water Service P 1CPWS or
r 1RPWS
1PPRSEWG Private Sewage Disposal System FF IPCESS Cesspool
1BPWATER Install/alter Water Pipe
1BPFIXTURE Plumbing Fixture jr
1 PGASRES Residential Gas Piping System P
1-4 Outlets
I BPGAS Gas Piping System 5+ Outlets jr
/ IPPERMITFEE JlPlumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ ITRAVDOC Travel & Documentation Fee B
IBUSLIC Business License B
M.Indoor Air Quality and Finishes
1.UWih>ft,40C RW 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use tori VOID A 31AQ/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
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7. '.. # fi�leibo® 1 4 IAQ/Health. pts y=yes 0 SOM
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes0
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 Rap*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
S.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 f
Total Points Available: 1 1401 130 57
Total Points Project Received:1 01 0 0
e U
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