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09110087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10133 RIEDEL PL CONTRACTOR:ALLSTAR PLUMBING PERMIT NO:09110087 OWNER'S NAME: ANDY O'DONNELL 326 PHELAN AVE DATE ISSUED: 11/16/2009 � ER'S PHONE: 4153073741 SAN.IOSE,CA 95122 PHONE NO:(408)230-5569 ❑ LICENSED CONTRACTOR'S DECLARATION gUILDING PERMIT INFO: BLDG� ELECT� PLUMB� License Class�3�_ Lic.# �� z�� I� MECH� RESIDENTIAL� COMMERCIAL� Contractor A\�`�T�4�— ��r"�"e�� Date 1 I- ic,-- ��`'► JOB DESCRIPTION: SEWER LINE REPLACEMENT HORIZONTAL ONLY UNDER I hereby affirm that I am licensed under the provisions of Chapter 9 HOUSE (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 I have and will maintain a certificate of consent to self-insure for Worker's 5 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. � � pa�ion:Si��00``' I have and will maintain Worker`s Compensation Insurance,as provided for by Sq.Ft Floor Area: . . Section 3700 of the Labor Code,for the performance of the work for which this s�'��`.- ;� . permit is issued. APN Number:31621061.00 a y Occupancy Type: APPLICANT CERTIFICATION ' '�"� •- I certify that I have read this application and state that the above information is : coirect.I agree to comply with all city and county ordinances and state laws relating PE�IT �XPyIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save wITHTN''�80 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply /-/ ��. with all non-point source regulations per the Cupertino Municipal Code,Section -- Date:( 9�g �j Issued�� ,G�---_". Dace // � '�/ Signature ' RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All mofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. l,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the stnicture is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER constn►ct the project(Sec.7044,Business&Pmfessions Code). 1 hereby aftirm under penalty of perjury one of the following three g��RDOUS MATERIALS DISCLOSURE declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o t e Compensation,as provided for by Section 3700 of the Labor Code,for the compl ancejw th the Cuperti odMunicipal CodeSChapt r 9 12 and the Hea h&tain performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shal] Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's � C,(] Compensation laws of California. If,after making this certificate of exemption,I Owner o• thorized agent: Date:1�• -/ 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. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this pecmit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i iify and keep harmless the City of Cupertino against liabilities,judgments, c� ,and expenses which may acciue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 1 understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31621061 . 00 DATE ISSUED. . . . . . . : 11/16/2009 RECEIPT #• • • • • • • • • : BS000009205 REFERENCE ID # • . . : 09110087 SITE ADDRESS . . . . . : 10133 RIEDEL PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANDY O'DONNELL ADDRESS . : 10133 RIEDEL PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2337 RECEIVED FROM . . . . : ANDREW RHODES CONTR.ACTOR . . . . . . . : DUARTE TADEV LIC # 22189 COMPANY . . . . . . . . . . : ALLSTAR PLiJMBING ADDRESS . : 326 PHELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC _-NEW_BAL_ ---------- ------------- ---------- ---------- ---------- ---- 1BCBSC VALUATION 7, 800. 00 1 . 00 0 . 00 1. 00 0 .0 1BSEISMICR VALUATION 7, 800 . 00 0 .80 0 . 00 0 . 80 0 .00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 .00 1PRSEWER iJNITS 1. 00 21. 00 0 .00 21. 00 0 .00 1TRAVDOC FLAT R.ATE 1. 00 42 .00 0 .00 42 . 00 ______0_00 ---------- ---------- ---------- TOTAL PERMIT : 106 .80 0 .00 106 . 80 0 . 00 METHOD OF PAYMENT AMOUNT _-REFERENCE NUMBER ----------------- ------------ CREDIT CARD 106 .80 VISA --------------- TOTAL RECEIPT : 106 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- -------- -------- ------------------------ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING � � � � � �� , � CITY OF CUPERTINO �� ='� REPIPE/SEWER/MAIN SERVICE CUPEY T�No PERMIT APPLICATION FORM � Date: APN # ' �� P � � v� l� � � ��`,�6 ; C' Building Address: �IL i � �l� � L Phone#: Owner's Name: . � _ 3 p - �j�}y l "� , '� � Phone#: Contractor: � Fax#: �ST , ^'.� (n�`12� Contact: Phone#:yC�� 2�'� - "E v t E�'�- 2 I�}-iv 2�`✓ Contractor License#: }�j 2 (o i � Cupertino Business License#: �2 1 �� Job Description: c�.j�2'u.1-t,'✓ \ '�Z 2„ IC��-t wtt'✓� 't' r�Z-�.�n�� ,1 v�� V��c�-�.-., �4.v9 L Residential � Commercial ❑ Valuation: `' � `�� — 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 Buildin Points: Quantity Fee ID Fee Description Fee Permit Type Grou 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 1BSEISMICOM Seismic Commercial P Revised O1/07/09 :�, CITY OF CUPERTINO :�y �� REPIPE/SEWER/MAIN SERVICE � CUPEt�TiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou j 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT ! Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS � sewer/sanita sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER InstalUalter 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 I 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B � ,' , M. ndoor Air uality and Finis es 1.Use lAwMo-VOC Paint 1 IAQ/Health pts y=yes � 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes � 3.Use Low/No 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 � Formaldehyde 61AQ/Health pts y=yes 6.Use Exterior Grade Plywood for interior Uses 1 IAQIHealth pts y=yes � 7.Seal all Exposed Particleboard or MDF 4 IAQlHealth pts y=yes � B.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 � � � 1 N.Ffooring 1.Select FSC Certified Wood Fiooring 8 Resource pts y=yes � 2.Use Rapidiy 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 Fnished Floor 4 Resource pts y=yes � 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes � � i 1 Total Points Available: 140 130 57 Total Points Pro'ect Received: � � "� � 0 - �� G �-� G: ta/progslgreenbuildngguidelines/remodelerslg2enpointsfina12.12.04protected.xls Community Development ��,'-�:.. , 10300 Torre Avenue ��y. ; Cupertino CA 95014 �' :��'' Telephone(408)777-3228 Fax(408)777-3333 CITY OF „UPEf�TINO Buildin De artment JOB ADDRESS: PERMIT # /�3� ;=e C��'(�a o�`� OWNER'S NAME: n; �� rv ' C.L- PHONE #f� p " Z "_ -(�d`r� GENERAL CONTRACT R: E4��S 2 �� ,� ��rv�. FAX# __..___..�_..__ . �_______.--._� //-�� o I am not using any subcontractors: � Signature Date Please check a licable subcontr�ctors and com lete the followin information: SUBCONTRACTOR BUSINESS NAME SUSINESS LICENSE # Cabinets &Millwork Cement Finishing Elecirical 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