The URL can be used to link to this page

09100223 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDJNG ADDRESS: 1006 WESTLYNN WAY CONTRACTOR:VIP PLUMBING PERMIT NO:09100223 AND DRAIN CLEANING -WNER'S NAME: MARY GATO 4020 PAYNE RD DATE ISSUED: 10/30/2009 rVNER'S PHONE: 5302595016 PLEASANTON,CA 94588 PHONE NO:(408)644-2288 ❑ LICENSED CONTRACTOR'S DECLARATION ,r- r r J f✓�,y BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G - ��'✓ Li,#_ eJJ �j yam, Contractor V l P PL v h�;;�G�Date ►JChauJr MECH RESIDENTIAL COMMERCIAL �� 1 hereby affirm that 1 am licensed under the provisions 9 JOB DESCRIPTION: RE-PIPE COPPER (commencing with Section 7000)of Division 3 of the Business&Professions Code 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 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:$7500 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:35927007.00 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.1 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 expens^ Date:which may accrue against said City in consequence of the /G granting of this mit. Additionally,the licant understands and will comply Issued by: with all non o' source regulations per gepupertino Municipal Code,Section 9.18. j 1/ I RE-ROOFS: Date i � c� All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ElIOWN ER-BUILDE 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(Sea.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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 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 1 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 or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B y Area Air Quality I nagement District 1 performance of the work for which this permit is issued. will maintain compliance with the pertino Municipa ode,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 550 5533,and 5$34. Section 3700 of the Labor Code;for the performance of the work for which this permit is issued. Owner or authorized agent C Date: 1 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 CONSTRU TION LENDIN AGENCY 1 become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 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 APPLICANT CERTIFICATION Lender's Address I 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 to building construction,and hereby authorize representatives of this city to enter i the above mentioned property for inspection purposes.(We)agree to save mnify and keep harmless 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 Municipal Code,Section Licensed Professional 9.18. Signature Date_ CITY OF CUPERTINO ' REPIPE/SEWER/MAIN SERVICE CUPEi�TINO PERMIT APPLICATION FORM b6' 102- APN# Date: Building Address: 006 Ls iL-(iv nJ w X ort-Zi t,) C � O Owner's Name: _ Phone (�V4 R 1 (j30) 5-0 16 Contractor: Phone#: V i? ?L0HB 6 6 riD WiqjA) C EON/4i Fax #: Contact: KONIZAD 6-V-06> YE6S Phone#: (q08) Fax #: Contractor License#: 06o?-g3 Cupertino Business License#: 13 061 ,?— Job Description: Residential Commercial ❑ Valuation: SOCA O a Project Size: Express yC 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 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEf�TINO 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 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG 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 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 M.Indoor itua ity an Finishes 1•lyse] b-VOC Past 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowA oYOG p 3 IAQIHealth 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..$ i all ALUM 4IAQ/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 1 0 1 1 1 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 Avai a le: 1 1401 1301 57 Total Points Project Received: ` 0 0 0 �S (D/� ZooC1 G:data/progs/greenbuildingguidelineslremodelerslgreenpointsfinal212.D4protected.xis � .: Community Development } 10300 Torre Avenue w ;= : Cupertino CA 95014 Telephone(408)777-3228 C(TY OF Fax(408)777-3333 CUPEIkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: gC nfq PHONE # ID'% 6 22 56"C6 GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Q4 cs Signature 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