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09080119 (2) CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:NELSON PLUMBING PERMIT NO:09080119 BUILDING ADDRESS: 22071 HIBISCUS DR DATE ISSUED.08/13/2009 2071 MAIN ST OWNER'S NAME: HOOPES RICHARD N AND PAMELA J PHONE NO:(408)280-5311 SANTA CLARA,CA 95050 ER'S PHONE: 4087370683 LICENSED CONTRACTOR'S DECLARATION BL ILDING PERMIT INFO: BLDG ELECT PLUMB ❑ License Class G�—_— Lic.# �" �� f 767 MECH RESIDENTIAL COMMERCIAL Contractor Q Date 13 6 a JC B DESCRIPTION:WHOLE HOUSE COPPER RE-PIPE&WATER 1 hereby affirm that I am licensed under a provisions of Chapter 9 SERVICE (commencing with Section 7000)of Division 3 of the Business&Professions RI.PLACEMENT Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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. Valuation:$6500 I have and will maintain Worker's Compensation Insurance,as provided for y Sc.Ft Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type: permit is issued. APN Number:32602019.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 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 ofthis per Addition he appli t understands and will comply Date- with all non poi o e regul ions er th pertmo Municipal Code,Section —Bate: Issued by- 9.18. y•918 Date Signatur RE-ROOFS: ❑ OWNER-BUILDER DECLARATION \11 roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOCS MATERIALS DISCLOSURE declarations: he hazardous materials 5 of the I have and will maintain a Certificate of Consent of self-insure for Wer the s ICaliforniah dHealth&Safety Code,sections 25505525533,and 25534.Chapter )1 will maintain Compensation,as provided for by Section 370 compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material, I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 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 I will permit is issued. maintain compliance with the Cu ertino Municipal Code,Chapter 9.12 and the cc of the work for which this permit is issued,1 shall Health& ty Code,Sections 505,25533,and 25534. I certify that in the performan the Worker's not employ any person in any manner so as to become subject to king this certificate of exemption,I O er o uthor' ent• Date: Compensation laws of California. If,after ma 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. C TRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's ve inform 1 certify that I have read this application c tandcountytordhatmances and state laws relating ation is for Name ,mit is issued(Sec.3097,Civ C.) correct.1 agree to comply with Y to building construction,and hereby authorize representatives of this city to enter ur the above mentioned property for inspection purposes.(We)agree to save Lender's Address i. ify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION co_,;and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature_____—__. Date_____— CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE UPE OF PERMIT APPLICATION FORM C R, APN #3 Z_ Date: _ C (� C� . IJ Building Address: Z Z 0 7 ) (A b P. Phone#:/� -7.37 _b�Q Owner's Name: pa m j 1©O s� � U �'I Phone#: Contractor: / i�� Fax#: C Phone#:(,/ Contact: / �e`�Oh Fax#: Contractor License 7(p Cupertino Business License#: 073 ek'. !�� - ' � � �a tier' Job Description: /,oxo lG Aak se e 6 flO 10. Commercial ❑ Residential Valuation: 6�C50 0 Major Project Size: Express Standard Large J Green Building: Please complete relevant portion of the Green Building Checklist & atqthe application or if applicable, include m plan set & the sheet index. Green Buildin Points: Fee Description Fee Permit Type Quantity Fee ID Grou 1PCSEWER Commercial b-zilding P 1CPSS sewer/sanitary sewer P 1CPRP 1 BPREPIPE Commercial r(-,-pipe per fixture 1 PGASCOM Commercial Cas Piping System P 1-4 Outlets B ALL PERMIT 1BCBSC Cal Bldg Standards Commission TYPES Fee 1BSEISMICOM Seismic Com ercial P Revised 01/07/09 CITY OF CU.PERTINO REPIPE/SEWERrnIAIN SERVICE CUP TYOF O FEE SCHI-IDULE Fee Description Fee Permit Type Quantity Fee ID Grou 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES ' 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer P 1RPRP IPRREPIPE Residential re-pipe I er fixture P 1CPWS or 1BPWSVCS Water Service 1RPWS IPPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE 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 1PLMBLNCK Plumbing Plan Ch,ck P 1PLMBINSP Other Plumbing/gas Insp. P / 1TRp,VDOC Travel &Documentation Fee B 1BUSLIC Business License B INPUT RescuTces Energy WZYHealth M.Indoor Air ua ity and Finishes 1.Use Lewft-VOG Pmt 11 AQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 21 AQ/Health pts y=yes 0 3.Use Lowft�Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 3esource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 6 AQ/Health pts y=yes 6.Use Exterior Grade Plywood for Interior Uses 1 AQ/Health pts y=yes 0 SealatlaEosedpatbdaboardor#ADF 4 AQ/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 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 Rapidly Renewable f=lowing Materials 4 liesource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 3esource 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 3esource pts y=yes0 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:datalprogs/gree ibuildingguidelines/remodelers/greenpointsfinat2.12.D4protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 a= , ' Telephone(408)777-3228 Fax(408)777-3333 CITHOF �XPERJINO Buildin De artment JOB ADDRESS:��x.,.71 ►1�6 lS Clot.S � • PERMIT # 0�o a �, 6)///l �l PHONE OWNER'S NAME: P1 a a FAX # GENERAL CONTRACTOR: 4 So A k I am not using any subcontractors: ate Sig.latur Please check a licable subcontractors and complete followin information: LICENSE # SUBCONTRACTOR BUSINESS NAME 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 --------------- Date owner/Contractor Signature