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10080101 CITY OF CUPERTINO BUILDING PERMIT CONTR ACTOR:DEMPSTER PLUMBING PERMIT NO:10080101 BUILDING ADDRESS: 10421 OAKVILLE AVE DATE ISSUED:08/16/2010 1639 PO WONA AVE EEEOWNER'S NAME: HENRY OH PHONE NO:(408)295-3911 SAN JO 4E,CA 95110 tER'S PHONE: 4082035367 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r rr � MECH r RESIDENTIAL COMMERCIAL License Class C k" I��Date /ur �O Contractor -- O-- JOB DESCRIPTION:REPIPE IN COPPER FROM METER TO ALL FIXTURES(8) I hereby affirm that I am licensed under the provisions of Chapter 9 EXCEPT'SHOWER HEAD RISORS (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. Valuation:$6525 I have and will maintain Worker's Compensation Insurance,as provided for by rAPN Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type: permit is issued. _ /� "umber:36912033.00 APPLICANT CERTIFICATIONI 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 relatingERMITEXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enterWITHIN 180 DAYS OF PERM against ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additiona ,the applicant understands and will comply with all non-point source re tions er the Cupertino Municipal Code,Section Date: Issuf d by: 9.18. Date _�— Sigr atu RE-ROOFS: OWNER-BUILDER DECLARATION All roofs 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 insta led without first obtaining an inspection,I agree to remove all new materials for insp<ction. the following two reasons: I,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, Sign iture 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). LS DISCLOSURE I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIA 5 of the declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505525533nt ,and 25534 .pter 91 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the con ipliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Sat aty Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Ad litionally,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 cot taminants as defined by the Bay Area Air Quality Management District I 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 shall Health&Safety Code,Sections 25505,25533,and 25534. 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 O �ne ge � ate: /rfo 1149 become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 1 ereby 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 fo•which this permit 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 f authorize representatives ofet is city to to sinter L order's Address upon the above mentioned property P p ( )agree -nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expenses which may accrue against said City in consequence of the g..nting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I in derstand my plans shall be used as public records. 9.18. DateL icensed Professional Signature _. CITY OF CUPERTINO PERMIT REC2IPT OPERATOR: patg 4 ITEMS OF 4 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36912033 .00 DATE ISSUED. . . . . . . ; 08000020187 10 RECEIPT #. . . . . . . . . 100801C1 REFERENCE ID # SITE ADDRESS 10421 OAKVILLE AVE SUBDIVISION . . . . . . . CITY CUPERT::NO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HENRY ()H ADDRESS . . . . : 10421 ()AKVILLE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3121 RECEIVED FROM . . . . : WILLIAM D DEMPSTER CONTRACTOR . . . . . . . : WILLIAM DEMPSTER LIC # 31263 COMPANY DEMPSTER PLUMBING ADDRESS 1639 FOMONA AVE CITY/STATE/ZIP SAN CSE, C 1195110 TELEPHONE . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT _THIS-REC- --NEW_BAL- ----- ----- 0 .00 -- ------------- ---------- 1.00 0 .00 1. 00 1BCBSC VALUATION 6, 525. 0 .00 8 .. 00 0 64 .00 0 .00 64 .00 0 .00 1BPFIXTURE NO OF FIXTURE 1. 00 42 .00 0 .00 42 .00 1PPERMITFE FLAT RATE . 0.00 1100 0 .00 1 .00 11 .00 __________ 1PRREPIPE NO OF FIXTURE ______ _________- L18 .000 .00 0 .00 118 .00 TOTAL PERMIT : METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER ____-____ CREDIT CARD 118 .00 VISA --------------- TOTAL RECEIPT 118 .00 VOICE ID DESCRIPTION-- -------- VOICE ID DESCRIPTION ------------- ------- -------------- -------------- 202 UNDERFLOOR PLUMBING 106 SEWER & WATER 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO REPIPE/SEWER/M-AIN SERVICE CITY FPERMIT APPLIC,�•TION FORM CUP Date: APN tAdde�s* l BuildiPhone#:L��.g �p� 53 �l OwnePhone#: c(,o ,S 7 7 ContrJ�-�� ,�,� �i Fax#: Phone#: °Cont -vw-C S`1 Fax#: Contractor License 37 1 5 0 Cu ertino Business License#: .t a ! u,-es p rr ror� Job Description: e i 1 L ^ P� Commercial ❑ Residential , Valuation: Major Project Size: Express Standard Large —� n Buildin : Please complete relevant portion of the Green Building Checklist & attach it to the Gree g application or if applicable, include in plan set& the sheet index. Green Buildin Points. Fee Description Fee Permit Type Quantity Fee ID Grou 1PCSEWER Commercial buildbig P 1CPSS sewer/sanitary sew-,r 1BPREPIPE Commercial re-pip--per fixture R P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets ALL PERMIT Cal Bldg Standard3 Commission.. B 1BCBSC 'TYPES Fee P 1BSEISMICOM Seismic Commercial Revised 01/07/09 CITY OF CUP ERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: D�,TE: REVIEWED BY: APN: BP#: 'VALUATION: $6,525 R*PERTTTYPE: Plumbing Permit PLAN CH ECK TYPE: Alteration /Addition/ Repair r ! APPLICATION 1 RPFIX PRIMARY SFD or Duplex TYPE: USE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Fixture or Trap 1BPFIXTURE 8 $64 Re-Pipe Interior 1 PRREPIPE 1 $11 75.0 TOTALS: A to Plumb.Plan Check Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 !:!c,_ fnsp Pce, NOTE: These fees are based on the preliminaryinformation available and are onl an estimate. Contact ITEMS or addn'l info. PFEES (Fee Resolution 09-051 Eff 7/1./1�>> FEE QTY/FEE ,c�c.. cc heck: $0.00 I--c�e PME Unit Fee: $75.00 PME Permit Fee: $42.00 i",>r O"I!r rion 'l-(n Work Without Permit? 0 Yes 1) No $0.00 7ant�1 l?ocrrrrrc�rttcrrii�rt (ir<'s: Select an Administrative Item AIc nim Fc c. Bid v Stds Commission Fee IBCBSC $1.00717 s � 1� t, SUBTQTALS i $118.1)0 $0.00 'TQ'I` L E $118.00 fa w - i Revised: 8/12/2010 Indoor Air UuBlity and Finisn es p 1.imi1 n-" C 1 IAQ/H;alth pts y�yes 2 IAQ/H:alth pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 0 3.Use Lowft VOC AdhOOM 3 IAQ/H salth pts y=yes 3 ResoL rce is es p 4.Use Salvaged Materials for Interior Finishes P y=y 5.Use Engineered Sheet Goods with no added Urea 6 IAQ1I-ealth is es p Formaldehyde p y-Y D 6.Use Exterior Grade Plywoodfor Interior Uses 1 IAQ/l-ealth pts y=yes 0 4 IAQ/I-ealth. pts Y--Yes B.Use FSC Certified Materials for Interior Finish 4 Resoirce pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Rescirce pts y=yes 0 10.Install Whole House Vacuum System 3 Mi-lealth pts y--yes 1 1 1 N.Flooring B Resource is es 0 1.Select FSC Certified Wood Flooring p Y=y p Q�f3apdy peke Fling rials 4 Reso lrce pts y=yes 4 Reso irce is es p 3.Use Recycled Content Ceramic Tiles p Y--yes p 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/liealth pts y=yes 4 Reso irce is - e-s 0 5.Use Exposed Concrete as Finished Floor P Y-y 0 6.Install Recycled Content Carpet with Low VOCs 4 Resoirce pts y=yes 1 1 1 Total Points Available: 140 130 57 Total Points Project Deceived: 0 0 0 G:daWprogslgreenbuildi igguidelineSJremodelers/greenpointsfinal212D4protected.xis Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /©`{2I �' PERMIT# l PHONE# ��$ -TT-7-7 OWNER'S NAME: 'HIE'� �1 1� �; BUSINESS LICENSE# GENERAL CONTRACTOR: (�� >')'e� S C� 757/0 ADDRESS: 11 v�^"�""` AJe CITY/ZIPCODE: Ste^ *Our municipal code requires all businesses working in the 4 ity to have a City of Cupertino business license. UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIOAVE OBTAINED AL BE HCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONT O H BUSINESS LICENSE. c� I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: ESS LICENSE # 6/ SUBCONTRACTOR BUSINESS NAMEBUSIN Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature