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09070162 CITY OF CUPERTIIIO BUILDING PERMIT BUILDING ADDRESS: 21960 MCCLELLAN RD CONTRACTOR:PREMIER PERMIT NO:09070162 PLUMBING AND REPIPE INC OWNER'S NAME: YKARI CHAVES 1725 ROGERS AVE STE C DATE ISSUED:07/24/2009 NNER'S PHONE: 4082524553 SAN JOSE,CA 95112 PHONE NO:(408)903-8184 LICENSED CONTRACTOR'S DECLARATION I� �� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# � r— MECH RESIDENTIAL COMMERCIAL Contractor Date�� '��^ I herebY.affirm that I am I sed enunder the provisions of Chapter 9 JOB DESCRIPTION: COPPER RE-PIPE THROUGH OUT HOUSE (comfiiencing 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:$6640 I 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:35608033.00 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 the7.- granting of this permit. Additionally,the applicant understands and will comply Issued byy Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. --7 RE-ROOFS: Signature ate 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 o 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) I,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. I 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 I 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 Bay Area Air Quality Management District.I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 ,25533,and 25534 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 2'' 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I mus: 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 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 v the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .nnify and keep harmless the City of Cupertino against liabilities,judgments, 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 Community Development k, 10300 Torre Avenue ,. y Cupertino CA 95014 Telephone(408)777-3228 it CITY OF Fax(408)777-3333 �:UPEkTINO Building Department JOB ADDRESS: PERMIT# �- OWNER'S NAME: (� Z_r PHONE # GENERAL CONT CTOR: n,` FAX # I am not using any subcontractors• �. Si;;nature 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608033 . 00 DATE ISSUED. . . . . . . : 07/24/2009 RECEIPT #. . . . . . . . . BS000008261 REFERENCE ID # . . . : 09070162 SITE ADDRESS 21960 MCCLELLAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER YKPRI CHAVES ADDRESS 21960 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PREMIER PLUMBING CONTRACTOR . . . . . . . : JOEE MENDEZ LIC # 30877 COMPANY PREMIER PLUMBING AND REPIPE IN ADDRESS 1725 ROGERS AVE STE C CITY/STATE/ZIP . . . : SAI JOSE, CA 95112 TELEPHONE (4C8) 903-8184 FEE ID UNIT QUANTITY SMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 640 . 00 1 .00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 6, 640 . 00 0 .70 0 . 00 0 . 70 0 .00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 11 . 00 0 . 00 11. 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 138 .70 0 .00 138 .70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 138 .70 master card --------------- TOTAL RECEIPT 138 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWS R/MAIN SERVICE xE CUPEi�TINO PERMIT APPLICATION FORM 6%2()1LPZ APN # �c � Date: . � J0? Building Address:. I Owner's Name: Phone#:2- 9 L c �A Contractor: Phone Q�" cti Fax#: Contact: Phone#: V 06' Q Fax #: Contractor License#: Cupertino Business License#: Job Description: C 0 rum- Residential Commercial ❑ Valuation: Project Size: Exp ss 0 Standard Large [] Major El 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 Descripl ion Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary ;ewer 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 1 BSEISMICOM Seismic Coma ercial P Revised 01/07/09 CITY OF CUPERTINO Z REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group O 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residentia: P IPRSEWER Residential building P 1RPSS sewer/sanitary sew,;r 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Di:posal System P 1 PCESS Cesspool P / 1BPWATER Install/alter Water ripe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets IBPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Ch(:ck P 1 PLMBINSP Other Plumbing/gz.s Insp. P 1TRAVDOC Travel &Documentation Fee B 1 1 BUSLIC Business License B M.lndoar Air Quality and Finishes 1.Use Low/No-VOC Parnt 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes D 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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes D 7.Seal all Exposed PartUeboard or MDF 4 IAQ/Health pts y=yes 0 B.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 D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 ?-.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 D 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 E E Total Points Available: 1 1401 1301 57 Total Points Project Received: 0 �91, 0 7.24- 0c7 G:data/progs/gresnbuildnoguidelines/remodelers/greenpointsfina12.12.D4protecled.zis