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09070185 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADI)RESS: 2i 101 RED FIR CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09070185 OWNER'S NAME: BOYER,HANG NUYET DATE ISSUED:07/27/2009 ER'S PHONE: 4086684583 PHONE NO: / ❑ LICENSED CONTRACTOR'S DECLARATION 1 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 .1OB DESCRIPTION:EXISTING GALVANIZE TO COPPER PIPE, (commencing with Section 7000)of Division 3 of the Business&Professions I:EPLACE ONE Code and that my license is in full force and effect. FIXTURE 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. I have and will maintain Worker's Compensation Insurance,as provided for by I;q,Ft Floor Area: Valuation:$3000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ►PN Number:35905037.00 Occupancy Type: 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 9.18• Issued b - Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: ,W 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 installed 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, will do the work,and the structure is not intended or offered for sale(Sec.7044, ;signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. i ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by !+afety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this additionally,should 1 use equipment or devices which emit hazardous air i ontaminants 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 shall lealth&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 I) ner or authori d agent: x become subject to the Worker's Compensation provisions of the Labor Code,1 mustDate:J J 2 7j J forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is br which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating .ender'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 ender's Address it -.i y and keep harmless the City of Cupertino against liabilities,judgments, c, and expenses which may accrue against said City in consequence of the graining of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section understand my plans shall be used as public records. 9.18. Signature Date 2 o� .icensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 35905037 . 00 DATE ISSUED. . . . . . . : 07/27/2009 RECEIPT #. . . . . . . . . : BSC00008290 REFERENCE ID # . . . : 09C70185 SITE ADDRESS . . . . . : 21101 RED FIR CT SUBDIVISION . . . . . . CITY CUEERTINO IMPACT AREA . . . . . . OWNER BO-iER, HANG NUYET ADDRESS 21101 RRED FIR CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4253 RECEIVED FROM . . . . : HAIDG N BOYER CONTRACTOR . . . . . . . : TBE, - TO BE DETERMINED LIC # 00096 COMPANY TBE, - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY I.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 3 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 3 , 000 .00 0 .50 0 . 00 0 . 50 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 .50 0 . 00 138 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 138 . 50 #2222 --------------- TOTAL RECEIPT 138 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO Co�� # " REPIPE/SEWE:R/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM APN # Date: -TL!LY d Building Address: 91101 VZED F(' 2- CT Owner's Name: Phone#: A-AJ e--;7 k 6—0 YO 77 C4gE:C,(-,b Contractor: 1-f�%1� ;� A Wit' �l C. r Phone Fax #: a2( — Contact: Phone#: Fax #: Contractor License#: Gj 4 2 Cupertino Business License#: Job Description: , Residential Commercial ❑ Valuation: Project Size: Express Standard 0 Large ET 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 Descript ion Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-?ipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets JT1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commorcial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWEIUMAIN SERVICE alF CUPErZTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 BCBSC Cal Bldg Standar is Commission B ALL PERMIT Fee TYPES / 1BSEISMICR Seismic Resident al P 1PRSEWER Residential building P 1RPSS sewer/sanitary selwer 1PRREPIPE 'Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas R ping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit lee Issuance P 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P ' 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B M.Indoor Air Ouaft and Finishes 1.1189(AAWVOC Pfd 1 IAO/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low*VOC AdhWves 3 IAQ/Health 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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0-6-W 7. OIIPgleoada�cAw 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 0 N.Flooring 1.Select FSC Certified Wood Flooring E,Resource pts y=yes 0 2.Else Rapidly Renewable Flooring.Materials 1 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles z Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl i IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor Resource pts Y--yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 Total Points Available: 1 1401 130 57 Total Points Project Received:' 1 01 0 0 ,o 7 QG c� G:data/progs/gree ibuildiingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls Community Development Ir 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Building Department , Ol JOB ADDRESS: PERMIT # Fi 4 Q l i A)0 ►r � %Z OWNER'S NAME: Qp J PHONE # 9 k — GENERAL CONTRACTOR: FAX# I am not using any subcontractors: 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 -rkO WA A.0> ' Tr—r i Roofing Septic Tank Sheet Metal Sheet Rock Tile I A a5�4��- — -J&A� .2 !l er/Contractor Signature Date