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09010001
CITY OF CUPERTINO BUILDING DIVISION PERMIT C�NTRAIxTCTIt IN �}�.�TI�N,~ BUILDING ADDRESS: PERMIT NO. 22654 OAKCREST CT NELSON-PLUMBING OWNER'S NAME: PERMIT ISSUE DATE 0 9 CONTROL NO. (408) 280-5311 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 a o p LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z UJ with Section 7000)of Division 3 of the Business and Professions Code nd my license is =y in full force andef ct. L;L% �� WATER MAIN REPLCMNT—NELSON PLUMBING PD ,FOR BUS r2 Z License Ctau Lic.M f Dam Contractor L I C RCHI ECrS DECLARATION I understand my plans shall be used as public records #23330 1/5/9 yU C y Licensed Professional h 3 OWNER-BUILDER DECLARATION j< I hereby affirm that 1 am exempt from the Contractor's License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county 9 which requires a permit to construct,alter,improve,demolish,or repair any structure !Z prior m its issuance,also requires the applicant for such permit to file a signed statement s that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation r$ (commencing with Section 7000)of Division 3 of thc Business and Professions Code)or .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of $1500 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(s500). 34248006 . 00 ❑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 and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for worker's Compen- .ation,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 required by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or Icss) L certify that in the performance of the wor f C which this permit is issued,1 shall not employ any pc n any m so as co sq( t t the orkers'Compensation Laws of Cali mice. Applicant NOTICE I 1 A G you should become subject a er's Com rovisio of larm, Codc you must Oforthwith camp! with such movisio or is permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY .�. I hereby affirm that there is a construction lending agency for the performance of Y..7 the work for which this permit is issued(Sec.3097,Civ.C.) QLendersNamc z Lcndees Address 0 I certify that T have read this application and state that the above information is 4 1-4 correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorim representatives of this city to enter upon the w W above-mentioned property for inspection purposes y Q. (We)agree to savKindemnify and keep harmless the City of Cupertino against y liabilities,judgments,co and a nses ich may in any way accrue against said City / Z in consequence of the g ntin of Pe it. "r APP CANT UND R A S D ILL COMPLY WIr AL NON-POINT Issued by: Date UR UL O S Re-roofs i nature of Ar ntractor Date HAZARDOU MATERIALS DISCLOStRE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes CRo Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove tit hazardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. strict? ❑Yes 7a•qr 1 have read the ous in ria icquircments under Chapter 6.95 of the Califor- niaHealth&Safety ode Sec' S 533 and 2.55, understand that if the building d ndy give te E. it' in,res ponsibility to notify c occu ant of the requi tswhic m met ' rto ssuanccofaCertificate of cupan 69 Signature of Applicant Date i Pa All roof coverings to be Class'n"or better n r or authorized a ent Date' CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 34248006 . 00 DATE ISSUED. . . . . . . : 01/05/2009 RECEIPT #. . . . . . . . . . BS000006890 REFERENCE ID # . . . : 09010001 SITE ADDRESS . . . . . : 22654 OAKCREST CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER TENOLD STANLEY E AND MARGO L ADDRESS . . . . . . . . . . : 22654 OAKCREST CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0830 RECEIVED FROM . . . . : NELSON PLUMBING CONTRACTOR . . . . . . . : RICHARD LEE NELSON LIC # 23330 COMPANY NELSON PLUMBING ADDRESS 2071 MAIN ST CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 280-5311 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BPWSVCS WATER SERVICE 1. 00 20 . 40 0 . 00 20 .40 0 . 00 1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 216 .48 0 . 00 216 .48 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 216 .48 #7121 --------------- TOTAL RECEIPT 216 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING n9ol oco I S11CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# � � � t , ` � � Date: Building Address: L Z 'S 1 DOX e&:5A C,� Owner's Name: Phone#: L Contractor: 0 Phone#: L1 p 1 Fax #: Contact: Phone#: .q G% 2�6p �j3t i q&% (4%0 67 311 Fax#: Contractor License#: C �>(P - 422 (p 7(® Cupertino Business License#: Job Description: A�2 <'V\ Residential Commercial ❑ Valuation: i S©� Project Size: Express 0 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 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou IPRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P I 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P r 1TRAVDOC Travel &Documentation Fee B 1 1BUSLIC Business License B Revised 6-16-08 I.Windows 1.InSW Ewgr-Eif iia t Windows a.Doubfe-Paned 1 Energy pt y=yes 0 b.Lov#aWSsi ft&w-E) 2 Energy pts y=yes 0 c.Low.Corxioo"Runes 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 ! 1 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on AN Duct Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Energy pts y=yes 0 S.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes 0 b.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pts y=yes 0 10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy pt y=yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yesl 0 1 1 1 K.Renewable Energy and Rooting 1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0 2.Install Solar Water Heating System 10 Energy pts y=yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes 0 1 1 ! L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y—yes 0 1 1 1 Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "WERTINO Building Department JO ADDRESS: �Jts�-� � PERMIT # d;l�.I OWNER'S NAME: f`W q10 PHONE # GENERAL CONTRACTOR. 4.Q<,-4an FAX # I am not using any subcontractors: Signatule 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