The URL can be used to link to this page

10080166 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11603 BRIDGE PARK CT CONTI:ACTOR:ABLE SEPTIC PERMIT NO: 10080166 OWNER'S NAME: MARVIN TEXEIRA P O BOX 24819 DATE ISSUED:08/24/2010 C FR'S PHONE: 4082556681 SAN JOSE,CA 95154 PHONE NO:(408)377-9990 ❑ LICENSED CONTRACTOR'S DECLARATION BUILI PING PERMIT INFO: BLDG r— ELECT r— PLUMB r License Class L1 Z Lic.#A 6 7:y S MECH r RESIDENTIAL r- COMMERCIAL r Contractor A BLF SJpT►C TANK, Date ^2,y" 1Q I hereby affirm that I am licensed under the provisions of Chapter 9 JOB 1 ESCRIPTION: SEWER REPAIR (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. Sq.Ft loor Area: Valuation:$1700 1 have and will maintain Worker's Compensation Insurance,as provided for by�L Section 3700 of the Labor Code,for the performance of the work for which this APN cumber:36652058.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of 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. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issue(, Date �• � 9.18. Signature ae S L L �'C jZ Date �' " d - RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roc fs shall be inspected prior to any roofing material being installed.If a roof is installs d without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspec ion. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signat ire of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I hav(read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the 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 I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Addit.onatly,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 conte ninants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Healt i&Safety Code,Sections 25505,25533,and 25534. 1 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 Own(r or authorized aget: n Compensation laws of California. If,after making this certificate of exemption,I �� Date:__/ 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. CONSTRUCTION LENDING AGENCY I here)y affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for wl6ch this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lend,-r's Name 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 Lend:r's Address upon the above mentioned property for inspection purposes.(We)agree to save i iify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION cu. and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I und,;rstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / 1.�+ Licei sed Professional L Signature O S c S✓Z Date q" CITY OF CUPERTINO REPIPE/SEWER/TVIAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM .`�_� Date: _Z L f_ APN # �,�; �� ' a Building Address: I j a � Owner's Name: Phone#�y� O o YA C� Contractor: S ��/ C r\ � Phone#Cy�� 3�4 �9 C{Q Fax #: Contact: Phone#: Fax #: Contractor License#: Cupertino Business License#: Job Description: 7e-1f Ui �)c r �Y Residential �� Ccmmercial �-�Dcj Valuation: 1 7 od Project Size: Ex ress 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 1 PGASCOM Commercial Gas Pi ging System P 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission. B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPE 2TINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36652058 .00 DATE ISSUED. . . . . . . : 08/24/2010 RECEIPT #. • • . • • • . • : BS000011260 REFERENCE ID # . . . : 10080166 SITE ADDRESS . . . . . : 11603 FRIDGE PARK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MARVIN TEXEIRA ADDRESS 11603 LRIDGE PARK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ABLE U11DERGROUND CO CONTRACTOR GILBER", GLEN LIC # 21407 COMPANY ABLE SEPTIC ADDRESS P O BO:: 24819 CITY/STATE/ZIP SAN JOSE, CA 95154 TELEPHONE (408) 3'77-9990 FEE ID UNIT QUANTITY AMOU14T PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ------- 1BCBSC VALUATION 1, 700. 00 1.00 0 .00 1. 00 0 .00 1PPERMITFE FLAT RATE 1. 00 42 .00 0. 00 42 .00 0 .00 1PRSEWER UNITS 1. 00 21 .00 0. 00 21. 00 0 . 00 1TRAVDOC FLAT RATE 1.00 12 . 00 0 .00 42_ ------ 00 0_00 ----- TOTAL PERMIT 1J6 .00 0 .00 106 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CHECK 106 . 00 #15317 --------------- TOTAL RECEIPT 106 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING M.Indoor Air Qualfty and RnIshes _ . ._ 1 IAOIHealth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes. 2 IA(UHealth pts y=yes 0 - ' $ 31AO/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 6IM14-l"th pts y=yes 0 6.Use Exterior Grade Plywood.for Interior Uses 1 IA(WHealth pts y-yes D 41AO/Health.pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Fnger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAlhiealth pts y=yes D N.Flooring 1.Select FSC Certified Wood Flooring B Res)urce pts y=yes 0 Z 00 OM-0 ROMOWO iFbomig M0tabs 4 Res)urce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Res)urce pts y--yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Res)urce pts y=yes 0 Total Points Available:j 1 1401 130 57 Total Points Project Deceived: 0 0 0 -K1Ds G:data/progsrgreenbuildr gguidernes/n:modelers/greenpointsfina121204proteatedxls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: tj PERMIT# tJ U OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 7rA N 1 BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: soom *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACIORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Y Z- g 2-LI O I am not using any subcontractors: Signatt re Date Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 Owner/Contractor Signature Date