10110130 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 884 COTTONWOOD DR CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10110130
OWNER'S NAME: FENTON RICHARD L AND SHIRLEY A 2552 SEABOARD AVE DATE ISSUED: 11/18/2010
OWNER'S PHONE: 4082527246 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL ❑
Q COPPER RE-PIPE OF ENTIRE HOUSE
License Class Lic.#
Contractor l O ��
I hereby affirm that I am licensed under the provisions of hapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
Sq.Ft Floor Area: Valuation:$4000
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:36918009.00 Occupancy Type:
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. 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 PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued Date:
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 y roofing
ROOFS:
all non-point re lations per the Cupertino Municipal Cole,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is
(l �� installed without first obtaining an inspection,I agree to remove all new materials for
Signature Date inspection.
Signature of Applicant: Date:
OWNER-BUILDER DECLARATION
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t _reby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE
compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the
sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will
t. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. O e r utho ed t:
2. I have and will maintain Worker's Compensation Insurance,as provided for by Date: v
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. �T CONSTRUCTION LENDING AGENCY
3. 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 I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 Licensed Professional
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
ing of this permit.Additionally,the applicant understands and will comply with
.n-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 884 COTTONWOOD DR DATE: 11/18/2010 REVIEWED BY: BOBS
APN: BP#: 10110130 "VALUATION: $4,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex `4�` I, PENTAMATION 1 RPDP
USE: p -«�- t'-'_'�=`�: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Area 1PREPPIPE 1 # $42
TOTALS: $42.00
Plumb.Plan Check T0.0Thrs $0.00
Plumb.Permit Fee: 1PPERMITl -
« Other Plumb Insp. 0.0 hrs $42.00
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS
,,
PME Plan Check: $0.00
PME Unit Fee: $42.00
PME Permit Fee: $42.00
t ,s;tti,'t;' ttt{e;t lri'iF71
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: 1 TRA VDOC $42.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $127.50 $0.00 TOTAL FEE: F $127.50
Revised: 11/08/2010
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36918009. 00
DATE ISSUED. . . . . . . : 11/18/2010
RECEIPT #. . . . . . . . . : BS000012047
REFERENCE ID # . . . : 10110130
SITE ADDRESS . . . . . : 884 COTTONWOOD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FENTON RICHARD L AND SHIRLEY A
ADDRESS . . . . . . . . . . : 884 COTTONWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4623
RECEIVED FROM . . . . : GENMOR PLUMBING
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95131
TELEPHONE . . . . . . . . : (408) 855-8348
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 000 .00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 4, 000.00 0 .50 0 .00 0 .50 0. 00
1PPERMITFE FLAT RATE 1 . 00 42 .00 0 .00 42 . 00 0.00
1PREPPIPE FLAT RATE 1.00 42 . 00 0 .00 42 . 00 0.00
1TRAVDOC FLAT RATE 1.00 42. 00 0 .00 42 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127.50 0 .00 127.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 127.50 7305
---------------
TOTAL RECEIPT 127 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
506 GAS TEST 507 FINAL PLUMBING
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# r�
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: 1A oy J2 LA IM Ij 1A BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*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 SUBCO>qRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 1-0
Signature D to
Please check applicable subcontractors and complete the following information:
V 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
. n oor it Qua lrty an Ftrns es
1.Use Low/No-VOC Paint 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 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
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--yes0
7.Seal au wed fardoleboard or MY 4 IAQ/Health. pts y=yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
1 1
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes kild 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y--yes 0
2.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 0
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 1 1
Total Points Available: 1 1401 130 57
Total Points Project Received:1 01 01 0
V�
G:data/progslgreenbuildingguidelineslremodelerslgreenpointsfinal2.12.D4protected.xls
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkT1NO PERMIT APPLICATION FORM
APN # :36 l �, rl �} Date:
Building Address: ��-
Owner's Name: C;� ,� Phone#: 408-
Contractor:
n8_Contractor: V�i Phone#:4Q� "
G'1W MW `Q� ��'+i'l ( /'LC Fax #: Q W - -l.Q
Contact: Phone#: O�—S� 7&--Sf 7
/c/
� 1� e q1,q1, Fax #: ` b
Contractor License#: 00 530) (0 I
Cupertino Business License#: J �<7/0/
Job Description: C (p j� )f42—,AW (f && tt f%UU j
Residential Commercial ❑
Valuation: cm
7 (
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
1 PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09