10110057I I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10692 PINOLE CT I CONTRACTOR: MASTERSERV INC I PERMIT NO: 10110057
OWNER'S NAME: TROY BARBA
560 LIBRARY ST I DATE ISSUED: 11/09/2010
;ER'S PHONE: 4083146703 1 SAN FERNANDO, CA 91340 ' PHONE NO: (800) 806-7674
❑ LICENSED CONTRACTOR'S DEtC�LA/RATION
License CI Lic.# �; O v `
Contractor Date
I hereby of rm tha I am licensed under the provisions of Chapter 9
(commenc g with ection 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.
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 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
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 accrete against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all nod-pvigt source. re bons per the Cupertino Municipal Code, Section
9 1 R I 1 //
Signature
L
Date
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
Section 3700 of the Labor Code, for the performance of the work for which this
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
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.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
i- unify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature
Date
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB f—
MECH r— RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: REPLACE MAIN WATER SERVICE COPPER 60'OF I" PIPE
KITCHEN SINK DRAIN ONLY
Sq. Ft Floor Area: I Valuation: $2881
APN Number: 36934023.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bI . - Date:
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
main 'n compliance with the Cupertino Municipal Code, Chapter 9.12 and the
He 0Safe de, Sections 25505, 25533, and 25534.
Ower r aut o ed agent:
�-
Date: l
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10692 pinole ct.
DATE:
REVIEWED BY:
UNITS
APN:
BP#:
"VALUATION: 1$2,881
xPERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex:p
7 -OT i,t.
r .��t,_,�
PENTAMATION 1 RPKT
PERMIT TYPE:
WORK
Water Service
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Plan Check 0.0 hrs $0.00
QTY
UNITS
BP FEES
Kitchen Type Trap
1 BPTRAP
1
#
$8
Water Service
1BPWSVCS
1
#
$21
PME Unit Fee:
$29.00
PME Permit Fee:
$42.00
Con,wriwfion Tax
Work Without Permit? 0 Yes No
$0.00
TOTALS:
Travel Documentation Fee: 1 TRA VDOC
$29.00
Strong Motion Fee: IBSEISMICR
A//)TL•. TL ...... .... ...... h,...,•.d ,.- .1— available and aro nnly an estimate. Contact the Dent for addn7 into.
tvvia:. a•s cuc c ....... .._........... ...
FEE ITEMS (Fee Resolution 09-051 E . './1%70)
T-TPlumb.
Plan Check 0.0 hrs $0.00
1'10- <'k
f hol C;hc''A
Plumb. Permit Fee: IPPERMIT
oifi c r. Wo Al,
Other Plumb Insp.0.0 hrs $42.00
PME Plan Check:
$0.00
A//)TL•. TL ...... .... ...... h,...,•.d ,.- .1— available and aro nnly an estimate. Contact the Dent for addn7 into.
tvvia:. a•s cuc c ....... .._........... ...
FEE ITEMS (Fee Resolution 09-051 E . './1%70)
_
FEE
___ _ _
QTY/FEE
MISC ITEMS
f hol C;hc''A
.SI/PP1. PC.' F(A"
PME Plan Check:
$0.00
P<'P nil, Fcw'
PME Unit Fee:
$29.00
PME Permit Fee:
$42.00
Con,wriwfion Tax
Work Without Permit? 0 Yes No
$0.00
Travel Documentation Fee: 1 TRA VDOC
$42.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1 --T-
Bldiz Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$114.50
$0.00 TOTAL FEE:
$114.50
Revised: 11/08/2010
6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36934023.00
DATE ISSUED.......: 11/09/2010
RECEIPT #.........: BS000011959
REFERENCE ID # ...: 10110057
SITE ADDRESS .....: 10692 PINOLE CT
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............. TROY BARBA
ADDRESS ..........: 10692 PINOLE CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: MASTERSERV,INC
CONTRACTOR .......: GEORGE ANDERSON LIC # 30854
COMPANY ..........: MASTERSERV INC
ADDRESS 560 LIBRARY ST
CITY/STATE/ZIP ...: SAN FERNANDO, CA 91340
TELEPHONE ........: (800) 806-7674
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
----------
----------
1BCBSC
-------------
VALUATION
----------
2,881.00
----------
1.00
----------
0.00
1.00
0.00
1BPTRAP
NO OF TRAPS
1.00
8.00
0.00
8.00
0.00
1BPWSVCS
WATER SERVICE
1.00
21.00
0.00
21.00
0.00
1BSEISMICR
VALUATION
2,881.00
0.50
0.00
0.50
0.00
1PPERMITFE
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
----------
114.50
----------
0.00
----------
114.50
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
114.50
---------------
114.50
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
REFERENCE NUMBER
--------------------
#2916
VOICE ID DESCRIPTION
-------- ----------------------------
202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
1. Use Low/Mo-VOC Paint
1 IAQ/Health pts
y --yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y --yes
3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all ExpDsed Particleboard or MDF
4 IAQ/Health pts
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2. Use Rapidfy Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y --yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
1401 130r----5-71
0 0
rd
�r
G;data/progslgreenbuildingguidelineslremodelerslgreenpoi sfina1212.D4prolected.zls
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: rtfi
OWNER'S NAME: `!'-d a,� o�
PERMIT # ZS
PHONE # - —V0
GENERAL CONTRACTOR:
BUSINESS LICENSE # S3 j
ADDRESS: V31 r
CITY/ZIPCOD ,'x /"A
*Our municipal code requiresAll businesses working in the city to nave a t.ity of Luperuuu uun1111r3N 1MU
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU ONT T S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. K
I am not using any subcontractors:
S' nature Date
Please check aDDlicable subcontractors nd corn lete the following information:
Owner //Contractor Signature
?/A / v
Date
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
?/A / v
Date
CITY OF
CUPEi�TINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
/(-it/ " ;J,/
APN # � fi � � � � ?
Date: �NvVJv
Fee Description
Fee
Group
Building Address: , /l / Q / C
1PCSEWER
Commercial building
sewer/sanitary sewer
Owner's Name: -T
Phone #:
1BPREPIPE
Contractor:
�ST-ex Se✓��
Phone #: 8-/g — 7 - yr �
G
1CPRP
Fax #: _ g_ �
Contact: (�%�L (r,,� ,,�
Phone #: �$ _ Y
P
Fax #:
Contractor License #: S 00 ( 7
1BCBSC
Cupertino Business License #:
B
Job Description: f�.� r// �� C, . .v �(
IBSEISMICOM
Seismic Commercial
P
[Residential Commercial ❑
Valuation:
Project Size: Express 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
Group
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1 PGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BCBSC
Cal Bldg Standards Commission
Fee
B
ALL PERMIT
TYPES
IBSEISMICOM
Seismic Commercial
P
Revised 01/07/09