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10090183 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10188 MACADAM LN CONTRACTOR:SANDIUM PERMIT NO: 10090183 OWNER'S NAME: SEAN HOU 4223 VERDIGRIS CIR DATE ISSUED:09/20/2010 ER'S PHONE: 3233656888 SAN JOSE,CA 95134 PHONE NO:(408)894-9072 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class Lic.# Obb��% MECH r RESIDENTIAL r COMMERCIAL C" Contractor caste&� Date_J"10 - JOB DESCRIPTION:WATER HEATER REPLACEMENT I hereby affirm that I am licensed under the provisions of Chapter 9 (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 Floor Area: Valuation:$1200 1 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 w 'ch APN Number:36901041.00 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 constriction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 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 �? 61-G with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: -- Date: / 9.18. Signature 74,e�n,�, N�, A Date L�� LAO RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one('f inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensatio u, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors tc construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have 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 Additionally,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 contaminants 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. Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow or authorized ent: Date: Compensation laws of California. If,after making this certificate of exemption,I s[ become subject to the Worker's Compensation provisions of the Labor Code,I m,ist forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relat ng to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save 'emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .s,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$1,200 ji, PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PENTAMATION PRIMARY SFD or Duplex 1 1 U<�t�� ",l;_�; PERMIT TYPE: PRWHEATR USE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $25 TOTALS: $25.00 Plumb.Plan C4jck 0.0 hrs $0.00 EP imb.Permit Fee: IPPERMIT Other Plumb In;p. 0.0 hrs $42.00 NOTE. These fees are based on the preliminarrTv in ormatio i available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS(Fee Resolution 09-05I Elf. 7,%7i102 FEE QTY/FEE MISC ITEMS P/on Clwck Fcc: PME Plan Check: $0.00 Szzppl" I isp Fee PME Unit Fee: 125.00 PME Permit Fee: 542.00 (.'oij.gruction Tera Icou.slicul 16,vicw Fe'. Work Without Permit? 0 Yes 0 No $0.00 Plr.zrzrtin�� f'c�<'�: Travel Documentation Fee: ITRAVDOC '342.00 Strong Motion Fee: $0.50 Select an Administrative Item 1344 Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $'110.501 $0.00 TOTAL FEE: $110.50 Revised: 9/14/2010 M.Indoor Air Quality and Finishes 1.Use Ijoy -VOA Rah 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowMgVOC AdhOSives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 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 01 7.SealA fxposed ftWebowd or t11©F 4 IAQ/Health, pts y=yes 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 01 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes ' ! 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 01 1 Total Points Available: 140 1301 57 Total Points Project Received: _01 01 0 G:data/progs/)reenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls 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: tok PERMIT# OWNER'S NAME: PHONE# 6 M GENERAL CONTRACTOBUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses Y&rking n 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 SUBCON'I RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: A A ',signature Da e Please check applicable subcontractors and complete the following information: j/ 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 Date Owner/Contractor Signature CITY OF CUPERTINO WATER HEATER CUPEtZTINO PERMIT APPLICATION FORM APN# Date: Building Address: I c I z� LYN Owner's Name: Phone #: Contractor: i ^ Phone #: Fax #: Cupertino Business License #: Contractor State License #: 888 t(I Contact: Phone #: leg V 4- b7 Z, Fax #: Building Permit Info: Bldg � Elect [ Plumb,' Mech ❑ Residential Commercial ❑ Job Description: Strapped ❑ On Platform Bonde(l ❑ New Location ❑ Replacement ❑ Valuation (cost of project): Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant p,)rtion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 03/10/10