10070138 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10393 LANSDALE AVE CONTRACTOR:NELSON PLUMBING PERMIT NO: 10070138
OWNER'S NAME: JEN HONG 2071 MAIN ST DATE ISSUED:07/20/2010
NER'S PHONE: 4089961016 SANTA CLARA,CA 95050 PHONE NO:(408)280-5311
❑ LICENSED CONTRACTOR'S DECLARATION
/J / BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class (/ Lic.# 7�
MECH RESIDENTIAL COMMERCIAL
Contractor Date l(J
I hereby affirm that I a icensed under t rovisions of Chapter 9 JOB DESCRIPTION: WATER MAIN REPLACEMENT 1"COPPER
(commencing with Section 7000)of Divi n 3 of the Business&Professions `*SEE NOTES**
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 Sq.Ft Floor Area: Valuation:$1500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36911004.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,t pplicant understands and will comply
with all non- ' t source regulat' WeCupe ino Municipal de,Section -�
9.18. / Issued by• Date: �' l
Signa Date
❑ fA
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code, ctions 25505,25533,and 25534.
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 or author' a
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: d
forthwith comply with such provisions or this permit shall be deemed revoked. -\ 1 �44
ONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
i—on the above mentioned property for inspection purposes.(We)agree to save Lender's Address
unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36911004 . 00
DATE ISSUED. . . . . . . : 07/20/2010
RECEIPT #. . . . . . . . . : BS000010910
REFERENCE ID # . . . : 10070138
SITE ADDRESS . . . . . : 10393 LANSDALE AVE
SUBDIVISION . . . . . .
CITY CU?ERTINO
IMPACT AREA . . . . . .
OWNER JZ4 HONG
ADDRESS 10393 LANSDALE AVE
CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014
RECEIVED FROM . . . . : NE: SON PLUMBING
CONTRACTOR . . . . . . . : RICHARD LEE NELSON LIC # 23330
COMPANY NE: SON 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
---------- ------------- ---------- ----------- ---------- ---------- ----------
1BCBSC . VALUATION 1, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRWHEATR UNITS 1 . 00 25 .00 0 . 00 25 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 110 . 00 0 .00 110 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 110 . 00 #7497
---------------
TOTAL RECEIPT 110 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: `VALUATION: 1$1,500
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex APPLICATION
USE: p - �� f= TYPE:
a a
3 � 7
APPLIANCE/EQUIP TYPE CAPACITY //FEE ID TY BP FEES
Water Heater 1 BPW TEAT 1 $25
TOTALS: $25.00
Plumb.Plan Check TO.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 1 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 hjf' T]-,09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.)o
PME Unit Fee: $25.)0
PME Permit Fee: $42.00
Travel Documentation Fee: ITRA VDOC $42.)0
Select an Administrative Item
131d.- Stds Commission Fee: IBCBSC $1.)0 7
SUBTOTALS: $110.)0 $0.00 . TOTAL FEE: $110.00
Revised: 6/30/2010
CITY OF CUPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN# Date-
Building Address:
Owner's Name: Phone #:
Contractor: Phone #(qo
/I le6aN 0Zv1n /A
Fax W
Cupertino Business License #: Contra or State License #:
7e�
Contact: Phone #: � 53 J
lVelso
Fax #:
Building Permit Info:
Bldg Elect :dumb Mech ❑'�^
Residential Commercial ❑
Job Description:
Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement D
Valuation (cost of project): / j
Sao
Project Size: Express Standard ❑ barge ❑ 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 achieved:
Revised 03/10/10
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde E IAQ/Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF � IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
■ 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
■ i 1 1
Total PointsAvailable: 1 1401 130 57
Total Points Project Received: 1 01 01 0
G:data/progs/green'juildinoguidelines/remodeiers/greenpointsBnal2.12.04protected.xls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
ELI] Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: -3 PERMIT# ,1)-7D
OWNER'S NAME: z e PHONE #
GENERAL CONTRACTOR: t?G BUSINESS LICENSE
ADDRESS: yWljl
� 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 INS CTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRnOHA[E OBTAINED A CITY F CUPERTINO
BUSINESS LICENSE.
I am not using an subcontractors: o�/c
Y
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINE SS 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
OwnYr Contractor Signature Date
REVISION# .
CITY OF CUPERTIN43 BUILDING PERMIT
BUILDING ADDRESS: 10128 LEBANON DR CONTRACTOR:C&D FREITAS PERMIT NO:09070208
CONSTRUCTION
OWNER'S NAME: CAROL ELLIOTT :3620 MORREL CUT-OFF RD DATE ISSUED:03/23/2010
OWNER'S PHONE: LOS GATOS,CA 95033 PHONE NO:(408)356-5780
/ LICENSED CONTRACTOR'S DECLARATION 13UILDING PERMIT INFO: BLDG r ELECT r PLUMB
icense Class Lie.# MECH r RESIDENTIAL r COMMERCIAL
Contractor Clc�) Fle1�145 Date e2-
I hereby affirm that I am licensed under the provisions of Chapter 9 LOOMESCRIPTION: SFD ADDITON/REMODEL-MASTER SUITE,MEDIA
(commencing with Section 7000)of Division 3 of the Business&Professions ,AUNDRY,CHANGE FLAT ROOF TO A PITCH ROOF
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 `� u 1 U
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. Sq.Ft Floor Area: Valuation:$280000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34214023.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point a regula'ons per the Cupertino Municipal Code;Section 180 DAYS FROM LAST CALLED INSPECTION.
9
Signa e _ "w t to 7 ` Issued by. ��'� Date: , G
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the ol —
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this pennit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
t.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
t, ilding construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional