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10050149 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20426 VIA VOLANTE CONTRACTOR:STREET PLUMBING& PERMIT NO: 10050149 ROOTER 2293 V►ALNUT GROVE AVE DATE ISSUED:05/18/2010 "'NER'S NAME: SANDRA R GREENFIELD PHONE NO:(408)496-1155 SAN JOSE,CA 95128 rhereby PHONE: 4088928484 LICENSED CONTRACTOR'S DECLARATION BUIL')ING PERMIT INFO: BLDG ELECT PLUMB r C-36 Lic.# L,59?-2-17 — MECH F RESIDENTIAL r COMMERCIAL sy �J Contractor 7f�`�' Date 040[1�_ JOB DESCRIPTION:WATER HEATER REPLACEMENT firm that I am licensed under the provisions of Chapter9ng with Section 7000)of Division 3 of the Business&Professions hat 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 Valuation:$300 performance of the work for which this permit is issued. Sq.D Floor Area: 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 APN number:31601054.00 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 ,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, -[80 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which ma crue against said City in consequence of the ant understands and will comply granting of this permi nail Date. '< with all non-poin g a' er th u unicipal Code Section Issued b xe Date /� v -natu RE-ROOFS: 13 OWNER-BUILDER DECLARATION rAll oofs shall be inspected prior to any roofing material being installed.If a roof is Iled 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 insp:ction. the following two reasons: Date: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: 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 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I h ive read the hazardous materials requirements under Chapter 6.95 of the declarations: nt to self-insure for Worker's California Health&Safety Code,Sections 25505 eand 4the Health&tam 1 have and will maintain a Certificate of Conse Compensation,as provided for by Section 3700 of the Labor Code,for the Sa ety Code,compliance S Section 25532(a)should I th the Cupertino sto a orestore 9 12 andhandle hazardous material. performance of the work for which this permit is issued. Ad ditionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by co rtaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this m;99!! o Municipal Code,Chapter 9.12 and the permit is issued. Hi 25533,and 2 534. 1 certify that in the performance of the work for which this permit is issued,I shallnot employ any person in any manner so as to become subject to the Worker's ate: Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,Imus10, forthwith comply with such provisions or this permit shall be deemed revoked. NSTRUCTION LENDING AGENCY I Hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION fcr which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lmder'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 Lender's Address the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue again§t said City in consequence of the granting of this permit. all plicant understands and will comply I understand my plans shall be used as public records. with all non-point r la' unicipal de,S tion Licensed Professional 9.18. Signatu Date CITY OF C13PERTINO 5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31601.054 . 00 DATE ISSUED. . . . . . . : 05/lF/2010 RECEIPT #. . . . . . . . . : BSO00010436 REFERENCE ID # 1005C149 SITE ADDRESS 20426 VIA VOLANTE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SANDRk R GREENFIELD ADDRESS . 20426 VIA VOLANTE CITY/STATE/ZIP CUPERPINO CA, CA 95014 RECEIVED FROM STREET PLUMBING&ROO CONTRACTOR . . . . . . . : MARK ;STREET LIC # 29069 COMPANY STREET PLUMBING & ROOTER ADDRESS . 2293 WALNUT GROVE AVE CITY/STATE/ZIP SAN JOSE, CA 95128 TELEPHONE (408) 496-1155 FEE ID UNIT - QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - ---------- _____ ____ ----- ----- __ ---------- BCBSC VALUATION ----- 300 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 300 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 0 .50 0 . 00 1. 00 42 . 00 0 . 00 42 . 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 0. 00 ---------- -- __ TOTAL PERMIT : -------- ---------- 110 . 50 0 . 00 110 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 518 WATER HEATER - ---------------------------- ---------------------------- IsCITY OF CIR ERTINO WATER HEATER PERMIT APPLICATION FORM CUPERTINO Date: APN # , Building Address: 2 0'4 2(, 1 �� Owner's Name: kPhone #: by rA1 E Phone#: 4108 1446— 1 (55 Contractor: 5--rf 65r tArI Fax #: qDW q q 6 -d 3S5' Contractor State License#: Cupertino Business License#: SE u 17 Phone#: qpg 210 -6317 Contact: qtLW-JEEr Fax#: Building Permit Info: Bld Elect Plwnb Mech Commercial El Job Description: t, f i j�cY(A eETIE l- Strapped ❑ On Platform Bonded [] New Location ❑ Replacement Valuation(cost of project): 1-3co Fuilzf s ❑ Standard ] Large ❑ Major❑ se complete relevant porti��n of the Green Bu&thebeet ind attach it to lication or if applicable, include in ptan seppts achieved: Revised 03/10/10 0 1 f CITY OF CUPERTINO WATER HEATER -UPEk1 INO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Grou 1PCWBEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standarcis B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1PCSWHTR Commercial Solar B PCSWHTR Thermal Water Htr 1 PRWHBATR Residential Water B PRWHEATR HeaterNent 1PRSWHTR Residential Solar B PRSWHTR Thermal Water Htr 1BCBSC Cal Bldg Standard; B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit p / 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.Use LowWVOC 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 p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6lAQ'Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ'Health pts y=yes 0 7.Seal all ExposedPlarticleboard or MDF 4 IAQ Health. pts y=yes p 8.Use FSC Certified Materials for Interior Finish 4 Res)urce pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Res)urce pts y=yes p 10.Install Whole House Vacuum System 3 IAC/Health pts y=yes 0 1 1 1 N.Flooring im 1.Select FSC Certified Wood Flooring 8 Reso jrce pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Reso irce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resollirce pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/liealth 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 p i 1 1 Total Points Available: 1 1401 130[___ 57 Total Points Project Received: �' 01 0 0 G:data/progslgreenbuildinocjidelines/re eenpointsfinal2.12.04prolected.zls 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: Q QTF— PERMIT# P NER'S NAME: DY � �/ U! PHONE#NERAL CONTRACTOR: (1,(1`(g/�((, t Ill. BUSINESS LICE SE # DRESS: 2Z 3 �{}4L�UCIT V 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 OCCUP SPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S VE OBTAINED A CITY O CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Sign re ate Please check applicable subcontractors and complete the following information: 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 1/ Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /j, Da wn Contractor ignature