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10030159 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10670 HALE PL CONTRACTOR:MASTERSERV INC PERMIT NO: 10030159 OWNER'S NAME: DAVID KOPELS 560 LIBRARY ST DATE ISSUED:03/29/2010 1ER'S PHONE: 4084463008 SAN FERNANDO,CA 91340 PHONE NO:(800)806-7674 ❑ LICENSED CONTRACTOR'S DECLARATION _c��G/ 7- BUILDING PERMIT INFO: BLDG r- ELECT I- PLUMB� License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor/ Date c7J Z /d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER RE-PIPE NO FIXTURE REPLACEMENTS (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:$5495 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. APN Number:32640012.10670 Occupancy Type: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree tocomply 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 upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 G with all non-point source regulations_p&r the Cupertino Municipal Code,Section 9.18. Issued by-_ Date: 2�I SignatureDate RE-ROOFS: L, 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE 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 permit is issued. maintain compliance with th Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code on 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 OH rize a Compensation laws of California. If,after making this certificate of exemption,I ate:3 Z 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. 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 relating 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 nnify 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 I understand my plans shall be used as public records. with all non-point sou a regul per the Cupertino Municipal Code Section 9.18. Licensed Professional Signature Date �' CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 32640012 . 10670 DATE ISSUED. . . . . . . : 03/29/2010 RECEIPT #. . . . . . . . . : BS000010044 REFERENCE ID # 10030159 SITE ADDRESS 10670 HALE PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DAVID KOPELS ADDRESS 10670 HALE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM MASTERSERV, INC OF N 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 5,495 . 00 1. 00 0 . 00 1 . 00 0. 00 1BPWATER UNIT 1 .00 42 . 00 0 . 00 42 . 00 0. 00 1BSEISMICR VALUATION 5,495 . 00 0 . 60 0 . 00 0 . 60 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 : 127. 60 0 . 00 127. 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------ --------------- -------------------- CHECK 127. 60 ##1037 --------------- TOTAL RECEIPT : 127. 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --- --------------- ------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# 9) C� c, Date: Building Address: Owner's Name: Phone# Contractor: Phone ekc)) 6"CAo -1 Fax#: Contact: Phone rV Fax#-, Contractor License t � I -Cupertino Business License#: Job Description: Residential Commercial ❑ Valuation: Project Size: Express El Standard 0 Large Major 0 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 IPCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P ICPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets I BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES IBSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE �UPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT 1 Fee TYPES / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P / 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P / 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P / 1 TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B INPUT Resojlces Energy IAD'Haafth Tinlrcioor Air ua ity an mts es 1.Use LowMo-VOC Paint 1 IAD/Health pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAQMealth pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAD/Health pts y--yes D 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 p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQMealth pts y=yes D 7.Seal al EVosed fWtideboard or MDF 4 IAQ/Health. pts y=yes D B.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 10.Install Whole House Vacuum System 3 IAQMealth pts y=yes p 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2 Use Rapidly RanewaWe 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 1 1401 1301 57 Total Points Project Received: \ 01 OF---0j G:datalprogs/greenbullcfingguidelines/remodelers/greenpointsfinal21204proteoted.xis 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:/pvxd 1wege L, PERMIT# G �R OWNER'S NAME• PHONE 0 -- GENERAL CONTRACTOR: VS J.k':5 BUSINESS LICENSE# ADDRESS g 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 SU CONTRA ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: l �a Signature Date 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date