10020015 CITY OF CUPERTI vO BUILDING PERMIT
BUILDING ADDRESS: 7527 TIPTOE LN CONTRACTOR:TATS INC DBA MR PERMIT NO: 10020015
ROOTER PLUMBING
'NER'S NAME: YAMADA KO W AND JOANN S 44777 S GRIMMER BLVD STE C DATE ISSUED:02/01/2010
t,.r NER'S PHONE: 8009299902 FREMONT,CA 94538 PHONE NO:(408)271-2822
❑ LICENSED CONTRACTOR'S DECLARATION r rr r•
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class�%� Lic.# ?�'b 7/�, ^
f� MECH RESIDENTIAL COMMERCIAL
Contractor Lv� Date f�
I hereby affirm that I am licens d under the provisions of Chapter 9 JOB DESCRIPTION:SEWER REPLACEMENT;TRENCHLES�CITY CLEAN OUT
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect. ;;
�.Al
I hereby affirm under penalty of perjury one of the following two declarations: � !r
I have and will maintain a certificate of consent to self-insure for Worker's t ►
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
S Ft Floor Area: r
I have and will maintain Worker's Compensation Insurance,as provided for by q' i � Valuation:$2000
Section 3700 of the Labor Code,for the performance of the work for which this
.4
r
permit is issued. APN Number:3592 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 PER] PIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
4
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 `,-)
with all non-point source regulations per-the upertino l nicipal Code,Section Issued by Date
9.18
i
mature :�;2Date
1-11, 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 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 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;S`ectiops 25505,25533,and 25534.�-�
not employ any person in any manner so as to become subject to the Worker's Ow�er!� th ag'e �/
Compensation laws of California. If,after making this certificate of exemption,I Date: Zv��
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
-n the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,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 so ons per 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 . . . . . . . . : 35928010 . 00
DATE ISSUED. . . . . . . : 02/01/2010
RECEIPT #. . . . . . . . . BS000009668
REFERENCE ID # . . . : 10020015
SITE ADDRESS . . . . . : 7527 TIPTOE LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YAMADA KO, W AND JOANN S
ADDRESS 7527 TIPTOE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5836
RECEIVED FROM . . . . : EMILIANO CORTEZ TIN
CONTRACTOR . . . . . . . : TATS INC LIC # 23496
COMPANY . . . . . . . . . . : TATS INC DBA MR ROOTER PLUMBIN
ADDRESS 44777 S GRIMMER BLVD STE C
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE (408) 271-2822
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 000 . 00 1. 00 0 .00 1 . 00 0. 00
1BSEISMICR VALUATION 2, 000 .00 0. 50 0 . 00 0 .50 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRSEWER UNITS 1 . 00 21. 00 0 . 00 21 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 .50 0 .00 106 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106 .50 MC
---------------
TOTAL RECEIPT 106 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
ic"c> C)
CITY OF CUPERTINO
} REPIPE/SEWEa2/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# Date*
t 4?
Buiiding Address:
O neK's ame: Phone#:
torn if / Phone#: �" �>- `'Z' L"
CoMF'vC'r� lv',^"�i� Fax#:
Contact:
Fax#:
Contractor License#: 2��
Cupertino Business License#:
Job Description:
Residential Commercial ❑
Valuation: �1
, ._
Project Size: Expressn Standard Large [j 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 Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial G,;Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF C'UPERTINO
REPIPE/SEWEIt/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID :Fee Description Fee Permit Type
Group
IBCBSC Cal Bldg Standar is Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1 PRSEWER Residential build:ng P 1RPSS
(
sewer/sanitary se ever
1 PRREPIPE Residential re-pile per fixture P 1RPRP
1 BPWSVCS Water Service P 1CPWS or
1RPWS
1 PPRSEWG Private Sewage Disposal System P
1 PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas F iping System P
1-4 Outlets
1BPGAS Gas Piping Syster.n 5+ Outlets P
I PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan C:leck P
I PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Docum,;ntation Fee B
1 BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.Ui3eiiSigt 1 IAQ/Health pts y=yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. D
3.Use Low*VOG AdvO-M 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ/Health pts y=yes'
0
D
6.Use Exterior Grade Plywoodfor Interior Uses 1 IAQ/Health pts y=yes
7. 1IA[ 4IAQ/Health pts y=yes 0
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
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Ra*y Renewable Mooring Materials t Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 1 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes D
5.Use Exposed Concrete as Finished Floor 1 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
1 i 1
Total Points Available: 140 1301 57
Total Points Project Received:1 ' 1 01 01 0
Fe-,b
G:data/progslgre!nbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis
Community Development
10300 Torre Avenue
x Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Buildin De artment
OB ADDRESS: PERMIT #
J �..
-r e�- �l 1 t 0 U
OWNER'S NAME: 3- ,�,� U,�►,�,,,rr�� ONE # `��
GENERAL CONTRACTOR: -I--
FAX #
I am not using any subcontractors: �
Signature Date
Please check applicable subcontractors and co m lete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date