10050203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10799 WILLOWBROOK WAY CONTRACTOR:GREAT AMERICAN PERMIT NO: 10050203
PLUMBING CO INC
'NER'S NAME: EDWIN WONG P O I;OX 26942 DATE ISSUED:05/27/2010
OWNER'S PHONE: 6507668251 SAN JOSE,CA 95159 PHONE NO:(408)279-1515
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB
License Class "�3 Lic.# �-y f 0 4 S
Contractor� 'V—AA&0(40 Um1MWt9 S_717-0
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL PROPERTY LINE CLEAN OUT
(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.F:Floor Area: Va ti :$1
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:36922 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 FERMIT 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, 80 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-p int source regulations per the Cupertino Municipal Code,Section Issut d b Date"Z 7
9.18. Y�
A 7
'atur0_a6� Date :�
U
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All rcofs shall be inspected prior to any roofing material being installed.If a roof is
instal ed 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)
1,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 hav 3 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 Calif)rnia 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. Safet✓Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Addil Tonally,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. main:ain 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,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's V.r or sut ed ..
Compensation laws of California. If,after making this certificate of exemption,I Date:5--,2- 1 V
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 w rich this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lend:r'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 Lend:r's Address
the above mentioned property for inspection purposes.(We)agree to save
nnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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 und,:rstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. U / 7� Licensed Professional
Signatu ib6+----- Date d7g6)
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lc)t:
APN 369220: 8 .00
DATE ISSUED. . . . . . . : 05/27/2010
RECEIPT #. . . . . . . . . BS0000=.0501
REFERENCE ID # 10050203
SITE ADDRESS 10799 WILLOWBROOK WAY
SUBDIVISION . . . . . .
CITY CUPERT:=NO
IMPACT AREA . . . . . .
OWNER EDWIN WONG
ADDRESS 10799 'gILLOWBROOK WAY
CITY/STATE/ZIP CUPERTLNO, CA 95014
RECEIVED FROM THE GREAT AMERICAN
CONTRACTOR CORPORkTION LIC # 18061
COMPANY GREAT ZIERICAN PLUMBING CO INC
ADDRESS P O BOK 26942
CITY/STATE/ZIP . . . : SAN JOSE, CA 95159
TELEPHONE (408) 279-1515
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- ------
1BCBSC VALUATION 1, 900 . 00 1 .00 0 . 00 1. 00 0 .00
1BSEISMICR VALUATION 1, 900 . 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
----------------- --------------- -- ------------
CHECK 106 .50 #114900
---------------
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
C)07�vLID 0
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEi�TINO PERMIT APPLICATION FORM
APN o Date:
5-a7-lo
Building Address:
074N W<<Cow&2UCX-z W A 14
Owner's Name: Phone#:
L-706d/.0 W6w6-- 69D
Contractor: Phone#:
C-,tC4T Avne-0 /�cmi /"C (4rWbbt- - Fax #: de-
- S3
Contact: Phone#:
Fax #:
Contractor License#: �j 1065
Cupertino Business License#:
Job Description:
Residential Commercial ❑
Valuation: G 615
0 G U
Project Size: Express rd" Large Major
Green Building: Please complete relevant portion of tr a 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
1 PGASCOM Commercial Gas Pip ng 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 CUPI�RTINO
REPIPE/SEWER/MAIN SERVICE
CUPEIZTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
113SEISMICR Seismic Residential P
1 PRSEWER Residential building P 1RPSS
sewer/sanitarysewer
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1 BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping '3ystem P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/gas Insp. P
f1TRAVDOC Travel &Documentatic,n Fee B
1BUSLIC Business License B
INPUT _. AD
M.Indoor Air Quality and Finishes
1.Use Low,,No-VOC Paint 1 IAa/ ealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IA()j-iealth pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAD/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 61AQvHealth pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQj fealth pts y=yes
7.Seal all Exposed Particleboard Qr MDF 4 IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Res)urce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Reswrce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQmiiiimkEE66mi
N.Flooring
1.Select FSC Certified Wood Flooring 8 Reso Irce pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Reso irce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/lisalth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Reso irce pts y=yes 0
1 11
Total Points Available: 140 130 57
ml
:
Total Points Project Received01 0 0
&data/prop1greenbuildng juidelinestremodelerstgreenpointsfinal2.12.04proteoted.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: I -r- via ,egmt WAS PERMIT#
OWNER'S NAME: QW/ PHONE# d
GENERAL CONTRACTOR: /o USINESS LICENSE#
ADDRESS: CITY/ZIPCODE: f2i 4 -Sl 10
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signatu re Date
Please check applicable subcontrac ors and complete tf a following information:
SUBCONTRACTOR BUSINESS N AME 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