08050102 CITY OF CUPERTINO � BM�rA.awanaen. e ttw
�
BUILDING DIVISION PERMIT aCONTRACTR INI?UI2MATION ._
BUILD N DESS PERMrf NO.
KENDLE ST CAL—COAST REPIPING, INC. 08050102
R'S NAME: FERMII ISSUE DATE
SCHOOLEY LOUISE B 1371 TITAN WAY 05/12/2008
PHONE: SANITARY NO. CONTROL NO.
(714) 578-5090
ARCH171E7ff1:NGtNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
fop
LICENSED thotI CONn AGID0.'$DEsionof hap Job Desert tion
mC ON
1 hereby affirm Net 1 am I'xxnsetl under Provisions of chapter Y(mmmcncin{ I3
OU alit Section 70fIU)of Dividon3ofNe Buaneu and Profudem Code,aralmylicense is REPLC PORTBL WATER LINE. CAL—COAST REPIPING
a in fall rmc,anal acme
i'�: Cleans Ci.0 Lia.. PERMIT
Dam ARCHHECrSDECCLARAnON WAS VALID WHEN WK DONE ON PREV PERMIT #05010027,
� cS lundemaadmyplam`mallxmedaepublic meama THIS PERMIT .:ISS'D DUE TO PREV PERMIT NEVER HAVING
{o Licensed ftemaanal
5 OWNER-BUILDER m CLA0.AnON
C Q f 1 kmby afford Nat 1 1. .anmpt from the Cssion oa license law for de
i.O O following mown. a rmit T 7031.5.Business and Pmfe.dam Cam:Any city or county
$
which ms lima•permit m conmueL alms,impmw,h permit or mash any ssrunum
pnarbslicendportin,ssuance.also W the tbeaPimed ofam fer suchpmmit m File Law(Cigmil ammcnt
£ < thssbeiracmedpumtion7 )ofDiuonsofme oftheecrosandPrQssioCode)or Sq.FL Floor Area $ Valuation
C59
that he 1. ng with Section mOivuion3 of showEntries. eM Profession Cade)of 7760
Nath 7 e,emb Nctefmm and Ne Win for the aagt esemant to a vip nIty of
Seton]031.3 m hay red dwnt for.permit mbjecu Ne applicant m a mil penalty err Number
set seam alae„hundred dml,n(ssoE3 32613107!�� Occupancy Type
❑1,u owner of th propvsty,o my employes wit wager a Neo mW campenvdon,
will do the wort,and the suucmm is notimm uded ooneumd farfara(Scc.7066,Busiws
and Pmlesdonr Cade:Th Conuncmrs license Law dees set apply m an awncr of Required Inspections
pnopeny who builds or impmwr thmmn,and who does ouch work Wmselr w ducugh his
oweemploycen,provided that such impm emenu am not mountsid oraRertd farsaln.If,
however.the buiWing w improvemcet m mid within enc year of cmvpWtim.Ne owner-
builder will Time the When of p o ring That he did not build os improv for purpose of
sat
❑1.n owner of de property,w exclusively committing with licensed emnummm to
contract Ne project(Sec.7064.Business and Pfofeamms Cade:)The Cmummrs U.
come law does tot apply TO an owner of propeny who builds of impose.Neseon,and,
who com ucu for such Projects wits a mnmamea s)liceved Fairmont he the Convenor,
Liccnee Law 11
❑lase pt under F. ,B i P C for thisIF mann
WORKER'S OOMPENSAr10 DECLARATON
I hereby afnm under pcha ty of perjury,one of the following dalamdoos:
❑Iawandwillmaintn•Cerdfiamof ComenuomIr-imumfm Wort 3Compcn.
Inion,an provided for by Section 3700 or t tabor Code.for the performance of the
wart for which This permit is issued.
❑I W,c and will rostrum.Warless Compemation Wsm .,as sequined by sccdon ,
3'1110 of dm Labor Code,for the performance of the work for which was Permit Is issued.
My Workers Compenton Interaction carni.aM Policy numb.am:
Cartier: Policy No.:
CERTIFICATE OF E%EMMON FROM WORKERS'
COMPENSATION INSURANCE
flTuncctim aced nth completed Ude Permit I,fmore hundred dello,(SI00) .
or lest)
I certify was in the pmfmmancc of the work for which this permit it;issued.I and ma
cmplayanypc ,ryas rm5Y mbjcnmde Worken'Compcmation
laws of Cali ..Dattee I J -f?X
Applicant L eY,13 i'1�iw]»
NOTICE TO APPUSA .lf.afwrmWngNuCcnlrLutdofExemptim,ymu mld
become subject W the Workers Campewtion pmNsimu of the lobar Coda you most
.J O forthwith comply with such paovidnv m Nu permit mail be rA ro
dremwkcd.
CONSTRUCTION LENDING AGENCY
(•'.. 1 hereby affirm than thcrt isa cmmnnetim sending agency for the perfoma of
C'>
ft work for whim this Permit s boiled(sce.309'/.Ci,C)
W�Q Leader.Name
z Lanier:Addrre
U O 1 certify that 1 ave road this applims an and saw dm The wWw information b
gL E comms I•gree m comply with all city and county Ord omeea and smm laws missing m
O Wilding cnnswclum.and hembymmonae iepiesehimioaof on.ity to cnmrupon tine
r LU above-meMaaed pmpcny for impeetian porpoises.
gy (Wc)agree maw,indemnify and keep hamkst de Cty of Cupetrw•gaunt
5 h liabilitia,Judgmenm.cosu and eapemoa which mayin anywayancnm againstsaid City
U z in consequence of On granting of this pcmlL
50PL1 ^Nfr UNDERST NDS AND WILL COMPLY WITH ALL,NON-POINT Issued by: Q�&�J Date
Z. ��pu J2,� Re-roofs
Stgnatute dApplicamuVonuacmr Dem
HAZARDOUS MATERIALS WISCLOSURE Type of Roof
Will the applicant or foam Wilding osmtpant some or handle haoardom maw"
fined by de Cupertino Mand Code,
Chapmr 9.13.and de Health and Safety
.Seton 25532(,)?
❑Yrs Na All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection,I agree to remove
Will Ne applicant or fucose Wilding occupant use cyuipmat m dcim which g anns peC
Dlruium�um ssr comamin t as 0ncd by the Bay Arta Air QwdLY Mm.gcmcm all new materials for inspection.
❑Ym No
Ihew set the hmaNuua mamnab roquimnetm unJcr Chapmrb.95 of the 4lifon
nb Hral d:SafmYCodc,Setw25505.25SIIat2553a.IundvwiW thsifde Wilting
Jae. t WmndY hew a eosin.Nss it b mY ne.pomibilitY b ratify Nt mapant of dal
m fru whi�t tP'ormwuan.af>,Cenireamafaropm , Signature of Applicant Date
`�
Owner or authorured agent Dam All roof coverings to be Class')?"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32613107 . 00
DATE ISSUED. . . . . . . : 05/12/2008
RECEIPT #. . . . . . . . . : BS000004745
REFERENCE ID # . . . : 08050102
SITE ADDRESS . . . . . : 22331 KENDLE ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SCHOOLEY LOUISE B
ADDRESS. . . . . . . . . . : 22331 KENDLE ST
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1024
RECEIVED FROM . . . . : LOUISE B SCHOOLEY
CONTRACTOR . . . . . . . : CHARLES L VERSHAW LIC # 23227
COMPANY CAL-COAST REPIPING, INC.
ADDRESS . . . . . . . . . . : 1371 TITAN WAY
CITY/STATE/ZIP . . . : BREA, CA 92821
• TELEPHONE . . . . . . . . : (714) 578-5090
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BPWATER UNIT ' 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1BSEISMICR VALUATION 7, 760 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
-7-------- ---------- ---------- ----------
TOTAL PERMIT 123 . 17 0 . 00 123 .17 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 123 . 17 #3172
---------------
TOTAL RECEIPT 123 . 17
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- -------- ----------------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEI'TINO PERMIT APPLICATION FORM
APN# 3 ,? 'o 13/ Date:
7, � 0 o�
Building Address:
2 7- fCE AJ 1) S T
Owner's Name: Phone#:
Z- 0L)I s� � , Sc �oL � y cQ ys- /,�- 7 ?
Contractor: Phone #- 7/y) S7P — Z qD
�!L CoA sT �EPiP/�J i t�C .
Fax #: // 1-7P - soy
Contact: Phone#:
Fax #:
Contractor License#: �, 3
Cupertino Business License#: a a
Job Description:
Residential Commercial ❑
Valuation::
Green Building Check list must be completed and attached to this application.
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 Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial p
/ 1BSEISMICR Seismic Residential p
IPRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
aizo
REPIPE/SEWER/MAIN SERVICE .
CUPER, TiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
IPRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
IPPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
IBPWATER Install/alter Water Pipe P
IBPFDCTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
/ IPPERMITFEE Plumbing Permit Fee Issuance P •
IPLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
ITRAVDOC Travel &Documentation Fee B
/
IBUSLIC Business License B
•
AOF
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408) 777-3228
fINO Fax(408)777-3333
4kUPE
Building Department
JOB ADDRESS: PERMIT #
; 2 �>_� D L F (�2L4--d of U
OWNER'SNAME: Lout OOLEPHONE # o2gX- /ft '?
GENERAFAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
60 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