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06060056 CITY OF CUPERTINO '•BUILDI 'NG-DIVISION PERAUT ,.., 'ON'sCRAC'ATQR'Il f`Q TIQ;,N y BUILDING ADDRESS: WATER CLARITY PLUMBING PERMIT NO.06060056 10158 MYER PL OWNER'S NAME: PERMIT ISSUE DATE GUGLIELMETTI RICHARD 1872 STONE AVE 06 E: SANITARY NO. CONTROL NO. (408) 275-9300 ARCHITELTR?NGINEER: BUILDING PERMIT INFO BLDGO ELECT O MECH p0 LICENSED CONTRACTOR'S DECLARATION IbD0SCf1 Description I hereby affirm am Rat I licensed under provide.of Chapter 9(cmuO om ting P w)Ih Section IBMs)of Division Sof Me Business and Professions Code,and my Ikena is „ in full Form andnH - ^3z REPIPE, MAIN WATER SERVICE; WATER HEATER )gz Lkenso Clsv Lie.0 Dam.Contractor ARCHITECTS DECLARATION I undersand my plus shall be used a public meorda s iC c Licensed Pmfuaianal OWNER-BUILDER DECLARATION E I hereby a1Rrm that I am exempt from Ne Contractors Licence Law far Ne 0 0 following mason.(Section 703 I.S.Business and Pmressions Cade:Any city at county S$V which requires a permit to construct.alcor,hnpmve,demolish.or repair my suunum $6000 -i rrn prior in is issuance,also requires Ne applicsm farsuh permit to file asigmd comment €� Nat he I,licensed permpt to Ce provisions of Nes Conuacae,license Law(Clupkv9 Sq.Ft.Floor.dkTea Valuation $ (commencing with Sudan 7000)of Division 3 of the Business and Pmfessons Code)or .- that be is exempt therefrom and the basis for the alleged exempilon.My violation or Sachets 7031.1 by any applicant for a permit subjects the applicant N a civil penally of r U U Occupancy Type not mom Nm five hundred dollars(5100). ❑i. l wser afatapropmty.um.ti.my .offeredf. ouso.1044. naanm, willPr les im.,seams he ContumUnmad an I,.redfuWcpply 70as 9aairca Required Inspec ane property who h ons Cade:The Contractors and dwho law doss set apply lf rt owner of q P mento plombuildaodmprovuchimpr andwsisme auneade moffi al Waugh hu ownemployees,providedvittsuch Improwmamsarem11nm reuoQemd formic.If. however,Ne building u Improvement is sold a did ane year of mpromf r Ne a es of builWr will love Ce burdu of proving Nat he did set bulla or hnprove far purpose of / sal..). ^ 7 ❑I.a cater of the property aA anduaivelY eanuaming with licensed mnhacsora to canae me (Sec.70/4,Businessand Pefesrana Cade:)The CommU. ences cameLaw do.notapply en arorpropedywce build,rsheft..and. whocontexts for proecu with n canhmoN)licensed person,to fteanumwfs License Law. ❑I oreestmpt undo See. .B B P C fu this mann owner Dam WORKERS COMPENSATION DECLARATION 1 hemby affirm under penalty of perjury am of Ne following declaavans: I have and will maintain a CWfirom of Consent to self-imam fa Warkees Compen. action,as provided for by Section 3700 of the labor Code.for the performance of the work for which this Permit is imbed. ❑I have and will maintain Workers Compensation Insurance,as squired by Scmim 3700 of me tabu Code,for me performance of the wank for which Oda permit is issued. ' My WorkersC man ice c�riu and Policy me are: Cartier, v OI Icy No.: IFl iOF EXEM ON FROM WORKERS' COMPENSATION INSURANCE cres mise dead notbecampkhW Irate permit Is rerone hunmeddoban(5100) or jest) I cerdfv Nat in the perform.of me wart for which Nis permit Is issued.I"I set employ any person In my mmmrso as be become subject an the Workers'Compensation Laws of California.Dam ApPlicml NOTICE TO APPLICANT:If.after making this CeNncam of Exemption,you AMW become subject m the Workers Compensation provinces or Ce labor Com.You muss .J 0 ronhwith comply with such providam or Nis Permit radI be accrued rooked. z CONSTRUCTION LENDING AGENCY (+ Thereby affirm Nat New laacotmrutinn lending agency for CO Performance of C6 ,7 the wart for which this permit is Wood(Sea.3097,end.C.) QLenders Name M z Lenders Address U O I sonify that I haw read this application and team the f&bow information is w P Comm I agree to comply with all city and county ordinances and arm laws slating to 0 U building construction,and hereby authorise mpmsenutivea of Nis city to enter upon the OW. ahcw-recnuuncd peoperly,for inspection purposes. (Wes)agree in save,indemnify and keep hamden the City of Cupertino agaWl tl"y In liabilities judgments.cont,and expenses which may In my way&rcma against said City U in consequence of the ing of this orth. �+ APPLICANT UNDEgMANDS AND WILL COMPLY WITH ALL N-POINT Issued by: 60 Date SOURCER NS. Re-roofs �--- SignmuCanumror ase HA7.ARDOUS MATERIALS DISCLOSURE Type of Roof Will Om applicant or Future Wilding acupsmrmc urhandle huardom material as dented by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safely Cade,Scedon 25531(a)7 All roofs shall be.inspected prior to any roofing material being installed. ❑Yu No IWill Ne applionm u f are Wilding aceupant va equipment u devices which If a roof is installed without first obtaining an inspection,I agree to remove he'rardnu&air cuaminama dcMed by me Bay Arta Air Quality Management all new materials for inspection. Claude? ❑Yes Nu I ban mad the harardous materials requiremuu mderChmer 6.95 of Me Cslifor- nlaHnalNd:Safelyc 25101.25533 and 25334.1 understood!thr Buss Wilding does ml eureemty It W set that Ity responaibillty cenotify the ml of W mquimmenuwhi as t anceofa CeNncamof Occas SI plicant Date owner ser o am All roof coverings to be Class"B"or better CITY OF CUPERTINO om 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . 31623046 . 00 DATE ISSUED. . . . . . . : 06/07/2006 RECEIPT # . . . . . . . . . : 34729 REFERENCE ID # . . . : 06060056 SITE ADDRESS . . . . . : 10158 MYER PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GUGLIELMETTI RICHARD ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : WATER CLARITY PLUMB CONTRACTOR . . . . . . . : NICK SATALINO LIC # 23255 COMPANY . . . . . . . . . . : WATER CLARITY PLUMBING ADDRESS . . . . . . . . . . : 1872 STONE AVENUE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 275-9300 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPREPIPE NO OF FIXTURE 1. 00 9 . 00 0 . 00 9 . 00 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPWATER UNIT 1. 00 9 . 00 0 . 00 9 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 100 . 83 0 . 00 100 . 83 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 100 . 83 MASTERCARD TOTAL RECEIPT 100 . 83 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development s 10300 Torre Avenue ti Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 ' CUPERTINO Build ing Department JOB ADDRESS: �I PERMIT # OWNER'S NAME: G i PHONE GENERAL CONTRACTOR: , y FAX # I am not using any subcontractors: �vi� gnature Date Please check applicable subcontractors Ad complete the following ' ormatiom 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 CITY OF CUPERTINO a10 PERMIT APPLICATION FORM CUPEf�TINO N# Date• r BuildiggQ � r� P Mailing Ad r ss if different from building address): � Own s ame• t1 w � Ph #: _ s � e 2 License 3 C act: / P e:40$Z-7S-97(K) Cupertino B siness License#: 1 / Fax: 46V F7,3 StJG Building Permit fo: Bldg ❑ Elect ❑ Plu Mech ❑ Job Description y vJ�� S 1A e Residential [� Commercial ❑ Sq.Ft. F e6 Sq.Ft.: Cost ofP * (4 00-D Occupanc(� - T: Type of Cons ction: Please check this box if the project is a i C&_ u_k second-storyaddition: E3 ro'ect Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX hid/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of CITY OF CUPERTINO CUPERTF PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit.Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING , BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water ervice PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appl.iance ELECTRICAL 2 of 3 aCITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fa m PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3