06070146 CITY OF CUPERTINOamx : i `� -
BUILDrNG DIVISION PERMIT GONTA6 ORJNFORMATIQN $.
BUILDING ADDRESS: WATER QUALITY PLUMBING PERMTr N006070146
7628 SHADOW
OWNER'S NAME: PERMIT ISSUE DATE
TODD SOO HOO 1860 ALMADEN RD 07/21 /2006
NE:
SANITARY NO. CONTROL NO.
(408) 267-9330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
p LICENSED CONTRACTOR'S DECLARATION lob Description
m1 bunch,affirm that 1 am licensed under pmvisima of Chapar,9(cemmer,mg
2 witb Scctian 70(l0)af Division 3ofibc Busimust and�Pyrafes�sim�esTCode.and my haat is
% in fall fomond affccx T�1G )� REPIPE GALV. TO COPPER
ta�2 Litems lass Contractor
ARCH A, /
—� CSDECL
ARCHITECTS DECLARATION
U1 understand my plans shall W used as public records
Gy Licensed Profcuionel
'tt��
3 OWNER-BUILDER DECLARATION
f I herchy affirm to I em exempt from IW Coutractoes license Law its,ft
:00 following mason.(Section 703 L5,Bosineas and Profession Code:Any city M county
m which most.a Permit as..4 alcor,imprave,dcmalim.ser repair any slractma 700
?ZY pot he islicensed
ensedpramint to
Nrvisu C.f Tae a aehperl11111acense fined(Chapter
rent
��< Ibu Wencinnudpumsanmo Ncpmvision3af ConuacsoriLiccfc nrCluptcr9 Sq.Ft. Floor Area stir
� tat he is xemptb therefrom
and
of basis f r of tW B ed exe p er.Any
Code)of
Nal W ts exempt Nercfrom and Ila buil for to alleged eumpuan.Any violation of
Securn 7031.3 by any applicant for a pewit subjects to applicant to a civil Penalty of
nor marc than fiva hundred dollars(M). Occup �ijpe
❑I,u owner of IW prapery.m my wployces with wage u Neu sole camperaauen, �p
will eo the work and Neswcm¢tsrwtineMed oraRcrW le,(Sec.701.1,Business Required Inspections
and Prefeasions Cade:The Contractor's Liarue n e ns law donot apply to an owner of q P
progeny eche builds or improves theme.andwho doessuch work himselforthrough his
awn employers,provided that such improvements are not intended oroRered forsale.If.
however.tha building ar improvement u sold within am year of compleum.Ne..
builder will have tW burden of praying that W did not Will our improve for purpose of
old.).
❑1.as owner of IW properly,am exclusively contracting with licensed awacta s as
construct Ne project(Sec.7044.Business ano Profestiau Cade:)The Commune's Li-
eense law does sot apply to an owner of Progeny who Wilds or improses tWteun,and
who conwcu for such projects with a cam ectot(s)Banxd pursuant to to Corommoes
License law.
❑I am exempt under Sec ,B&P C for this moon
Owner Dale .
WORKER'S COMPENSATION DECLARATION
0
1 WrcbY aDumunder pcvlty r(perjury me o(Ne following dceWauans:
1 have and will maintain a CartiOcare elemental m self-insuro far Warker's Compton-
muan,u provided for by Section 3700 of dh labor Code.for tha performance of ft
work for which this pawn is issued. at
❑11 and will maintain to
compensation Irwor which
u unposed Perm by Section
3700 of to Labe Code,far Ne reent, ane of the work for which this permit is issued.
My Workef ompensauon Insurance artier and Policy number,are:
Comer: Policy No.:
C imcATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
mossecuon teed oat becompleed ifft pewit is for one,hushed rattan($10(1)
less)
1 amity that in to performance of the work for which this permit is issued,I shall not D'
employ any persan in any m rnmrso as,as become subject to ft Warman Compcuauan
Laws of California.Data g�
Applicant I y
NOTICE TO APPLICANT:If,after making this Ccnificam of Exemption,you should
become subject to IW Wortrfs Compensation provisions of IW labor Code,you must I
.J O faMwit comply wit such provisines or this pewit mull W dcemcd mewled. •Lv
z CONSTRUCTION LENDING AGENCY
[••i 1 hereby alfim that there is a construction landing agency I'or to performance of
6i Ne work for which to .it las issued(Sec.3097.Civ,C.)
ILI
0 Landa's Name
z Lender's Address
C)Q I certify,thn I have read On applicuion and sate that the aWve information is
F^ towel.l agree to comply wit all city and county ortmoces and sum laws misting m
O V building consuacdan.and hereby authonna representatives of Nis city to cnterupnn the
mmec-ror
med
pare
4 Imbilies, opogroms,crty forepeason on which ms.
(We)agree to save,indemnify and keep bawless da City of Cupsono against
UN incoisequncofthe crowing ex this Permit. may in anyway acme agamutsaid City
U z A consequence of the granting of this permit
APPLICANT UpryJDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / L
SO
• R�LXA
ni� 7 I���
SmgnatorApp mData Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding aecupantwrc m handle haaardous material
0 defined by the Cupertino Municipal Coda.Chapter 9.13.and Ile Health and Safety
code, 0den vs3z(a)+ All roofs shall be inspected nor to an roofing material beim
❑res a P P � Y g being installed.
res th aPpfinnt ser mmrc banding attvp nt a cymnmem or d es wmm If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? /
QYos �pT
I have mad the hvaNwsmaarials mquircumms under C'bmu,r6.95 ordh Cabror-
niaHealth&Sa(ctyCodc,Seruru MMS.25533 and 25534.Imuca Land deradtho building
Joosnot eameraly pm a tram Nat il'u my aupomibilitY w emify do aaupmt of Ne
rtyu'cmcn fii f ra, Ipdortiavanaarachrofeahrf0aupmey. Signature of Applicant Date
-c7 7 9 � All roof coverings to be Class "B"or better
Owners authorizc0:gem Da g
X Community Development
4 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
16UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
6.12 60?D l 4
OWNER'S NAME PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: �T
ignature 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
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36224025 . 00
DATE ISSUED. . . . . . . : 07/21/2006
RECEIPT # . . . . . . . . . 35337
REFERENCE ID # . . . 06070146
SITE ADDRESS . . . . . : 7628 SHADOWHILL LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : TODD SOO HOO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WATER QUALITY PLUMB.
CONTRACTOR . . . . . . . : SATALINO, MARTY LIC # 21526
COMPANY . . . . . . . . . . : WATER QUALITY PLUMBING
ADDRESS 1860 ALMADEN RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . : . . . . . . : (408) 267-9330
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ------ ---------- ---------- ---------- ----- ----- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---- - ----- ---------- ---------- ----------
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------- - - - ------ ------------ ------- - ----------
OTHER 47 . 37 AMEX
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
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CITY OF CUPERTINO
�am�tok.,,, CITY
SERVICE
• CUPEI,TINO PERMIT APPLICATION FORM
APN Date:
Bui ding Address:
Owner' e: Pne
Q D— KLO o
Co Phone: of--2e;17 ,9230 License#:
Ceuta Phone: Cupertino Business License #:
v
Building e it Info:.
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•