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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
101-47 VISTA KNOT.T. RLNTD
CAL -COAST REPIPING, INC.
PERMIT NO. 06030060
OWNER'S NAME:
PERMIT ISSUEDATE
DANA GUNDERSON & THUAN HO
G1371 TITAN
NE:
SANITARY NO, CONTROL NO.
(714)578-5090
ARCHITECUENGINEER:
BUILDING PERMITINFO
ELECT PLUMB MECH
LICENSEDCONTRd
Job Description
underSDECLo of Chapter
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
p
Division 3 o the Business and Profrssians Code, &M my license is
wit,Scotian 7 i
ndo)of
iuemlm¢eana cream
COPPER REPIPE WHOLE. HOUSE
DatadmGlM Lie'
Data Comracmr
MAN.* j- 2006
A CHITEshollWTS DE I N
public
I uMcnunJ my plans shall W used u public rds
atl
ENV
�UI®LJ' IG
Licensed Professional
OWNER -BUILDER DECLARATION
p�`�tt{(I
I hereby affirm that 1 am exempt from the Contractors License Law for the
y
fallowing maven. (Section 703 1.5, Business and Pmfesuuns Calc: My city or county
which acquires a permit m Consumer, altar, Improve, demolish, or repair any structure$6320
Sq. Ft. Floor Area
Valuation
prior to its issuance. also requires the applicant for such permit to rile a signed sulemcm
Nat he is licensed to the of the Comrazmr's license Law (Chapter 9
punuwn provisions
(commencing with Section 7") of Division 3 of be Business and Prefcssinns Code)of
that he u exempt therefrom and the basis for the alleged exemption Any violation of
APR c
Occupancy Type
Section 7031.5 by any applicant for a permit mbjccu she applicant m a civil penalty of
not mom than fw hundred dollars ($5M).
❑ I,uownerofthepmv ny,mmy=ploymwithwagesu Weirmlecompenation,
W III do the Wolk, and the sWMUR Is natintm ted orofored rarmle (Sec.70m, Business
Required Inspections
and Professions Cade: The Conuactnra Limnse Ins, does trot apply ro an owner of
property w he builds or impwes thereon, and who does such work himsel f or through his
Own employees, provided that such improvements ase not intended oroRered forsale. If.
however, the W ilding or improvement is sold within m¢ year of eompleuon. We owmr-
builder will have the burden of proving that W did not Wild or improve for purpose of
salcJ.
❑ 1, a owner of the properly. am exclusively contracting wish licensed women on to
consumer the project (Sec. 7044, Business tad Professions Code) The Contractor's Li.
Cave Law dos not apply to an owner of .,my who Wilds or improvss damem. and
who contracts for such prejecu with a contsanor(a) licensed pursuant u the Contractors
License Lash.
❑ I am ex am" under Sec. ,B&PC for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under paraty, of perjury aro of the following decluetions:
1 haw and will maintain aCerliriata of Consent to self -Insure for Workers Compere
duan, u provided far by Section 3700 of dta Labor Code, far the performaae of the
Weak for which this permit is issued.
w and will maintain Weakcrs Compensation Insurance, a ralumed by Section
7 of the Latma Code. far the of lM fm is issued.
performance waft which this permit
My Worker' C mpeuatian Wuunce earn and Policy number
Carver. Policy No.:
CEMR ATE O^ EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be Completed if or permit is Foran, hundred dollars (5100)
or less.)
1 carol, that in the performance of the work far which this permit is issued, I shall net
cmploy m, person in any manner an a to become subject to dte Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Cenifcaw of Exemption, you Would
become subject M th, Wohcr's Compensation provisions of the Labor Code. you must
comply with such provisions or this permit shall W deemed mvnked.
CONSTRUCTION LENDING AGENCY
1 emby affirm that acre is a construction lending agency far the performanceof
the nark fur Which this permit is issued (Sec. 3197. Civ. C.)
Under's Name
Lendeh Address
1 certify that I have mad this application and sum that We shout inrnsmation is
caned I agree to comply wit all city and county ontinances and seta laws relating be
building construction, and hereby authdme representatives of adaciry, to enter upon the
above-mentioned prepeny for inspcNon purposes
(We) ago, to ave, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and Cap.., which may in anyway ACCTm against said City
in couequenee of the grating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:S4tQ� 3
SOURC ULATIONS
Date djdr
_ /��
Re -roofs
si oaa p rc Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
bei We applicant or future building meupanl now or handle hanrdou mwcriu
u defined by the Cupertino Municipal Code. Chapter 9.12. and dm lr,alth and Safety
Cat. Second 2553257 ' �,✓
❑Yea !'C"
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
I M7,aoous oil contaminants as Jcfncd by tlm Bay Area Air Quality Management
all new materials for inspection.
trict?
]Ys
I have mad the barafdo sm derads requirements under Chapter 6,95of the Califor-
niaH ) 8SafctyCode,Sections255115,25533and25534.1un&mmdthatifthe Wilding
Jou not currently have a tenant that it is my rospouihility as mdry Ir, occupant of the
wgmm hick mustme o nmanexora Cewficataoroccupane'
o�� ��-1 �6
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner err ay oumtl agent Dam
or 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .... ...: 32613120.00
DATE ISSUED.......: 03/13/2006
RECEIPT #.........: 33536
REFERENCE ID # ...: 06030060
SITE ADDRESS .....: 10337 VISTA KNOLL BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 3
OWNER ............: DANA GUNDERSON 6 THUAN HOANG
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1035
RECEIVED FROM ....:
RYAN CLEMENT
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
E ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
BPREPIPE NO OF FIXTURE
11.00
99.00
0.00
99.00
0.00
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
BUSLIC FLAT RATE
1.00
----------
105.00
0.00
105.00
0.00
TOTAL PERMIT
251.37
----------
0.00
----------
251.37
----------
0.00
METHOD OF PAYMENT AMOUNT
_________________
NUMBER
------------
OTHER 251.37
--_---__-----_-__-
VISA
TOTAL RECEIPT 251.37
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
301 ROUGH PLUMBING
502
FINAL PLUMBING
ENERGY
507 FINAL PLUMBING
sa,
CITY OF
IOUPERTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Deuartment
JOB ADDRESS: PERMIT #
10337 l<,il &A 1 0603o0 <� e
OWNER'S NAME: /)a,,\ irtx,derson I PHONE # x/08- S69 -2y�rl
GENERAL CONTRACTOR: Cc -1 C-oc. S4- `Q.Dd(�:FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
s
Owner/Con actor Signature
3-13-06
Date
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
o j.
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
s
Owner/Con actor Signature
3-13-06
Date
a�ggg_,
CITY Or
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
b&a 306&b
APN# 3,7),/_
I z /av
BUILDING
BPGAS
Date: 3I ?, OC
U
Building Address: /0337
337
1 V '/ f46,
' '
� t,J
BPREPIPE
Owner's Name:
PLUMBING
BPFIXTURE
PLUMBING
Phone #:
Contractor:
PLUMBING
n
Phone:
21
PLUMBING
License #:
Contact:
C
one:
9/G -
M-
Cupertino Business License #:
a3 a
U
BUILDING
I -
Building Permit Info:
Bldg ❑
Elect
❑
Plumb
Job Description: Comer
rep. -at
I v%D /f hgvf2
Residential N,--
Commercial ❑
Cost of Project:
63
20
•
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
Repipe of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
•