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06070146 (2) 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 • �cecslblCo 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 •