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07060059 CITE OF CUPERTINO BUILDING DIVISION PERMIT � �TQCTI . PERMIT NO. BUILDRI� �EssHOMESTEAD RD AQUATEK PLUMBING INC 07060059 L PERMIT ISSUE DATE OWNER'S NAME: 06/08/2007 20900 HOMESTEAD PARTNERSHIP P O BOX :?3271 SANITARY NO. CONTROL NO. NE: (408) 295-7767 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description Vr- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE EXISTING GAS LINE t`om in full form and effect. �i77s 7 CONTRACT'DR PAID BL W/ PERMIT FEE v�Z LiceClass Lic. Datense Con Ugrrnr ARCHITECTS DECLARATION i a I understand my plans shall be used as public records ;WU U.H Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 3 p O following reason.(Section 7031.5,Business and Professions Code:Any city or county �,�, which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation —rn Prior m its issuance,also requires the applicant for such permit to file a signed statement $f.Ft.Floor Area ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $8000 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 2 6 0 9 0 2 9 Aptl Number P Y Type not more than five hundred dollars(5500)• 0 I,as owner of the property.or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The ContractOes Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 700 of the Labor Code,for the performance of the work for which this permit is issued. My Worke�esCompensation Insurance carrier and Policy number aarre- Cartier:J# . ns � �h C ANrV Policy No.:`r�! CERTIFICATE OF EMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY E.t -• I hereby affirm that there is a construction lending agency for the performance of a+> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Lenders Address U 0 1 certify that I have read this application and state that the above information is f3. correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless Ute City of Cupertino against V) liabilities•judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting this permit. Date APPLI NT DERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU REG TI /� Alit "t/ Re-roofs Signature of Applican on or Date 'j Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by Ute Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? (� All roofs:hall be inspected prior to any roofing material being installed. 0 Yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new In Iterials for inspection. District? 0 Yes No I have read the hazardous materials requirements undcrChapter 6.95 of the Califor- nia Health&Safety Code,Sections 5505,25533 and 25534.1 understand that if the building docs n urrently ave a tenant.th 't is my responsibility to notify the occupant of the Date rcyui nts wh' ust pri r tc of Occu cy Signature of Applicant All roof coverings to be Class"B.'or better Dart 0 r or aut rized ag ' CITY OF C'UPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609029. 00 DATE ISSUED. . . . . . . : 06/08/2007 RECEIPT #. . . . . . . . . BSO00001587 REFERENCE ID # . - - : 070E0059 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . . CITY CUPERT INO IMPACT AREA . . . . . . OWNER 20900 HOMESTEAD PARTNERSHIP ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 RECEIVED FROM . . . . : AQUATEK PLUMBING CONTRACTOR . . . . . . . : SHEPHERD, JAMES LIC # 21658 COMPANY . . . . . . . . . . : AQUATEK PLUMBING INC ADDRESS . . . . . . . . . . : P 0 BOX 23271 CITY/STATE/ZIP . . . : SAN JOSE, CA 95153 TELEPHONE . . . . . . . . : (403) 295-7767 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPGAS OULETS 1. 00 5 .40 0 .00 5 .40 0 . 00 BSEISMICRE VALUATION 8, 000 . 00 0. 80 . 0 . 00 0 .80 0 . 00 BUSLIC FLAT RATE 1 . 00 107 . 00 0 . 00 107 . 00 0 . 00 PPERMITFEE FLAT RATE 1 .00 38 .37 0 . 00 38 .37 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 151.57 0 . 00 151 . 57 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 151. 57 8990 --------------- TOTAL RECEIPT 151. 57 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF C UPERTINO alwor PERMIT APPLICATION FORM CUPEI,TINO .ON# � Date: Building Address: U Mailing Address (if different from building address): Owner's Name: Phone#: It s� ��e yon a��- �� ContractorLicense #: � 7�. � 7 Contact: Phone:,NS- 7'7lo7 Cupertino Business icense#: / Q. �C Fax: Building Permit Info: Bldg ❑ Elect ❑ Plum Mech ❑ Job Description: /. I� Syfo Residential ❑ �� 4699� LIl/1�9 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Q �'j Occupancy Group: QQ � �- Type of Construction: //'' Please check this box if the project is a 4. 15 second-story addition: ❑ Project Size: Standard ❑ Large ❑ Majcr ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER O:her Appliances MECHANICAL BBOILERI Boil,-,r<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Bo ler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH F otel and Motel BUILDING BCONSTAXR Con,tax —Resi/Mobile BUILDING BELEC 1000 Elec. 600V<= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec S vcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Er.ergy Add Multi BUILDING BINVESTIGA Ir vestigation fee BUILDING 1 o.'3 y . CITY OF CUPERTINO Cin OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL -- - -- - BNUCOMMM New m omMechanical 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?iping 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 Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawr. Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalVAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT R-,inspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relc cation 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 Polc/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Re:ocation of Hood MECHANICAL BREMREPALT Rep air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 20 F 3 a1C10F CITY OF CUPERTINO CUPf(�TiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rind Signs Add Branch ELECTRICAL BREMSIGNS Remc del Signs, Marquee ELECTRICAL BREMTHEATR Thez trical Lighting Fix ELECTRICAL BREIVPVENFA- N Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scab Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE S,-ismic Fee Res BUILDING BSPECIAL SI ecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tem ora Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC E ectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mcchanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC PlanningI,R Comme/Multi-Fam PLANNING PLLONGRNGR Planning ong Range Residential PLANNING 3of3