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10060159 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22172 BITTER OAK ST CONTRACTOR:WATER QUALITY PERMIT NO: 10060159 PLUMBING OWNER'S NAME: MONICA GERSTNER 18 i0 ALMADEN RD DATE ISSUED:06/25/2010 OWNER'S PHONE: 4087330873 SP N JOSE,CA 95123 PHONE NO:(408)267-9330 LICENSED CONTRACTOR'S DECLARATION JCB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class �f 3!o L_ilc.# Z306—cam/CE5 COPPER RE-PIPE Contractor w �- �l Date 6 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32651048.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Date: granting of this permit. Additionally,the applicant understands and will comply Is ued by: — with all non-point sour regulations per the Cupertino Municipal Code,Section 9.18. �` //__ RE-ROOFS: °nature Date Co_ v Al l roofs shall be inspected prior to any roofing material being installed.If a roof is in:tailed without first obtaining an inspection,I agree to remove all new materials for in:pection. ❑ OWNER-BUILDER DECLARATION Si;;nature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I Lave read the hazardous materials requirements under Chapter 6.95 of the C:,lifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three mAntain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupi;r*9 Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by th,Health&Safety Code,Sections;,550 55 3, 5534. r Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I I ereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) L4 rider's Name APPLICANT CERTIFICATION Li rider's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating r�building construction,and hereby authorize representatives of this city to enter n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ..iemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I i nderstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Li tensed Professional 9.18. Signature Date / Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST ; �2 PERMIT# /.f�� JOB ADDRESS: OWNER'S NAME: C) PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: "� S� 2 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANC. INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON AC'C9p HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signat are Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: 7.,ot: APN . . . . . . . . : 32651048 . 00 DATE ISSUED. . . . . . . : 06/25,2010 RECEIPT #. . . . . . . . . : BS000010707 REFERENCE ID # . • • : 10060/59 SITE ADDRESS . . . . . : 22172 BITTER OAK ST SUBDIVISION . . . . . . CITY CUPER`CINO IMPACT AREA . . . . . . OWNER MONICA GERSTNER ADDRESS . . . . . . . . . . : 22172 BITTER OAK ST CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WATER QUALITY PLUMB CONTRACTOR . . . . . . . : SATAL[NO, 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 AMO'JNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 8 . 00 88 . 00 0 . 00 88 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 215 . 70 0 . 00 215 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CHECK 215 . 70 17626 --------------- TOTAL RECEIPT 215 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # �� Date: Building Address: (o -- Owners Name: Phon #: C-3t6)- -- 7S3-C-27-7 Contractor: ` Phone#:�lO� -�-7-�1�3 U � 19-1 ��w�,b�r- Fax #: Contact: � Phone#: Fax #: Contractor License#: p�"'p� Cupertino Business License#: Job Description: Residential Ccmmercial ❑ Valuation: Project Size: Express tandard 0 Large ❑ Major Green Building: Please complete relevant portion of the Green Building Chec ' t atta it to the application or if applicable, include in plan set& the :sheet index. Green Building Points: �� C) Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial buildin; P 11CPSS sewer/sanitary sewe:- 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piling System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercia. P Revised 01/07/09 I : CITY OF CUPERTINO REPIPE/SEWER/MkIN SERVICE CM of CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P IRPRP 1BPWSVCS Water Service P ICPWS or IRPWS IPPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P / IBPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas In P 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B s