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10020055 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22201 BITTER OAK ST CONTRACTOR:WATER QUALITY PERMIT NO: 10020055 PLUMBING ^'VNER'S NAME: ROY JOHN G AND SUZANNE C 1860 ALMADEN RD DATE ISSUED:02/10/2010 . .,NER'S PHONE: 4087460633 SAN JOSE,CA 95123 PHONE NO:(408)267-9330 ` LICENSED CONTRACTOR'S DECLARATION r r - 13UILDING PERMIT INFO: BLDG ELECT PLUMB License Class '�� Lic.# �R MECH r— RESIDENTIAL COMMERCIAL Contractor, l,P. 0 �P&Date 9_4 T-I C) I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER RE-PIPE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. ., Y I hereby affirm under penalty of perjury one of the following two declarations: kt I 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 y performance of the work for which this permit is issued. 3q.Ft Floor Area: `" Valuation:$6800 I 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 permit is issued. AOccupancy Type: PN Numbers 25.0 APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harn,*ss the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 7 with all non-point source regulations per the pertino Municipal Code,Section Issued by: — — Date: 9.18. Siv_nat e ` Dat RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 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 Own or-a age/ t: Compensation laws of California. If,after making this certificate of exemption,I i Y Date:2-- _ become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save .nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the ertino Municipal Code,Section 9.18. Licensed Professional Signatu Date �� f CITY OF' CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B]k: Lot: APN . . . . . . . . : 3651025 . 00 DATE ISSUED. . . . . . . : 0,' /10/2010 RECEIPT #. . . . . . . . . BE�000009727 REFERENCE ID # . . . : 10020055 SITE ADDRESS . . . . . : 2 :201 BITTER OAK ST SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ROY JOHN G AND SUZANNE C ADDRESS 22201 BITTER OAK ST CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0103 RECEIVED FROM . . . . : MARTY SATALINO JR CONTRACTOR SATALINO, MARTY LIC # 21526 COMPANY WATER QUALITY PLUMBING ADDRESS 1860 ALMADEN RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE (608) 267-9330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 800 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 6, 800 .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 1. 00 11. 00 0 . 00 11 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00. 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 138 .70 0 . 00 138 .70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 138 .70 AMEX --------------- TOTAL RECEIPT 138 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO µ REPIPE/SEWEIUMAIN SERVICE CUPEi�TINO PERMIT APPLICATION FORM APN # Date: _ 25 2- Building Address: Owner's Name: Phone#: Contractor: Phone#: Fax #: Z Contact: Phone#: Fax#: Contractor Lic nse Cupertino Business License#: Job Description: Residential -- Commercial ❑ Valuation: Project Size: Express Standar Large—[] Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & I he sheet index. Green Building Points: Quantity Fee ID Fee Description Fee nPer:m:itType Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary s,-wer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Ga, Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standzrds Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF C'UPERTINO Z�ITYOF REPIPE/SEWEIR AIN SERVICE CUPM iNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P f 1PRSEWER Residential building P 1RPSS sewer/sanitary sewwer / 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1 BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage i;isposal System P 1 PCESS Cesspool P 113PWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping Syste-n 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/;ias Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License: B Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;UPEkTINO Buildin De%PERMIT JOB ADDRESS: # OWNER'S NAME: # � 3� GENERAL CONTRACTOR: �. F # I am not using any subcontractor Silftature Date Please check applicable subcontractors and complete the followinginformation: 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