06060028�.,CITY OF CUPERTINO _- a �• ��" = ''°"' " "° `t''
BUILDING DIVISION PERNIIT .,COI!I`�R:*1CTORII�1I1'ORMA'EIf)N
BUII�IEADDRM , AQUA FLOW PLUMBING PERMITNO.06060028
11C'OWNEPERMIT LSUE DATE RHONDA NUNEZ 565 N STH STF 06/05/2006
NE: SANITARY NO. CONTROL NO.
(408) 265-9504
ARCHREC 7ENG'INEER: BUILDING PERMITINFO
BLDG E12C7 PLUMB MECH
0 0
o� LICENSED CONTRACTORS DECLARATION lob Description
:WE 1 hmcby dfum tub1 un 11¢8x1 oder Ro•itiou a O.P.9(eomtmrelnt P
Biu rdi SoNan7O1D)o(Divirion3of dx Bu9rea,rd Pram,essCoie.id my Ikea L3
13 .mnram ad ens �•' REPIPE GALVANIZED TO COPPER FROM METER TO ALL
FIXTURES . REPLACE WATER HEATER
•Fo DucCme,cm
AreCrS DE LLA ION
'� Iundcru,ml my PW",u"awIWuxdupbBc word
,i .
yU
:p Licensed Pureubw
OW NE.BUILDER DECLARATION
nI miyo .(Sei oo I em tempt tram tPO Cm um,Co,Lkrnc ly for the
:0 pff (ot Oh nt .. (Ssllon 7rt51.5,Buunu„nd K.tenon Coir:Any eay aegmay
LL MhlLh IqVftlaPetmlt"'Gton.,lb.hnfor ul imereiii. fimPNr Ny L(WYR
.i) P Ml izS ICmn¢.alw"'qui.pOOiUxwU of f«Cm toii',Lk. litn[(Lipter9
c N, k.I: aPmn�n,wN aaNrcam,w ,Lw: =L. (o m9 Sq.Ft. Floor Area Valua[$d000
i� (clmmendng tnth Section 7000)a(Div S of do,Bustle,ud PtMminm Code)o'
2 r$ Na Y u.,I Naef.and one bass for me dktnd metnpdm Any viduim of
St 7031.5 by my appO=fa,period,fubjea lle,pplfcmt W advil peudy,ofp,p�NS�mber Occupancy Type
s«m«e Nan Bae kW"Idned chum(55001. 3 5 6 2 3 0 4 6 . 0 0
❑1.m owar of the pmpvey,a my wpbyv4 rub p(U u thea mk mmpenaJon,
wal on the w«k.ud One smdmule h rut kmdeL or offered f«uk(See.7 .Buttes, Required Inspections
"Proremam Code:The Cmducmh L License U,ions ort apply Wan aww a q P
property rho Wad,«Improxs thecmd.ud oro d«„urb wrk mmelf«WrouN his
awe empbym,poNtled Jw diet,imptmeme",•dine m1. ._ ,_.«olfemd for ule If,
kmvevor.Ne IaNLlnt«impro.®eu u sold.LIMO One yer of.0 dim.the ownv-
bild,n mL bade the trade"a Proving Nu he iii and Wild a hopOnK for ptvpox of
uk.l.
°1.u axecr a one propeny.w veIien"iy cona,ming rich Mame,co,o,uon m
consWTI Ne nt;" (see n..Bus of Pr,f wi cte;.0 pn Conmaot,LL FI
�
pax Lor is o,at'Pt'Inah. apeopmy wh,WdIn«impm.m Nermv.,nd.
Like l�,[I](Of.LlCh pda)CN MIdt]La,IlYlm(i)IIR"xd pCf]YW WNC e0,1lY.1Cr, ���
Llavm V..
❑lam...mpd luldv ace .BdPC(«Nu ream '',N
WORKERS COMPENSATION DECLARATION
I teneby dam Orderpm,lty,Of perjury arc of the founding decWulvu: yyy��y Le ��1DU0
IhsRand rN m•"•naCrrJflamafConxm Wxlf-vlure(«WahaYe Compenp d��
,dm.r provi i fpo by Senlmd 7100 a tie Lab«Cock.fm We podrcmrc a the 1�v(I ���
work.t rtkd Thu pvmit u Tim;issned.3
3 hne ud Mill mu0ui,Wor 'eompeouda.I..a rtywtcd by Section
a the Libor Cod,In,IM pvfamumsof the rack In,w IOU pump In Lswed
My Wo zcompeeaft orrkr W Policy nwober dim:
77�
Curkr PoOcy FROM
RIIFlCGTE OF EXEMPTION PROM WORKF]LS
COMPFNSA710NINSURANCE '
mat, ,lm need on,be,OOi lUdifdx pvm,u fo ono hmtmel down(51001
orleu.)
1 emJfy Net in the ped«m,rcr of Ne work In,w1m li Thu pm,u IS isend.1 swl ons
employim.person in any maervm a a became ini in Ne W«ken'rte•.. m
IJw'S a Cdlf«du Duo
Appllmm
NOTICE TO APPLICANT:If,div making this Cenifinle of Exemption.you Odoold
Weome ini W ft W« s eutopcneJon prm UiOns a No Iitor Goa you mm
.,O ranhwiN cnmPly riN=h Provisom«this Per '"I ne dermad rt+okcd .
'Z CONSTRUCTION LENDING AGENCY
[-+IV, I hemby drum NU Jens u,co OnnkdWa,t,teoey r„NC Pcf..of
CCS Ito work(«which Jlis Pcrmid u IVIS(S«.]041.CO,C)
Ledet"Name
.,� Z l<defa Aidan 5 .
U0 1 eadfy dtit l have ton this wlkssu rd sue Thu din id,O 0 idomulm u
LL I.., torted l and to canply wad,all tidy W,000rf orditwtcei ind Stile lar,mlrint to
O U Wilding comouction,aM hemby auJwnv eprmcnuti. of Nir city to enter upte Nc
>' W aMvc-mcmi«W papcny(«
imlccvm ptapoxs
(We),gtce to uta.Indemnify and keep harmlou the City acupmino dune
" N Ilabiliiq Judgmeoa,emu admpense,whit maymudy way,cmae,gslw ab City
UZ in canapatta atter truvintaNi,puma
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. _ _
au0 G/S/flG Re-roofs
Ignra ',4SHAlA D�OUS MATERIALS DISCLOSURE —� Type of Roof
WIII Je WPlkant«(umm hdldint omgmt uac a hadk haa,tloto mamrul
u dc0md ty 1h Cupmim MuNcip,l Code.Csaper 9.12,rdtl tic HalN ani Sdmy
ewe.s«Jan 255324011 All roofs shall be inspected prior to any roofing material being installed.
°m
Will ft awlicvlt«Intone Wilding oamp,«ax eatupaiwt rr&M w b If a roof is installed without first obtaining an inspection,I agree to remove
,mit Ilvudou dr mnlLldrlrn,u dcGnd by Ih Bay Atm Air Qdity Mm,tcmcnd all new materials for inspection.
Qa ort
°Yon
I hack mtl One hvaN,rs maxnau mqulmmum mhr CluPWri.95 of Ne CaB(«-
LiuHmIIhk WuyCode.Seen..25505.25533 snd25534.Itindesu it IJUl fife Wi4tiet
ion not cmmaly Nre a Insane Thu It u my tapomibilidy W nodfy ft omyru a the
mquaelre whichmaebcmctpnorWisuanas,eenilkvcor Signature of Applicant Date
All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35623046 . 00
DATE ISSUED. . . . . . . : 06/05/2006
RECEIPT # . . . . . . . . . 34679
REFERENCE ID # . . . 06060028
SITE ADDRESS . . . . . : 11351 BUBB RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JOSE & RHONDA NUNEZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : DAVID GREGG
CONTRACTOR . . . . . . . : GREGG, DAVID LIC # 21162
COMPANY . . . . . . . . . . : AQUA FLOW PLUMBING
ADDRESS . . . . . . . . . . : 565 N 6TH ST STE F
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 265-9504
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ - ---------- ---------- ---------- ---------- ----------
BPFIXTURE UNITS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPREPIPE NO OF FIXTURE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 . 52 0 . 00 102 . 52 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 102 . 52 VISA
TOTAL RECEIPT 102 . 52
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : '35623046 . 00
DATE ISSUED. . . . . . . : 06/05/2006
RECEIPT # . . . . . . . . . : 34680
REFERENCE ID # . . . : 06060028
SITE ADDRESS . . . . . : 11351 BUBB RD
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOSE & RHONDA NUNEZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DAVID GREGG
CONTRACTOR . . . . . . . : GREGG, DAVID LIC # 21162
COMPANY . . . . . . . . . . : AQUA FLOW PLUMBING
ADDRESS . . . . . . . . . . : 565 N 6TH ST STE F
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 265-9504
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- - --- ---------- ---------- ----------
BPFIXTURE UNITS 9 . 00 81 . 00 9 . 00 72 . 00 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 34 . 86 0 . 00 0 . 00
BPREPIPE NO OF FIXTURE 1 . 00 9 . 00 9 . 00 0 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 38 . 37 0 . 00 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 10 . 79 0 . 00 0 . 00
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 50 0 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 174 . 52 102 . 52 72 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - ----------- ----------- -------
OTHER 72 . 00 VISA
------------
TOTAL RECEIPT 72 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
C1fY OF Fax(408) 777-3333
J&UPEkTINO
Building* De artment
JOB ADDRESS: PERMIT #
5 Qtz6 0 6o a-z
OWNER'S NAME: PHONE # Z 7
GENERAL CONTRACTOR: FAX # 4�
I am not using any subcontractors:
Signature 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
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�- , er Contractor Signature Date
el as� I
CITY OF CUPERTINO aeowoo Q
crvoF PERMIT APPLICATION FORM
CUPEkTINO
APN # ��,—�_ 23 Date:6,
Building Address: VJ Mailing Addres (if diff rent from building address):
S
Ow is Name: Phone#:
4
Co tractor: License#:
,Q Z c
Cont Phone: Cupertino Business License#:
ct:
v z Fax: 2 77— o4
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description: 12�_r p� c-ore,- /ec c
Residential K w+a-ce- /.,gQ ,tom Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost Project: Occupancy Group:
7
Type f Construction: Please check this box if the project is a
( J
second-story addition: ❑
ro'ect Size: Standard ❑ _Lare ❑ Ma�or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I00K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of
lw)
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical 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 Piping 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 Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER , Sewers PLUMBING
BPSPRINK ' Lawn S rinklerBackflo PLUMBING
BPSTORM Stomi/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation 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 Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
g6Q_uantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE -Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
3 of 3