06070074 FIU[LDING
Y OF CUPERTINO
UILDING DIVISION PERMIT 3�g.CCSNTRAG'LO INF;QRMATIO
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ADDRESS: SAN JOSE PLUMBING �+MRNo.06070074
26 BYRNE AVE RS NAME: PERMIT LSl1E DATE
BARBARA KELLOGG 1732 HILLSD
NE SANITARY NO. CONTROL NO.
(408) 296-1820
ARCHnECT,rENGINEE1L BUILDING PER INFO
BLDG ELECT PLUMB MEa
3oc
LICENSED CONTRACTOR'S DECLARATION ]Ob Description
�+C 1 hmcbY Nlrm tlw f am Ilaa,m ortticr ptoNsbns of Claps 9(mmmcain5
ZZW �NSauon T0110)ofDlHabn]ofdo BumlrcmmPmfauunmCodd,mmrna�u ^ i•`� f},
+ rwuaaana COPPER REPIPE & GAS I+sN.E, �F'OR:ti DRr
i Eloise_� ��� K uc. 1 `1 :r
f� Dam CXTfECI-5 DECD ATION �/�(y �i11 �a
1 YPI•^s•h•ll be Urdu Wblic rtcaNa !UL / `� N96
a c Licca cd Pror.nal
b� Oso I too OWNER-BUILDER DECLARATION
C I
IN G
I hemby&lira Nu I am exempt from the Gamna Cot l.icOnc city
for Ne
a o Mnich n:mum.(Sccom 7031.5. tflwr and Pmfaia it Cock:Aoy city l marry
$ whkh mquicu.panit b cm.n t el�cr.imp�a.e.dcmoruh,m mpolr any vwart $4975
prlarm as iswuce.ahtrequucs the applicant Oar such Omit m 0k.
< mat baulirc�dparaumtothePm�iamaarutacma�rI '' (Clmc,9 Sq.Ft Floor Area -Valuation
i�� (wnmeainS.IN Salim 7000)of Divalon Sof Ne Busineasm Proforma Cadc)m
ER— SSoc as 703.13 by any ap lPL ett a.Pic-^n�-blew�.uaam 1o.nrnil p�mwlmr or
tom arae eta rive hmdrtd aatlan(tSBBt er Occupancy Type
❑I.uowarr of Na ptop".amy wPloym wnn..6aa u Nck ak cmnpmtauloa,
wijdown.art."do, "".u.batiOttol"ofrarmr«aala(Sac.ro.B'm'+a' Required Inspections
m Pmrmalmu Cede:Tba ConuacmYs I kOns Lav do,,not appy man o.aer or
pmpmr.bo WBds a Imparu NaavA ane vbodasmahamk Wmsr3f m IhtaoW bis
ora employees.ptwdcd Nat a ch io,m ,auu.re not otadrd..ff,.d farad.If,
hawew.do btddwn5 ar bcproavam u mW.ua.am Y.of—Plrrlm-to o.om-
bullda.iB aR Na btadct of promo that k did tart build or znr a fm pups of
,ai").
p 1,n awrcr o<ft popnl•am acclaiv lr coodacting.'ah limned mnu.nan m
cmauom Ne pmjea(Ser.]Ila.Business Ilceo
t m Profuaimu Cada:)The Cdo=Wes Li.
ca
ansa La.daonm.IPyao o.na MIaWrtY.MWP mmmImpoas
who mncu for such pajaam.anh cma.morrA) xol d pa.l n Nc cn CoovactOh �
E]❑
I=Vv.
lam eumPt mda See .BlPCfm Nuremm
U mr D•m
WORKER'S COMPENSATION DECLARATION
1 k c,,Y adOrro uMer PetaltY or pujmy One of Ne raU inj tet•^ ^�
I ha.eand!.ic for by aCeniOaa of Gat Labto.Codcnsurefar N'atr—Oftn-
anon,u prwded for by Sudan l7(p o<Ne IAbor Code,fa de perfmaaoa err tote
work far.bicb Nis pmnit in jaunt
1 ban and w I mdNaln Warkch Cmnpcdabon Iwrarcc,u rqulrtd by SaUm .
3 of Nc labor CaEO,for tlo prformacccad,. fm.hkh this Parrot la(mtad.
My Worl�— ,,
adPolityJrMI"N3-UI N FR M P15URAb1LE
riT ¢calm nxd nm be compkW If do pamu is In,arc huoArd doBm(5100)
or less.)
1 a (v Nat In Nc performt.or Na.oh Oar. this pamn u Xatcd.I mail not
Ora"any pram in any maamr so u b bammc mbjat to tic Wor cnf CoonpmsaUm
Iowa or Csduorvia.Bae
Applcud
Nonce TO APPLICANT.it,aft"nowne Nu cerurtaua or Exenoption,you shoaw
become ttbjaa b be Worlds Carnpoatim IaOnar Of the LIhm Cod.Yon mum
OfaMwio comply with soca prorislom no Nu permit mall be dented mated. '
Z CONSTRUCTION LENDING AGENCY
1barely&Brum Nu dcrt is a cmarauoa krdin5 ametcy fm Ne Patrttrrnr of
the.at for.hkh Nis permit Is Laud(ser.309'f,CW.C.)
Gp lenddi Nax
2 lenders Address
U0 I anuY tat I Ia.e rad Nu.pplkuion and umc that Uta abo c inrmo.tltn u
U. P .roan l alra m canply v lh all city and emnty orthmrt¢s and nate Ia.s m W o,to
0 U Wildinecons tion,and bemby audnwix rc rt ntni.cs a(04 city on mor upon Nc
W wiaromentiuned property for impccuon pu�
(Wc),.c to are,indemnify m keep husks&tic City of CupcnLiOO a5tiut
y Iiabilium jodt.m coca"upmru.hich my In any arty aaam a5.lna a ab City
Uz In cnn amc anun5 of laper
s mDate
it.
,-. AI UND STAND ll.AND WILL COMPLY WITH ANON-POINT Issued by:
_CE [F.GU ONS.
�� Re-roofs
Si¢�v of ApptionV nor Disc
HAZARDOUS MATERIALS DISCI.o URE Type of Roof
W B We appUmit ar futurt bWlmnS aavpuaaort a hvtdlc haardawn mueti.d
u dented by Nc Cupenino MankiNt Code.Cepa 9.1;"the HaIN m Safmy
Code.Scci n25531O' All roofs shall be inspected prior to any roofing material being installed.
[D Y. oNo
Will do applkata M..bWltllnS aanpaa cqulpmmtadMcca kh If a roof is installed without first obtaining an inspection,I agree to remove
man aaNna.ur coo.iturRs as mOmd by the Bay Ata M,Qwllty Natal..' all-new materials for inspection.
DWrkrf
OYa 0 N
I aK mad Ne humdna m„"N&u mqu'uctrcn.u Ciaptm&95 of No Califon
not HrWN x SafvyCam-soman 155W.25533”2553+.1 atda,vma N.udm nuldl
the
Of ft
114�C adv' r uq Nam it a my mspo=Wity to ;7f y�ar/�
1 khmaa matmm' or.cmunataora Sig natureofApplicant Date
ar.at11o11R'd want m All roof coverings to be Class "B"or better
f _ Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
6UPEf�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: Y PHONE # 6 T
GENERAL CONTRACTOR FAX #
i
I am not using any subcontract rs �
ignature 41)a e
Please check applicable subcontractors and complete the followinginformation
SUBCONTR4CTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwo
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
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35715076.00
DATE ISSUED. . . . . . . : 07/13/2006
RECEIPT #. . . . . . . . . : 35235
REFERENCE ID # . . . : 06070074
SITE ADDRESS . . . . . : 10326 BYRNE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BARBARA KELLOGG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DAVID PLENONS
CONTRACTOR . . . . . . . : GARZA, KEVIN LIC # 21761
COMPANY . . . . . . . . . . : SAN JOSE PLUMBING
ADDRESS . . . . . . . . . . : 1732 HILLSDALE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408)296-1820
%E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4, 975.00 115.56 0.00 115.56 0.00
BPGAS OULETS 1.00 5.40 0.00 5.40 0.00
BPREPIPE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00
__________ __________ __________ ----------
TOTAL PERMIT 129.96 0.00 129.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ---__-______---___
OTHER 129.96 VISA
TOTAL RECEIPT 129.96
VOICE IO DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
• OF
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owner's Name: Phone#:
Contractor: / 1Phone: License#:/
I C
Contact Phorl Cupertino Business License#:
Build4g Permit Info: o 3 7 e d
Bldg ❑ Elect ❑ Plumb
Job D cription:
Residen ❑ V 61 Commercial ❑
Cost of Projec S J
• J
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 Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
0