06040070 CITY OF CUPERTINO /'7 a=taw ;msvai rr'^ r"-(�""� l
BUILDING DIVISION PERMIT v-0Nr A&6T0R4N 0
Bu,LDING ADDRESS: WATER QUALITY PLUMBING PERMII ND.0604O070
22220 HOMESTEAD RD
OWNER'S NAME: PERMIT ISSUE DATE
DOTTIE DISHER 1860 ALMADEN ED 04 /1 -4/2,110f;
NE: SANITARY NO. CONTROL NO.
(408) 267-9330
ARCH17ECffENrINEER: BUMDING PERMIT INFO
BLDG
l� t� PLUMB� l�
±op LICENSED C0NrRAC1OR'S DECLARATION l Job Description
I U 1 bereby>Rm Jul I w Ikenscr under provisions of[hurter 9(commercial p
wrlh Secdm7O0IB of Division 3 of Je Businear hod Profcam mu Code,and my license LL
± N infull to= ndari_ REPLACE EXISTING WATER HEATER
vh Z Lknnx Lau Lk.
m
corxmr r ulfPj[PE FROM GALV. TO COPPER UP TO THE FIXTURES
1 eg AR hall Zu SDECLARATION 1�
I undcnunJ my plana hall M1e uteJ ss puM1lic rtcorm � p
L
eG Licensed Professional
c,A OWNER-BUILDER DECLARATION
0I ED
1 hereby affirm than 11. exempt from the Convectors I:my c Law for Jan
5 OO following own. emits 7031.5,B. Itar. and nae,de erns Cattle:my tilt or county APR
$ whish¢yuimu n permit to construct.sites,Improve,demolish.or.pair and structure /lI-f{
-zy
prior to its ivuavc.Wu require sc applicant far such pcnnitmIll.aaigncJ sutemml
that he is licclucd Fusion,to the provisional of the Contractor'sUanse law(Chapter 9 Sq.Ft. Floor Area Valuat B 2 0 0
E $ (commencing with Section 701M)of Division 3 of the Business and Prormttians Code)or
that he LL exempt themfmm and se bait for the alleged exception.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofApN Number upancy Type
oat mart than five hundred dollars($511)). 32651006 . 00
❑iuhewerk.die property,m1, otinuo ka wW wegca r Jm4 ick7044.B nation,
will Pr thework.Carse ah Omar idesLnense La dem hat apSee.7061.Business Required Inspections
proand Profession who ba Code:The Convelnre License law uch ant apply to rt owner of q p
Own employ b.provided
da herinM h aroffear Waugh bLL
awn cmpkyeWiprogor i poeer improvementsamset year
ofcaroRned fur awase,
however,the Wilting or Improvement mild within hoc year of comple fa,the baleen
builder will have the b.den of proving this K did xl built m improve for purpose of
isle.).
❑1.u corer of the propenY,am exclusively contracting with Scanted contractors m
comment the pmjen(Sec.7044.Businm and Profesdmts Code:)The Contractors Li-
ave law flans out apply to m owner of property wbo builds or improves the.mr.sed,
who canlracu for such projects with acomucmr(s)Ilan dpurxanttose Convenors
Licenm law.
❑IamuempsunderSee ,B&.PClocthsax
ianw
Owner OData
WORKERS COMPENSATION DECLARATION
1 hereby Arian colder penalty of perjury Cru of Je fallowing deelmWma
I Is.and will meinWn aCerti0cate ofCavent toxlfdvum far Warkera Catalano,
sedan,an provided for by Section 3700 of W labor Code,for the perform.of the
work for which ibis permit is issued.
❑1 have and will maintain Workers Compensation Insuramm,at acquired by Section '
3700 of the Lobar Code.far am perlan s.of the work far which this permit is issued
My Workers Campegyaa�pon Inmmam.artier and Policy number are: _
Cmrier.Zt/-5 I Y % Paliry N.7: b��533�0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThLLxctlan sed not od completed If the permit Is Torose hundred rattan($109)
or itis) ,
1 certify that in the performance of the wank for which this permit is issued.I had nue
employ anypereon in icy mxnerx as to We=@ subject to the Worken'Compevation
Laws
."California.Data
Applicant
NOTICE TO APPLICANT,If,after making this Cenincate of Exemption,you should
become Subject an the Worker's Compensation provisions of thc labor Code,you mon
.J 0 forthwith comply with each provisions or this permit shall M deemed revoked.
'Z y CONSTRUCTION LENDING AGENCY
[-r Ibemby M.that sem is a cmumunlnn lending agency for Oe performance of
R'.> the wart for which Wt permit In issued(Sec,31197,Civ.C.)
dQ lenders Name
7 z Leaders Addmas
C)Q 1 modify sat I have read this applkuian and rum that the shave information it
Comm I agree to comply with of city aha county mainancu AM tum laws miming m
0(, building construction,and hereby autboriw mprescnuivev of this city 10 color upon the
r a ave-m rationed properly for inspection purposes
(We)agree to taw.indemnify and keep hmmless W City of Cupertino against
ti% Iiabilitus JWgmenu. Cndupensv Mich may in Cay mytmue agdvtrsid City
C)rZ. I.maaq at
i"
ERMA g AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE
'v Re-roofs
Si mor JConuxwr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will applicant or futum Funding accupxtsmm orhxdle haoNans mamrisi
as defined by Je Corcoran Municipal Code.Chapter 9.13,and Je Hurt and Safety
Cane,cation 25533(')? All roofs shall be inspected prior to any roofing material being installed.
❑Yet �a
VAR done applicant or fffuture building occupant use equipment ordevicea which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaMnns air contaminants u&flmd by the Bay Area Air Quality Management all new materials for inspection.
District?
El Yet
I haw mad ousanated Is yuimmcnta un der Ch.mr6.95afJ.Califon
nia Heald&SMI. SacJ 533and25534.1 unJcraunddomlfte building
Jana oat a y a t Is my on.'s ibllhy to..dry J.occupant of aN.
nequlmn.w u nor to Issuance of a Cmuncam ar Ocmpaney. Signature Of Applicant Date
Dam All roof coverings to be Class'B"or better
Ow or mthads cat '
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN I . . . . . . . : 32651006 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT # . . . . . . . . . : 33971
REFERENCE ID # . . . : 06040070
SITE ADDRESS . . . . . : 22220 HOMESTEAD RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DOTTIE DISHER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0115
RECEIVED FROM . . . . : PAUL KOCH
CONTRACTOR . . . . . . . : SATALINO, 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 AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 54 . 65 0 . 00 54 . 65 0 . 00
METHOD, OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 54 . 65 VISA
TOTAL RECEIPT 54 . 65
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
' ITC CITY OF CUPERTINO
cuf TY OF o- PERMIT APPLICATION FORM M4010
N# � � - oo, n Date: -12. OW
BuildingAddress: lX Mailing Address (if different from building address):
2' ��.
Owner's �:J;2 l / Phone#: _ C[0-3
O�-3
ontractor: License#:
fer Q 1i � � JOS D I
Contact: Phone: ZW7 - 933D Cupertino Business License#:
Fax: L/w- COZ31
Building Permit Info;
�cp11Pi Feom [APF`r uP-}nuses/
Bldg ❑ Elect [ ' Plumb Mech L7
Job Description: C jo. c2 j2h Z-P-t•^i —
Residential Ja- I e Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiect: -71 a O v v Occupancy Gr u:
�3
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard Q Large ❑ Major ❑
Quantity Fee 10D Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1,75141 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
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acEo
CITY OF CUPERTINO
CUPITINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
13MISCELL 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
BP13ACKFLOW 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 Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIJU AN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace> IOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREN MISC 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
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CITY OF CUPERTINO -
CUPEi�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Si , Marquee ELECTRICAL
BREMTHEATR Theatrical Li ting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct• MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBIND' Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSVaM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electricals 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 Commel Multi-Faro PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change -'BLJaDING
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