06080182 (2) CITY OF CUPERTINOMA
V-.
BUILDING DIVISION PERMIT ° CON'T'RACTOR TNF',UR .TIUi` ,
•. ,�C.� .v'v:e.h,.�Tnr a o- s`�S:A,^. s a..ru. VT
BUILDING ADDRESS: AAAA—DRAIN PATROL PEaMITNo.06080182
7467 DE FOE DR
OWNER'S NAME: PERMIT ISSUE DATE
MATSUDAIRA TAKEO AND KEIKO 2400 LINDBERGH 91 08/22/2006
E: SANITARY NO. CONTROL Na
(408) 989-6005
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOCH
loo LICENSED CONTRACIDR'S DECLARATION lob Description
1 hereby afRrm dent 1 am Imsmad under provisions of Chapter 9(commencing
ZE with Section 7")or Division 5 of den Businwas and Professional Code.and my licenmu 1.fullItms&adeffet. REPLACE 50 GALLON WATER HEATER. EXTEND EXISTING
L+censc Clsss enc.Is 'l 2 t 3 �
Dae�ContranWr ��ai�htre>t GAS LINE 3 FEET AT DRYER LOCATION AND REPLACE
Rc crsDEcuaAnSF" HOT & COLD VALVE AT LAUNDRY LOCATION.
i I understand my plans hill M used w public records
°end Licensed Pnttcssional
ly OWNER-BUILDER DECLARATION
i M C I Mmhy alarm that 11. ummpt from the Cornerstones o :A License Law
at for the
:MC o fallowing moon.(Section 7(11.1 Bualmr. and Pre.denull Code:Any city lir county
$�
which requirca A permit w tmwuct alter.Mpmw.demnl W,lir repair any umcturc
ty prior m its issuance.also require the applicant for such permit o file a signed AAWmem
< that he is licensed Ferment to the proviswm of ft Canuacmrs Lia.Law(Chapter 9 Sq.Ft.Floor Area Valuation
C (commencing with Section 70001 of Division m of tha Business and Profession.Cou)ar $2250$ that he u summit therefrom and the basis fen the alleged compt+on.Any violation of
Section 7013 by my,applicant for a permit subjects the applicant W a civil penalty of APN Number Occupancy Type
sent mom den fmw hundred dollars ISM
❑I,an owner of the propmsy,lir my employees with wegu a their sale comPenadM.
willdothc"kasdthegtmctumlana,inw h .roBeredfwd (Sw.70a,Busiess Required Inspections
and Professions Code:The ContrwlW e nsor's License Law doss m'apply an owner of fi P
pmpenywMbuild.wimpmwa1Maron,andwhodorsouchworkhm fmdumghha
own employers,provided that such improvements artsat ina,ded aroaered fmsdk.If. R� app{{{ s
builders,throw obi Weeks
ed did
not year ofcamove rarurawer- �� /f{L
huskier will Wen i.Mrdcn Improvement mI that wdid ml build lir improve fen purpose of
r- jl�I g
sak.
❑1,As owner of the propenY,am eumuducly,contracting with Became cantrcetars W
ronsuuct the project(Sec 7044,Business And Profusions Cane:)net Cmuac7nrs U. ) �jf3n�t
ounce Law data nolapply in owfpsapeny who bnildaarlmprovesdtemon,and ��/
W mro
FI,It14
who contracts fat such projects with a mnwemr(s)Rented purAmM m the Contrumh r (s 1sV
Lice.law.
❑lam uemp'uMa See .BkPCfor Wsmason ji st sll� ({ ,eSs>.
Owner Dam tJ4]t{tN"fq r'®{+ Fs17�i�',"S®Ja�l"9
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of(M following declantimtc
❑I have and will maintain aCaNOcamof Cnsuem to elf-Ineum for Workees Campen.
sat+on,an provided fen by Scum 5700 of tM labor Code,for the performance or the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,As required by Section
5700 of de tabor Code,fen den performance of site wont for which this pored,is tssuW.
My WarterPA CompenAuan Insurance:cartiv and Policynumber a2:
Carrier. /S U Polley No.:'7'1 14-7M
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sealon need an,be completed Been Permit is forme hundrcddallan GIg)
or tut)
I certify the,In the part....of the.,it far which this permit IA issued 1 shell ret
employ any person in any manerso As W become mbjut a den Workers Compensation
Loss of Cnifum+a.Dow
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
Incomes subjet W the Weaker's Compensation provisions of the labor Cade,you menu
.JO forthwith comply with such provisions lir this permit shall be demand newild.
Z► CONSTRUCTION LENDING AGENCY
(-m IMrcby alBnn dentdenm lalronutucum kndingagcey rm laperfwmuxeuf
CG> the wart for which this permit is issued(sec 3097.Cl,,e.)
QLaMar's Name
a z Leaders Address
V I cdnify thin I haw sad this appliadan aM sure that the Above+nfoanadun is
U, F correct.I agree to comply with all city and county oNinawes and state laws mining W
OV Wilding construction,and hereby authorize mpretruntives ofthis city to tenor upon the
[41 aMw-mcmiuned prepcny for Inspection purposes.
(We)agree W saw,indemnify and keep harmless den City of Cupertino!guns'
ti y Iabilides.judgmenW costs and expenses which may in anyway accrue against said Ctty
t)Z in consequence of the Swung of We permit.
•" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ONS. ~ --PIZ-ZIW
Signature a(Aps+ uR00Deft
MZZA0S MATERIALS DISCLOSURE Type of Roof
Will tM applicants,Or futum Wilding occupant more w handle hazeAous maarid
As defined by the Cupertino Municipal Code.Chaser 9.11.and We Health and Safety
Cole,Stood.15531(!)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or forum building occupant sea equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit board...air cormorms us As Bond by the Bay Arca Air Quality M AZMAnt all new materials for inspection.
Mulct?
lct7
❑Yen Nu
I haw mad the hoandun materials requirements under Chapter 6.95 of the Califar.
me WAIN k Safety Cade,Secoon 15505.25533 and 75534.1 undersand In Bthe building
data not currently haw a¢sant,that It is my responsibility W notify one accurate,of the
mtg,i"mew h� hambemetp�aCertificamor Signature of Applicant Date
owner.'a.marivm agtn —� 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 . . . . . . . . : 35924015 . 00
DATE ISSUED. . . . . . . : 08/22/2006
RECEIPT # . . . . . . . . . : 35719
REFERENCE ID # . . . : 06080182
SITE ADDRESS . . . . . : 7467 DE FOE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : MATSUDAIRA TAKEO AND KEIKO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AAAA DRAIN PATROL
CONTRACTOR . . . . . . . : ECCLES, CHET LIC # 10745
COMPANY . . . . . . . . . . : AAAA-DRAIN PATROL
ADDRESS . . . . . . . . . . : 2400 LINDBERGH ST
CITY/STATE/ZIP . . . : AUBURN, CA 95602
TELEPHONE . . . . . . . . : (408) 989-6005
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ - ---------- ---------- ---------- ---------- ----------
BPGAS OULETS 1 . 00 5 .40 0 . 00 5 .40 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 2, 250 . 00 0 . 50 0 . 00 0 . 50 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 128 . 29 0 . 00 128 . 29 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 128 . 29 40837
TOTAL RECEIPT 128 . 29
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
6UPERTINO
Building Department
JOB ADDRESS: PERMIT #
"74 l0 7 T71; P 1?—, 6 6 O —L
OWNER'S NAME: —M-(c�Ev M a-TFv cx�-+ � PHONE #(A-V g 2 78 _c)17
GENERAL CONTRACTOR 1og4�t rl FAX#
I am not using any subcontractors: .C�V.P-r2 T2�,.e�-
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
Ile Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
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Owner/Contractor Signature Date
d � CITY OF CUPERTINO p
AOCaD1182
ITMOr PERMIT APPLICATION FORM
CUPEkTINO
N# Date:
-2� C
Building Address: Mailing Address (if different from building address):
'<t-ro7 v3E:-;7- DL-- ggr>l�t-
Owner's Name: Phone#:
`T,L<1Cy a 1.n
Contractor: License #: , A-2 2 11, C,
Contact: Phone: C4-687> Cupertino Business License#:
Fax: ry70 017 " I o 7 45
Building Permit Info: 1Pt14Ct So qAt LbNsTE Q6FFIFTF$ X`rENDED lcfg C7V 2—
Li►� 3 T el:A D fctt� C�vtJ ND 4MVIO ,t
Bldg ❑ Elect ❑ Plumb JR Mech X &
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 4F tE Occupancy G oup:
2tz5o, _
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard SI Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M 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 Investi ation fee BUILDING
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��� CITY OF CUPERTINO -
CUPEf�F PERMIT APPLICATION FORM
QuantityFee 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent 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> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNR APP 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
BREMREPALTRepair/Alter HeatingMECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEf�F PERMIT APPLICATION FORM
uantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
g 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 Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temp6rary 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 Chan e BUILDING
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