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10030025 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1634 JAMES TOWN DR CONTRACTOR:AQUA FLOW PLUMBING PERMIT NO: 10030025 OWNER'S NAME: SUTTON A RICH AND CARMELLA 565 N 6TH ST DATE ISSUED:03/03/2010 SAN JOSE,CA 95112 PHONE NO:(408)265-9504 ;ER'S PHONE: 4082553463 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor ' Date 0 JOB DESCRIPTION:REPLACEE WATER PIPES FM METER TO BUILDING& I hereby affirm that I am I cen under the provision of Chapter 9 PIPES (commencing with Section 7000)of Division 3 of the Business&Professions WITHIN HOUSE.NOTE:BATHROOM SINKS&TOILETS ALREADY Code and that my license is in full force and effect. DONE. I hereby affirm under penalty of perjury one of the following two declarations: 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 performance of the work for which this permit is issued. 1 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 Sq Ft Floor Area: Valuation:$3000 permit is issued. APPLICANT CERTIFICATION anc Occu Type: I certify that I have read this application and state that the above information is APN Number:36610065.00 Occupancy yp 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 upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. 3 Date 't5 Issued by: � �� Date: Signature OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials or will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Own"r autAoozed agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I herebyaffirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i-a-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the t_ting of this permit.Additionally,the applicant understands and will comply with all non oint so a regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Da Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36610065 . 00 DATE ISSUED. . . . . . . : 03/03/2010 RECEIPT #. . . . . . . . . : BS000009865 REFERENCE ID # . . . : 10030025 SITE ADDRESS . . . . . : 1634 JAMES TOWN DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SUTTON A RICH AND CARMELLA ADDRESS 1634 JAMESTOWN DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5315 RECEIVED FROM . . . . : DAVID A GREGG CONTRACTOR GREGG, DAVID LIC # 21162 COMPANY . . . . . . . . . . : AQUA FLOW PLUMBING ADDRESS . . . . . . . . . . : 565 N 6TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 265-9504 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BPWATER UNIT 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BPWSVCS WATER SERVICE 1. 00 21. 00 0 . 00 21 . 00 0 . 00 1BSEISMICR VALUATION 3, 000 . 00 0 . 50 0 . 00 0 . 50 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 159.50 0 . 00 159 . 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 159.50 VISA --------------- TOTAL RECEIPT 159 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CITY OF CUPEkTINO PERMIT APPLICATION FORM APN # Date: r) Building Add es _DF Owner's Name: Phone#: Z,� � Contractor Pho-fie ff- Z 57 �' ( ' [ Fax #: Co Phone#: Fax#: Contractor License#: Cupertino Business License#: F� Job Description: ") - fry" I'l Pip A I 1AJ 0 Kc� C4 i r P ry dt Residential Commercial Fj Valuation: VJ C -C k) UIQQ� (% J Project Size: Express LJ Stand��—d�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& the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group IPCSEWER Commercial building P 1CPSS sewer/sanitary sewer IBPREPIPE Commercial re-pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets IBCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES IBSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER0"N SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P ,r 113PWATER Install/alter Water Pipe P ( 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B ( 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPE�TINO Building Department JOB ADDRESS: 4)S 4 G �;c'l M f PERMIT# /00,5002,5- OWNER'S NAME: u 44n n PHONE # o' �c GENERAL CONTRACTOR: r FAX # 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 t A/W 0 Owner/Contract gnature ate