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06050164
CITY OF CUPERTINO � BUILDING DIVISION PERMIT BUILDING ADDRESS: AQUA FLOW PLUMBING PERMIT No.0 6 0 5 016 4 1034 CRANBERRY DR PERMIT ISSUE DATE OWNER'S NAME: GREEN DALLAS M 1584 CHAMBERS DR 6 SANITARY NO. CONTROL NO. )NE: 4082659504 BUILDING PERMfi'1NF0 ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1 p C LICENSED CONTRACTOR'S DECLARATION Job Description WE I hereby affirm that I am licensed under provisions of Chapter 9(commencing ?Z with Section 7000)of Division3oftheBusinessandProfessionsCode.andmylicenseis REPLACE WITH COPPER PIPES WITHIN HOUSE, INSTALL o Z<,w,. in full force and c ;nz LicenscClass x GARBAGE DISPOSAL NEW WATER. NEW SHOWER PAN, NEW [-p Date Contractor CHITECI'SDECLARA N TILE FOR SHOWER. 1 unde nd plans shall be used as public records e U.H Licensed Professional •O OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the t co following reason.(Saban 703 1.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure u;-- prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation -Z< that he is licensed pursuant to the provisions of the Conttactur's License Law(Chapter 9 q $12300 YF (commencing with Section 7000)of Division 3 of the Business and Professions Co' )or i R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of anC OCCu Section 7031.5 by aapplicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type iry not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law dots not apply to an Owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however.the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property.am exclusively contracting with licensed co construct the project(Sec.7044,Business and Professions Code:)The Con=-OLD cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec r�• B&P C fpr this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �]i have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers CompeatWio tuaac carrier and policy number are: Cartier. Polity No.: ©z 9 r CER I C TE OF EXEMPTION FROM WORKERS'r COMPENSATION INSURANCE (This section need not be completed lithe permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. .Z.t CONSTRUCTION LENDING AGENCY E..r�. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name 0Z Lenders Address V 0 I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to 0 Ubuilding construction•and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and kap harmless the City of Cupertino against CA liabilities,judgments•costs an expenses wh' may in any accrue against said City V Z in consequence of the grand f thi Date (1 APPLICANT UNDERSTA D W OMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Dare Type of Roof HAZARDOUS MATERI CLOSURE YP Will the applicant or future building oc p store or handle hazardous material as defined by the Cupertino Municipal Code.Cha ler 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Cl Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes NO Ihaveread arerialsrequirementsundcrChapter6.95ofthcCalifor- nia Health&Safety ade,Sce2 5.25533 and 25534.1 understand that if the building docs not cu ly ave a ten t, is my responsibility to notify the occupant of the Date rcyuircmcn h must a issuance of a Ccrtificatc of Occupancy. Signature Of Applicant All roof coverings to be Class"B"or better Owner or tho c Date le D V �v L o� � J CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: amyw M 1 of 1 COPY # : 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36204052 . 00 DATE ISSUED. . . . . . . : 04453/ 2006 RECEIPT # . . . . . . . . . : 06050164 REFERENCE ID # • • • SITE ADDRESS . . . . . : 1034 CRANBERRY DR SUBDIVISION . . . • • • : CUPERTINO CITY . . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GREEN DALLAS M ADDRESS . . . . • • • • • CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : DAVID GREGG CONTRACTOR . . . . . . . : GREGG, DAVID LIC # 21162 COMPANY . . . . . . . . . . : AQUA FLOW PLUMBING ADDRESS . . . . . . . . . . : 1584 CHAMBERS DR CITY/STATE/ZIP SAN JOSE, 59504CA 95118 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW_BAL- __ ___ ---------- ---------- 000 201 . 96 0 . 00 . BPERMFEE VALUATION 12, 300 . 00 201 . 96 96 . 94 0 . 00 BENERGY PERMIT FEE 201 . 96 96 . 94 0 . 00 0 . 00 1 . 00 10 . 79 0 . 00 10 . 79 BPWHEATER PER HEATER 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 130 0 . 00 1 . 30 0 . 00 . ---------- BSEISMICRE VALUATION 12, 300 . 00 ---------- TOTAL PERMIT 349 . 36 0 . 00 349 . 36 0 . 00 NUMBER METHOD OF PAYMENTAMOUNT __________________ ----------------- OTHER 349 . 36 VISA TOTAL RECEIPT 349 . 36 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ ==301-== ROUGH PLUMBING502_== FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CU PERTINO oW5 0iceq avro PERMIT APPLICATION FORM CUPEI�TIN APN# Date: Building Addres Mailing Address ((if diff rent om building address): Building Addre�q L. I� Owner's a e. Phone#: License Contractor: Contact hone: Z(p S - O`1 Cupertino Business License#: �p a . Building ermit Info: Bldg El Elect PI Mech El Job Description: {�¢\cAC 2 c P� o � r p i QQ S vJ +� ,- N p vS� Residential, UJ -QC Q 0 c . r v : Sq.Ft. Floo Area: Sq.Ft. o C) CosEof ojec Occupancroup- Typonstruction: ' P se check this box if to project is a ' o -sto addition: Project Size: Standard ❑ Large ❑ Major ❑ Fee Description Fee Grou Quanti Fee ID 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 BBOILERS 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 BELEC 1000 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 3 CITY OF CUPERTINO OCIF PERMIT APPLICATION FORM CUPEI�TINO Fee ID e Descri tion Fee Grou Quanti FeBUILDING BMISCELL Miscellaneous Fee BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MEC, ANdICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING PLUMBING BPCESSPOOL Cess ool BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPL HK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE, Re i e Of Fixtures PLUMBING BPSEWAGE Sewa a Dis osal PLUMBING BPSEWER Sewers PLUMBING RIN I{:; Lawn S rinklerBackflo BPSPPLUMBING S RINK Storm/Rain Water PLUMBING BP STORM. STOR Kitchen Tr a PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Install/Alter Water Pi a PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS, Main Water Service PLUMBING BREMSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRE A/C Units<= 10,000 cf n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Li tin 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 ARRHLtus 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 13REMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 *C10F CITY OF CUPERTINO A PERMIT APPLICATION FORM CUPEI�TINO Zuanti 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 Insection 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fees foot PLUMBING PLLONGRNGC PlanningLR Comme/Multi-Fain PLANNING PLLONGRNGR PlanningLon Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3