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06040091
CITY OF CUPERTINO .OUILDINt.DIVISION PERNIIT `£ O,NT.R.A.G �QR I(NEOItMATI0IY BUILDING ADDRESS: PLUMB IN TIME INC PERMrr NO.06040091 18416 CHFT,MqFQRn RD OWNER'S NAME: PER10M LSSUBOATE Aft NAEEM ZAFAR 360 MEMO jPbNE: SANITARY NO. CONTROL NO. (866) 293-3031 ARCHITECffENGiNEER: BURRING PERMIT INFO BLDG EO B O iop LICENSEDCONTnACfOR'S DECLARATION Job Description cma.7 )ofrfl.that 1 amof the learned!under and visionsProp se ofC alk.. 9(commencing xx with SeNan]IXIU)of Division 3afthe Businw uM Pra(et4um Coea.aM mYliceve is s< in full toraane<rcecL B,UJ�1 REPLACE HOT WATER HEA �,Tgt TALL 12YR i�Z LmenuC a C�(.O �» L`g�D Deer :.4 1'7-fOf Cammear 1_ ACTS DECLARATION t2 t n f I understand my plus shall he used an public reends V' c MAY "IS-2006 e c Licensed Professional `m OWNEum exempt RER DECLARATION COO hereby moso than Nn 1 inn exempt from the CanbactCo Lcense law for N `p o following remon.(Secdan 701.5.Business and Pafatluns Cade:My dry ortoumy $ which tegmss a permit re construct,etre,trnprew,demolish.t or e 3 sig any structure $500 -�y prior mis issuance,also requires the applicatfonuch Permit �il�adgnedeuument pp�p that he is licensed pursuant m the previsions of Na Container's Limes law(chapter9 Sq.Ft. Floor Area tion Y $ (commencing with Schon 70D0)of Division 3 offm Bmw inand Profwen Code)at - Nu he u exempt Merefrwo and de bait for the alleged esunpdom My vialatlon of Section 70313 by any applicust for a permit subjew the appllaa to•dell penalty of r Occupancy Type not new Nan fes hundred doles(5300). ❑1,as owner of the property,or my employ=with wage as Neo role compensation, will do the work,and the suuctum Is re,headed a offered fonate(Sec.7044,Business Required Inspections and Profession Cade:The Contractors Lesson Law da rem ner nt apply m owof q P property who builds orimprawdmaeon.and whodaaauchwatkbimsel(a Waugh his own employees,provided thatauch impmwmenu art trot Intended reoffered forsa e.U. however,the building or improvement is sold within one year of caopledan,the owns, builder will have W budm of proving Wt he did not build or improve for purpose of t ale.). ❑1,an Owner of Ne property,am exelunively contracting with limned mnuactms an contract Ne Protea(Sec.7044.Business add Poopend n Cots:)Tie Comuacmrs U. can law dot est apply m m owner of property who betas m improv thereon,ad, whoeamxmsfortabpmkmwithmmnuawr(Olkensedpaawatmthe Conuam es Lketse law. ❑I nt temps under Be, ,B h P C for this mwn Owner Dau WORKER'S COMMSA770M DECLARATION I hereby affirm under penalty of perjury one of dm following dtzlaradane ,]I hero and will maintain a Cerdflau ofCocam nt a seifdnsum for Workers Compere sutian,as Provided far by Section 3700 of the labor Code.for the perfortnanm of the work for which this permit is imud. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Mbar Code,for,the performane,of to wss for which thin permit is blued. ' MY Workers Cam``pend1�am bsuOre,artier ad Polity number act: Cartier. 1-I Tlt. P.Ucy No.: SSA? I`( 0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This xctiw sed notice completed If was permit Is(man hunNddoBam($100) or Ws) 1 unify Not in the performance of Is work for which this Pewit is issued.)small ret employ any pennon In any summer to a in become subject to the Warton'CompenWon Laws of California.Dam Applicant NOTICE TO APPLICANT.If,afar making this Cmifcam Of Exnnidw.,you should become tubjm to Be Worlura Corepcwddn prevision W the labor Coen,you man .,O fOmhWith comply with such provisions m Nu demand"I M dmed lrmi ed. y'n CONSIRUCIION LENDING AGENCY 1hemby.firm that inert Is cdnstructinn lending agency for du perfurmence of Tlthe wart for which this permit b issued(Sec.3097,Cl,C.) Uj Q Lenders Name .�7. z Landers Addrw U0 I certify that 1 haw read this application and sum that the above information Is I U.F mrmcL I agree to comply with all city and county ordinances and sum laws slating m 0 U building construction,and hereby authorim representatives of this city to enter upon Nc �M1Wi ahove-m rationed property for inspection purposes. (We)agree to saw,indemnify and trop harmless;the City of Cupertino agalnt ski VI liabilides,judgments.coma and expenses which may In any way amus agalnt said City /�� U z in earsxqumm of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S U REGULATI NS. ' L1 - 17-Co Re-roofs Signature of AppllcadConuamr Date H RDOUS MATERIALS DISCLOSURE Type of Roof Will the applicants.future Wildingam. temmhmile haxadaw mnetial as defined by we Cupertino Municipal Code.Cheaper 9.12.and the Health and Safety Code.Section 13332(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes `d1Ne 41 Will the appticalt or future building Occupant use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove emit haardow air communants as defined by Be Bay Amt Air Quality Mangcmcm all new materials for inspection. Dismal ❑Ya PNo I hew sad the hwardsusmamdals mquimmens under Chepurf.93ofNe Glifon mix Health 8:Safatycode,Sectors 253o3.25333 and rend.l understood Na UW bolding des set currently have a actin,that It u my responsibility to notify the Occupant of the re urtma which most be met prior m inum ofa Ccrdficam ofOccupary. Signature of Applicant Date All roof coverings to be Class"B'1 or better Owner or mNorsad agent Dom CITY OF CUPERTINO eem 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 37522053 . 00 DATE ISSUED. . . . . . . : 04/17/2006 RECEIPT # . . . . . . . . . : 34018 REFERENCE ID # . . . : 06040091 SITE ADDRESS . . . . . : 18416 CHELMSFORD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NAEEM ZAFAR ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PLUMB IN TIME CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PLUMB IN TIME INC ADDRESS . . . . . . . . . . : .360 MEMORIAL DR STE 140 CITY/STATE/ZIP . . . : CRYSTAL LAKE, IL 60014 TELEPHONE . . . . . . . . : (866) 293-3031 *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 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: u PERMIT # OWNER'S NAME: .V� � z.cL PHONE # 40 - GENERAL CONTRACTOR: p FAX # I am not using any subcontractors: /,I,? �© Signature Date Please check applicable subcontractors and complete the following information: 60 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 v i 1,� -2 2 76,0.r Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date . . CITY OF CUPERTINO • WATER HEATER CUPS t�TINO PERMIT APPLICATION FORM APN oil - 22- 0�3 Date: Buildi g Address: Ow 's Name: Phone#- UCS- 5-\awl Contr ctor: License #: 19,Gs Conta t: DnA Cupertino Business License #: Builth ig Permit Info: Bld ❑ Elect ❑ Plumb`` Mech ❑ Job D scription: Resid ntial ❑ Commercial ❑ Cost o Project: CJD ,Qd, Stra d ❑ PP On Platform Bonded • New I cation ❑ Replacement ❑ Qty. if Appli.able Fee ID Fee Description BPWHEATER Fee IN Water /Vent BUILDING PPERMITFEE Plumbin Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING uAbnc, cca! -r 1 L4C