06070011 CITY OF CUPERTINO a +•: a^vs �' '� _-- "' �' 1*10
BUILGING-DIVISION PERMIT :GONrA%GTO'TIV'�UR VIAT,IU.
s. r$.ax`.SfFx^,n. sx:tt -
BUILDINGADDRESS: pLUMB IN TIME INC PERm"006070011
1322 FLOWER CT
OWNER'S NAME: PERMIT ISSUE DATE
ANNELIES WUTHRICH 360 MEMORIAL DR STE 1 40 07/05/2006
NE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ip0 LICENSED CONTRACTOR'S DECLARATION Job Description
W
bat 1 hereby affirmt 1 am licensed under provisions of Clamor 9(mmyenca, P
with Secdon 7Elkl)af DIN' n3 afthe Business ( Cope_,aNfillli..la
in fanfaraendoffen (r/ UX LACE HOT WATER HEATER 40 GAL GAS
ig: Deme sec.« _ .
pppp Dow - — cam sumo
y pARCHITECTS DEC A N
I undcrnand my plans shall he used an public rtconis
e� Licensed Professional
OWNER-BUILDER DECLARATION
iM 1 Mmhy aRnn that 1 am exempt from the CoMeMemf f License Law for the
OO fallowing reason.(Section 7101.5.Business and Professions Calc:Any City or County
5$ which mqulres a permit.conauwL dla.hopmew.demolish.or mpait any"elute $500
-zY prior.its isswnce,Wan requires lM applicant for such permit.Bkaaignalsuomant
< that he isliccnudpwwant.Neprovisions ofthocmu amesLice. awpcIarmr9 Sq.Ft. Floor Area Valuation
FCO (commencing with Section 7000)of Division 3 mire Buslnamand Pmfevinns Coda)or
3 that he h aurum therefrom and Use basis fes the alleged exemption.Any viclWon of
Salon 7071.5 by mY applicant for a permit subjects the applicant.a civil penalty of Occupancy Type
not Come than Bw hundred dollars(SM.
❑L u owner of the pmporty,ser my employees with wages u theirsole compenaadon,
will do Newark.and thesuuc.mat nainanded oroffered format(Sm.Told.Buuness Required Inspections
and PenfGWOns Cade:The C.MuscuNa I.know law does Cut apply 10 as canner Of q P
property who builds ser improves thereon.and who does such work himself w through his
Own employees.provided that such lmprowmenu art nmimwnded aroffttsd fora&If.
hawewn the have
t ng w improvement la that
he
a.,build
of comormto,on.theowner- ��
builder MB haw the huNen of Proving Wt he did not bWld w Mprow oar purpaw of ,(_� gam®
ale.). N(f��Jyh\J IIIWiJpS—T
❑I.as awar of the property,am much aiwly contracting with licensed Connattom an
construct the pmject(Sec.7044.Business and Professions Code:)The Com manes U.
canse law dose oro apply.an owner of property who builds or improves thmms.and yy
who Conmea fes such projects with a Conrammfs)licensed puraam.da:Conuaemis V�7r �_ 2000
License Law. U
❑I am exempt under Sea .B k P C far this reason � y aaa��f ,,yy ay
1371M
eer Data
WORKER'S COMPENSATION DECLARATION gbx}Y)'4'a1�✓1 UPf)01�\\`�r[r/1)
1 hereby elfiran under penury of perjury aro of the following deGantiom:
I haw and will maintain aCerdOcaw ofCamant.self-alum for Workers Compon-
an,u provided per by Section 3700 of the Labor Cade.for the performance of the
k for which this permit is issued.
1 haw and will maintain Worker's Compensation hwrana,u required by Section
of the Lab.Cade.far the performance of the anwk far which this permit u unwedicer' C.f9'm,lr/9wtiaoJwrane artier andPolley numb" '
Policy Na:
ERIIF�IIC��CApppTEMMMOeFEXEMpPIa17�074N�q�FRRAOgM�W RES
vfeA netMtdlh-SIlwB17 r1� 7Rmr
mruacaion p tiwpe Ru hundreddo0ass151001
orless.)
1 cerdfy that In the performance of the work for which this permit is laved,I"I am
employ any person In my man erns as.become"Isar.the Warkin'CumpemaBwt
Laws of Calirtmea.Data
Applicant
NOTICE TO APPLICANT:If.after making this Caninnm of Exemption,you should
become subject.the Wofte3 Compemadon provisions of aw labor Cade,you moa
.,O forthwith comply wish=it provisions or this permit shall be deemed revoked.
z r~N.. CONSTRUCTION LENDING AGENCY
[-+ I bertbyaRnn that Nem is a construction lending agency for the per(urmace of
a> the work for which this permit is trued(Sec.3097,Civ.CJ
�W Q Lender's Name
z Lender's Address
U 0 1 certify Nat I haw read this application and saw that the show information is
Iy P Comm.I agree to comply with all city and county ordinances and saw laws nladnt us
QU building construction.aM hemby auNarin representatives of this city to enter upon the
>4 [71 above-mcmiuned pmNriy fort iNction purposes.
OL (We)em a.to sew,indemnify and keep harmless the City of Cu mo against
rEi'AA Iia IIiB".judgmemu.Cosa and expemea which may in my way aceta ohne said City
U Z in ontcqucmcc of Jan grating of that pOrmiL
^' AP I UNDERSTANDS AND WILL COMPLY W ALL NON-POINT Issued by: Date
SOU EG LAT70 S. /J/l
i
Re-roofs
ignm rt ApplicmVC ARDO Dae
HAZARDOUS MATERIALS DI DsuRE Type of Roof
Will the applicant or future building occupant rehandle heaallons material
as de0ned by the Cupertino Munidpel C .Chep. 9 13,and the Hetlth mJ Ss(tty
Code,S"Uon 25537(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasardous air conuminana U flood by the Bay Area Air Qualhy Man49CMCM all new materials for inspection.
Diwict7
Ayes a
I haw mad the harardom materials mquimmenuundcr Chapmr6.95oftheCalifor-
nuHealthdsSafmyCode,Satiwts75505,25533 ad25534.I understand Jwlflhe building
does t eumendy haw a Mumtligalit u my responsibility to sadly,the=Up=Of the
to Im.nisyshiclinvulobe t 'oraissu IsCertificate of - Signature of Applicant Date
rwau@ariatda cot sew All roof coverings to be Class nBn or better
CITY OF CUPERTINO
sm 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2 '
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . : 36618041 . 00
DATE ISSUED. . . . . . . : 07/05/2006
RECEIPT # . . . . . . . . . : 35104
REFERENCE ID # . . . : 06070011
SITE ADDRESS . . . . . : 1322 FLOWER CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANNELIES WUTHRICH
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
�EE 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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 168 . 04 24022
TOTAL RECEIPT 168 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
F Community Development
10300 Torre Avenue
i /" Cupertino CA 95014
11
Telephone(408)777-3228
CITY OF Fax(408)777-3333
'CUPEkTINO
Building Department
JOB ADDRESS: 13�Z PERM�� I
Dal
44
OWNER'S NAME: PHONE #
GENERAL CONTRACTO : F
I am not using any subcontractors:
SignatureinformDate
Please check applicable subcontractors and com Tete the followin ation:
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
Tile
•
Owner/Contractor Signature Date
CITY OF CUPERT'INO 000100
WATER HEATER
CUP IZTINO PERMIT APPLICATION FORM
APN t Date:
Build. g Address: 6 a7I ob
13ad 1-owec- eT
Ownef s Name: keno 1�1
epi e S Phone#:
Contr ctor: k cLu VIo$ • gala
�., License#:
Conta t: Bv�Cupertino Business License #:
Building Permit into: �'
I
Bld j❑ Elect fy �/ _/
Job D$scription: Plumb `1M Mech p�
i t Cl
Resid tial ` i_
Commercial Lj
Cost o€Project: lbo
Strapped ❑ On Platform U
Bonded
' New LIbcation ❑ Replacement
I
Qty. if
A li able Fee ID
BPWHEATER Fee Description Fee Grou
I / PPERMITFEE Water Heater/Vent BUILDING
BEN MITF KU Y Plumbing Permit Issuance PLUMBING
BUSL,IC Energy BUILDING
Business License BUILDING
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