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06040050 C C ITY OF CUPERTINO BUILDING i)IVISION PERMITi�CONT"CTORINFORM,.A�ION. u" - ILDINGADDRESS: PLUMB IN TIME INC - P"Em"NO-06040050 22085 LINDA VTRTA PI. OWNERS NAME: PERMIT ISSUE DATE NEAR JAMES E AND NANCY T 360 MEMORIAL DR STE J40 n4/11 /2006 NE: SANITARY NO. CONTROL NO. (866) 293-3031' ARCHITECT/ENGINEER: 1 BUILDING PER .INFO BLDG ELECT PLUMB MECH O Oz LICENSED CONTRACTOR'S DECLARATION Wroby due 9(carearnmecog Job Description w'dhS.La F "..7MAM) -fDfvi ill—3oflivellusincesseed ProrcisionsCadimenclatylicencesis, in full force and affect. REPLACE HOT WATER HEATER/ 40 GAL GAS TALL 12YR Liccome class c_-5�2 .. OcaR92�_& "Oem Dam---L�E�CHMCCI`E DEC LARATION c I uncontested my plans shill be used m public mends )�u ett; Licensed Prolmsional I hereby ...OWNER-BUILDER DECLARATION j 2 Nat I am excenp,from the Connurector',License Low for the CiZo following mason.(Section 103 13,Bonsisom and Profeammar Code:My city or county 9 which caumm a Permit W construct,tied.improve.dorentim.Or ropeur any stram. $500 priar u)its iscumse,also requires the applicant for such permit to Us a signed statement than be,is licensed pursommi W mo provisions,of that Connector's Liconses Law(Chapter 9 Sq.Ft.Floor Area Valuation (contravening with Sestiort 7000)of Division 3 of ft Business and Prolkessim;Carta)or Nat he It attempt therefrom and ft basis for Na alleged exemption.Any violation Of Section 7031.5 by any applicant for a permit subjects ft applicant to a civil penalty of Occupancy Type not mom game fivs hundred dollars(3500). E]I.mowner oftie proNny.wmympioyamwed warm wNab salt wmpenudw, wed Nd Profession Coda;T1m Cmuremours License Law doest ML Apply M au MM Of Aafttions property who builds at themon,and whodo%mchwarkithessellor through his w3c' .employees.providead that such jorprovemmus m but imacradical orroffored ftermim If. however.the building ar,imponscresem itsold within 0.year ofcomplatum.duc manam- builder will how the market of proving that he did not build"Improv for ptupow of sok.). (_']1.as Owner of ders property.am excludycly contracting with licensed contractam;W commen man pmjca(Sam.7044.Business real Profession Co&-,)The Comarecuses Ll- SIX ONG ocress,Law does not apply as in answer of property who builds or improves theater.and. who concracts for such projects with a comouster(s)licensed paressumi to den Contracton's Llcmae Law. [3 1 son merept under Set _'B&P C for this meamm Ow. — us Da WORKERS COMPENSATION DECLARATION I mumby affirm motor penalty of perjury rom a man following dwlarmorta 4t 1 ban and will maintain a Certificate of Consent to salr4muse,for Warkeres Compen. mount..pat far by Section 3700 Of the Lab"Code.for Na per form eacc of the work for whims this permit m itatual. 0 1 have and will maintain Workers Compensation Incomes,.required by Session 3700 of Na Lester Code.for the perficarmanot of chat work,fee which this permit is issued. MyWorkce�MCITWn�.csaao.or and Policy number rom 2 Carrier. Policy No.: _`a1L? — CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE (rhas seettirm reed mat N camplema tithes permit Is forrove hundred dollars($100) or Im.) I comity Onat I.to Itcurammence of the work I.which this pareal,is Wood I WWI notemploy any pentrun in my manners as w laccame,subject to the Worker'Co�apcmrmkm Laws of Cedifmoia.Data Applicant NOTICE To APPLICANT:If.of mating this Certificate of Esemplion,you should become abject to the Wormers Compensation provisions of the Labor C"'Is.You mm 0z forthwith comply with each prervisiom cer this permit!hall be damnedanooka z 0 CONSTRUCTION LENDING AGENCY 1 hereby affirm Use theme Is a consuructiont lending agency for,ft purpormano,of ai> the work for which this permit 4 imused(Sec.3097.Ch,C.) Galander'.Nano G. Lender's Adidas, U Q I certify dial I law read this Application and sum Na to show Informed.is U,F connect.I agree to comply ints all city and county uncleanness and mile laws relating as 0 Ubuilding construction,and hereby autbGrice mpoeactomwa of this city to enter upon the L4 chow-mentioned property for inspection purposes. 06 (We)a&.to saw.indemnify and lampInmennism uses,City of Cupertino Slibut rad lis"i ties,judimmus,cam and expenses which may in my way accout against mid City in consequence Of the Smand"I of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date SOURTE TIONS _it_ Re-roofs Signatme,of ApplicantfCanuninctor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Witt ma applicant.future Wilding actsupentsuare or handle laccurdous trammel as defined by ft Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(!)? All roofs shall be inspected prior to any roofing material being installed. El Yce To Will the applicant or rulum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove orch hamodaus fit murnaimants as defirmsi by thas Say Am Air Quality Management all new materials for inspection. District? 0yes 1�< Ihaw mad the hadm.amHalsmquim=nmun&rChapmr6.95ofdicCalifon building does not currently have a motors.th"It 4 my responsibility to mdr,the occupsom of des reclal. ,muss be met priorte,Wartime ofa CernficamodOcculsomy. Signature of Applicant Date —0 CO& All roof coverings to be Class"B"or better Owner ustint.d.di about Date r Community Development 10300 Torre Avenue J' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: PERMIT # 2-1409z Lt,-,S Q b �o OWNER'S NAME: J o lv-e s PHONE # 4(9,0 S' OD 'S- GENERAL GENERAL CONTRACTOR: Ve,�lo <` — c FAX # I am not using any subcontractors: ^- Q- 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 Glass/ Glazing Heating Insulation, Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing i l 2 7 Ce 0 7 Roofing Septic Tank Sheet Metal Sheet Rock Tile • / Owner/Contractor Signature Date CITY OF CUPERTINO 46m 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608014 . 00 DATE ISSUED. . . . . . . : 04/11/2006 RECEIPT # . . . . . . . . . : 33925 REFERENCE ID # . . . : 06040050 SITE ADDRESS . . . . . : 22085 LINDA VISTA PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NEAR JAMES E' AND NANCY T ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4022 RECEIVED FROM . . . . : JASON SCHERR 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 • i CITY OF CUPERTINO oUo4 0013c) • WATER .HEATER CUP kTINO PERMIT APPLICATION FORM APN Date: 35 -08 - 011 - / II Buildi g Address: � fico �1 Owne 's Name: Phone#: MW\Q� r Contr ctor: License#: Conta t: + Cupertino Business License #: Buildi g Permit Info: Bld I❑ Elect ❑ Plumb In Mech ❑ Job DIscription: Resid tial Commercial ❑ �ler qC) 2 r' Cost of Project: 00 ,00, Strapp d ❑ On Platform Bonded • New cation ❑ Replacement Qty. if A li able Fee ID Fee Description Fee Grou BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbin Permit Issuance PLUMBING / BENERGY Ener USLIC BUILDING BB usiness License BUILDING i` \"y"b - ie7 -Tinny �vAbm.c Co��S�c�t L 1L rcvEu •