00120041CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
CONTRACTOR INFORMATION:
,.
BUILDING ADpgEss.81"MILFORD DR
G I.J
BUDGET PLUMBING
r
PERMIT NO.001G00A1
OWNER'S NAME:
BIRK.HOLZ JACK L AND JAPIE
A TR 49695 ROANI]N.E ST
APPLICATIONlJ): 1)q�
4/
HONE:
SANITARY NO. CONTROL NO.
(51.0)303-7847
i ARCIRTECT/ENGINEER: -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description -
1 hereby affirm that I am licensed under provisions of Chapter 9 (conmmencing
p -
wlnh$f[IIOn]T11XB of lyivinion3nf the Bhtsincax nnA Prcfcssionc Cotlo. anA dry license
is in full force addeffat.
s
WATER HEATER REPLACEMENT
License CLs Lic.4
'
Date Contractor
• ARCHITECT'S DECLARATION
_
I understand my plan, shall her used as public records
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Licensed Pmfes umul
OWNER-BUILDIiR DECLARA'fIDN
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I hereby affirm that 1 am exempt from the Cuntrucmr's License Law for This
following reason. (Section 7031.5, Business and Prcdesime; Cale: A, city or county
which requires a permit to construct, alter, improve, demolish, or repair any inner...
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primaminsissuance, nlw rtyuirex the applicant for such permit to filealiirrodzaleme t
- Sq. Ft. -Floor Area
Valu '
nkat he is licensed pursuant o the Mrs sionv of the Commctnt'x License Lw(Chapter 9
(commencing with Saloon 7000) of Division 3 of the Business and Professions Codid
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-
I911J0
nr Thai he is eamnpt therefrom and the hasis fin its alleged exemption. Any violation
,if Section 7031.5 by any applicmm for a permit subjects the applicanno a civil penalty
ofors entre ten five bmlmd dollars ($500).
APN Number
_
Occupancy Type '
32541.103.00
° 1, its owner of he propeny, or my employees with wages as their male coinpensation,
will do the work, and the structure is not imnmed or offered for sale (Sim. 704,
Business and Professor Cod, The Contmaor's License Law docs not apply m'an
- Re air d 1 5 e ti s
q
owner of property Who builds or improves thereon, laid who does such work himself
502 '— FINAL KI�B�IkSyl�-f ENERGY`
or through his own employees, provided that such improvements are not intended or
cRcred far sale. It, howls, the Wilding or itnp.nvemear is .cold wifltin one you of
-
506 — GAS TEST .
completion, the owner -builder will have the burden mproving than her did not build or
imp msefor Parna,c f.mdr.) 1
-
507 — FINAL.PLUMBING
° I, as owner of the property, run exclusively cnmmning with licensed contractors To
construct the project (Sec. 7044, Business and Profession, Codi The Contractor's
Liana Law doss not apply to an owner of Or erfy who builds or improves thereon.
and who contracts for such projors with a contractors) lioensed pursuant to the
Cmumcmr's License Law.
❑ I an cxempf under Sec 11 N P C for this ancon
+,
owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty nl perjury one of the following declarations:
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° 1 have and will mainmin a Cenifcatc of Consent to self-imum for Worker's
Compensation, as pmvld.d for Tay. Section 39110 of the Labor Code: dor the
perfortnana of The wad fof which this permit is issued.
° 1 have and will maintain Worker's Compematidn Insurance, as required by Section
37001 of Ile labor Code, far the perhmmance of the work for which this pemmi(is
-
issued. My Workers Compensation Insurance easier and Policy nuhnWr are:
..
Carrier: Policy No,
CCNI'IPICATION OF FXEM MON FROM WORKERS'
• COMPENSATION INSURANCE
on, .,,Ohio need oaf be completed if the Perri, is failure hundred dollars.'
`
I$ [(IT)) or I"'.)
'
1 verify that in the performance of the work for which this permit is issued, I
,hall not employ illy parson in any m neer so as to became subject to The Workers
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Compenuni°nlawsofCalifomia.Date
s
Applicant
NOTICE TO APPLICANT: If, afar making this Cenificam of Exemption. you should
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1w,l ne subject to the Worker's Cc mpensatmn provisions o1'the labor Cole, you mer
fdnhwitm comply with such provisions or is prior shall be deemed revoked.
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CONSTRUCTION LENDING AGENCY -
I herehy affirm that there is a contraction best agency for the pe.fonnatee
of the work for which this penin, Is issued (Sr,. 3097. Civ. C.)
Lenders Name
-
Lender's Address
I lenity That 1 have rot I this applicnfiou continue []all We all infbrmmtion is
correct. I agree ns comply with all city land county ordinances and state laws relating
,
to building construction. and Tacitly oehnriec reatccenwtvex of thus ity no enter upon
the uMve-mentioned nodality for inspection purposes.
(We) agree to save. Indemnify and kap hanni the City BI Caproino against
liabilities, judgmens, costs and expenses which may is any way acerae against .aid
City in consequence of the granting of this permit
APPLICANTUNDERSTANDS AND WILT, COMPLY Wl m ALL NON -POINT
Issued by: Date
SOUR
Signature of ApnlunntlConloctor [)all
Re -roofs
II AZA BOGUS MAI FIT IAIS DISCLOSUR II-
Will the oaplicamrn name having occupant more or handle hurricanes material
'
Type of Roof
as defied by the Cupesi no Municipal Coal, Chapter 9,12, and the Ilealth and Safety
Code. Seeman 25532(a)^. ' '
El yr, ON. -
All roofs shall be inspected prior to, any roofing material being installed.
- Will the upplicmi[ or future building iacuphmnt use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
Wit humrdous air contaminants as defined by the Bay Arca Air Quality Management
xhicl'r
all new materials for inspection. Applicant understands and wilt comply with
°Ye °No'
all non -point source regulations.
1 have read The hoodoos maenaLwrequimmenu ander Chapter 6.95 of The
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CalifomiaHealth&Safety Cale, Sections 25505,25533 and 25534. 1 understand that
if The building does not currently have a around, ihu, i, is illy responsibility it, notify We
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occupaat of the hopmucmmms which must W met prior to issuance of a Certificate of
"
OLenpan`y'
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ow-aermautharbcdagent Date
OFFICE
•
DEC. 5.2000 4:32PM NETCLERK INC
TO:EPERMITS
Dubuque 720 v
I,, ,�,.,,.-.. , �..•.,�* ^„i ._. ,y, r,� p' q Ave., South San Francisco, Ca. 94080
i,ti14 '�'„'' Government Services: 888-330-1777
.� Fax: 877-84 6-5888
'�f•�J..';,I��'�:,�I 1,,,; �,�ruPWx`::;�:,.w
I Email
TO: Cupertino
Building
City Hell 10300 Torre Ave
Cupertino
CA 95014
4087773333
NO. 726 P.1
rermit
Application
U O 0-00
Permit Handling Instructions
Mail
The approved permit will be mailed to you.
-,:. `ic .
Contract"O�r Information
Company! Budget Plumbing
Address: 28695 Roanoake St.
City: Hayward
State / ZIP: CA 94544
Phone: 5102641113
Fax: 5102649291
Email: budgetplumbing@home.com
Worker's Comp Carrier. HIH America Compensation
Worker's Comp: WC701-0000433
State Contractor's Lieense:769745
Business License M
Credit Card Information
Credit Card Numher: 4802099260046275 Visa:
Expiration Date: 3/2003 Mastercard:
Ce
ro Holder Name
Brandon E. Clark Other:
Pre -reg: YES
Payment: VISA
Agent Authorization: YES
ORGQ NOTA FV.Q
Project Address: 21381 Milford Drive
Comments:
t e 8
Attachments:
WCQ SCLQ SASEQ AA 0
Permit Type:
Permit ID: 66417
Exp. 01/12/2001
Exp. 10/31/2001
Exp.
Exp.
Exp.
I
•
•
It' DEC. 5.2000 4(32PM NETCLERK INC N0.726 P.2
CTrY OF CTJFERTTNO -
CONTRACTOlt
lauELDING IsMSION
IINFORMATTONt
BTIIIDINOy Via 45r
21381 Milford ON"
PPR)IM Not
Budnet Plumbin9
x OIVNPSl'S NMaYI
s Jack BlrkhOlz
n PLICATION DVH DAM
28895 Roanoake St.
PFWNB.
408-257-7721
Hayward 94544
SANIT'AAY NO. CONTROL NO.
p ACFB2PCT/@IR1NiafR1�
mmnnrG JammT INFO.
fj37
5102641113
Mina ' M PLT rmek3
41C'¢D CONTFA[TOc'S OAClA1NT1
' 1 hereby alum cat 1 an, beemea ov0¢ Ma .ieru of Cbeger 9 ( nemmp
Jobhewi9tn
. w aww 700(l) of oMxm 5 ar de, Distant,, Hcoal, w
.614110) nyntwaWater
heater replacement
Ltna. ClMO¢
GsS 76'9�74�5'."�'
bees: 11/20/2000 ceao-aaowm ^ •7q
® ?ncxlTEcraaeGlA3urIDN
Y plass shat b used u publk rte.da,
�^
L IN3mYUso
9
oramT"MlsEx DWURAT70N
I hereby Ifni. the, I am
Sq. Ft. FIOOr Amyl
Vnll3aOon
aatmV Dom ,ho CanwndefI Lions. Law fu tea
J❑i reo+wa (SeWion 70111, Basin. aro I'MTWitw Godo Any by or Maly
% W ieh 4-11.
Iwll lal t prod b M not, When im¢om deamtiah, a noir any .aMene
650.DD
P+ior as to imwnn, enc mhhm dm .Fpli Por such oenWi to Ill. o d®udamemam
£ diet he b Isewed Pvawm in & p avhlom of Iht Connector'. Lime Leu (over 9 (tommmwP
APN MIDI /L/
OCeupanry lypc
` u5µ S+aim 7000) of0 hash 3 elate B10mrw wd Paa4cim Code) or bol an be MM, IhM an
^
eld the hash for Ne olo(vd wempdm Any Wohlba or Scales 7MI.5 by any wo.r.l br
a
I Heist. the apFNmin to o blWI Mettler.., Donn dun Ove hoafte delta,. (1500).
4 a ¢vett of dm
u µmPedB m nq• myoym wWl wupel a Ibam 1Wa wmpttNdOry will do
me wad, Iso tbo etrudun o ode hlo:lmed ar oObM IDr win (Sas fOw, B¢m. end Pmf.kxl.
Re .101 Ing wtion3
7 P
of Omaedy wM bub& or impwn
Cale: Tha (1.mmr'n I% ch I & hem vol apply an an his
WtteerL and I.IIo Ow tm4 wad hhmelf Ik Ibtal9a hN new empl¢rzu, Plovlded mm aQ,
tgpa.'an+rbmevol mmdd mOhap M 1Nu R hawrtr, Wa had'mS ¢hllpnndme'u aW Wd'm
ow Inv al lac ewnarbWldtt avOl Gem tlx buwu of motets WW b did Her bWla
Du urp.;pHera.
m improve e of Wal
4 as awn. of Pmpm, y, am enaot,* ravaauln` with lba.,s d Winsttn, to
aanvtua the pryeet (Sea 7W4, DUat.ho and Prolasuons qw) no C.."aure.
'
Lime Law does not Italy b an Damn of IMI)MY wlb battle or kcptwu dYreen,
m0 As wamch JIM Hoch, Ply)wf Nib a tow .... is) litmae0 Pwwanl in the
(bntrwbab Li. lAat
❑ lonamagmdess.
B&I4.`fa Nis forma.
Own. pope
WORM ER•S COMPENSATION TIRLARATION
1 hereby aper lie tt peashy at paa)oy me of ba fellvwivS deWaMom:
1 lava and WII raja jA. a Cath m of Co.. to 1Nrimuw f. obdn,
tlnlpumtdON w Pwr W T. by Sudan 3790 or (be Labor Code, roe Ills
r tmtvw ofµ. work f.aRaee lalaced.
I low and WHO d., Walao'-
Wodm'a C... oft Imftk m muted Sermon
so of Ina Lobar Cada, fad
too of Ila wok !m uNeh This pennh b
iswW. My w.ktt'e Oompuluton ImuNnw sari. avd Policy number Ira
m I tone. rut
Gahan HIH America Compensation p.ii,x.:WC701-000043
CPAnP3CAilONOF ®TIO)"? IONFROMwpP,tCghS'
DNSetpo"d MSVr
(This n an MW Del in ifthe pf one hu
if ear Dao hundwd colon (dl, of ICN.)
I nua id,md
] wdtry dvt in fu the
of de wad Nr It
bi3 permit is Waled, 1
to say --
that rot nnpoy eon Proem m any numb w N to bamne Nhj. m Ibe WOdti f
.
Canpawllim Lew of CNiWmhj �+
1/20/2000
vh,1
NOTICa TO n?PLCANI: Q .Ser twlioS one cmlraic or Iti Wliw, yon .ha_ o
betmte svb)ml Io be Waimea OD-19oblim Penhons or dm I" Cora, AI,naa1
redhwid wmply wioh salon JMQ 1000 w Win p.mil that] be dueled Nosed, '
CONSTRUCTION LENDING ACEf1CY
I basally am. Ihn Ihu 4 a emawOioo Imdn9 as ... y for Ibe Porro w
offs wart f. mhiah Ibis pe.ls If INved IS. 5097, Ci, C.)
.
Lama's Nide
Lander'. Adder.
) calih bat I ban m do apPliwaien Iva Gab deal ale ebavt Nlmmnliw h
oner.L I Isere be slowlyWall al guy anll annow and.., Nd ow law talady
b bad I MYplltdah *0 lai[by -season r ineolo epi" of this Wh' to saw Uppl
de abw"Meeved wafteray it. btmwdm emal..
(We) seer ke won, Indannify and keep bnwta. am Ole or Cupaadro aSal.
pabilitim jaddmmy, awn .lull upmYon mem
es Oiay m way ..opines 440
of IM pv "..
APPLIC (WILL
NT TD^ '0 w
COWLY mf ALL NON -POINT SOVRCB
REOVLATIDNSyyy ,-
Typoofltoot
�r 11120/2000Ro.Ioa4
Slawlvmefnapom+ r nes¢
NAZARDOOS MATEBLALS D W CLOM W
Will the sootiness ¢ futon bwldinp oemPla Sim . handl. hwmds. nmuda
u 0afuw by We Rlperovv mwj ILw OWn Chador 9.12.and ala "son, me Sorryprior
Coda Semon 15513(¢)7 , Y(a Li No
,UI tone Ghali bn Inspector! to hay mdfmS Mat¢Iol being inxaDW.
If mot Is IMWIhd wiehoav fim oblolnins hd idspoelian, I agrae w remove
1
all naw mhmaals fey )nypeotive. Applicant Imderlwdds land will Pomp1Y with
WIII Iht applitad al,&bn hW151-9 atwpW uw equip..] or calms w0im
al non�.Wma ttsWk4enn.
.it IWl.dam a'v wvmlisanaln{d by Day Atm Air 13aNby Msnfmmml
punW7 Yes We
�aWCt
I ben rear w Sap eon negotiate rqulrtmenu ..dtr CheaM 6.95 of eke
11120/2000
Caibmo sinners & 6141Ay Coda, Swdow, 20105, 25515 and 354X 1 maaaaaa0 IMI
If ale 64100— •Y— —• —n., ttovt I ubnnl that i+ it my mpont0lli(y (6 nstlry'16a
Sighlbu6 or ADplinin; Dam
waroaa o�=h ..I be nut prMr to Omnes or a CeNd¢m.of
oavaPnnaY
All mpfeonrivp tops Chau"al'mbnbf
11/20/2000
OPMCE
..
OZ,.tud.bada pass . Al l�]
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY q 3
Sec: Twp: Rng: Sub: Blk: Lo[:32641103.00
DATE ISSUED.......: 12/06/2000
RECEIPT k.........: 14199
REFERENCE ID H ...: 00120041
SITE ADDRESS .....: 21381 MILFORD DR
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER ............: BIRKHOLZ JACK L AND JANET A TR
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1327
0
RECEIVED FROM ....:
MAIL -IN'
CONTRACTOR .......:
PATRICK T GOMM LIC k
22131
COMPANY ..........:
BUDGET PLUMBING
ADDRESS ..........:
28695 ROANOKE ST
CITY/STATE/ZIP
...:
HAYWARD, CA 94544
TELEPHONE ........:
(510)303-7847
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT
THIS REC
NEW HAL
d
BPWHRATER PER
HEATER
1.00
9.99 - 0.00
.9.99
0.00
PRITFEE FLAT RATE
1.00
35.52 0.00
35.52
0.00
T PERMIT
45.51 0.00
__________ __________
45.51
0.00
METHOD OF PAYMENT AMOUNT
NUMBER
_________________
OTHER
____________
45.51
__________________
VISA
TOTAL RECEIPT
.......45
51
VOICE ID
DESCRIPTION
VOICE IO
DESCRIPTION
1 502 FINAL
PLUMBING ENERGY
506 GAS TEST
{ 507 FINAL
PLUMBING
0