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06040048 CITY OF CUPERTINO $ rnTm*vT� r• M# `�" BUILDING DIVISION PERMIT ' CONTRA ,0WINFO �IATIOIV.`f:: .��w$'ta BUILDINGADDRESS: PLUMB IN TIME INC PERMITNO.06040048 21853 OAKVIEW LA OWNER'S NAME: PERMIT ISSUE DAM CARTER DONALD B ET AL 360 MEMORIAL DR 2006 NE: SANITARY NO. CONTROL NO. (866) 293-3031 ARCHITECT/ENGINEER: BUILDING PERMIT Iwo BLDG ELECT PLO MO 3o6 LICENSED CONTRACTOR'S DECLARATION NIOb Description 1 hereby"an Net 1 am licensed under provWons of Chepmr 9(commencing P with Section 7w)idonium.3 of Jse Business and Professions Cade.sttl my It..is ism tnrullraccr,MercecC�� Ltg (7 REPLACE HOT WATER HEATER/40 GAL. GAS TALL 12YR Dammambe need FINALE RCHI'IECI'S DECLA ATION IN Is f I mldcreunJ my plans ehdl M used w public records e G 9.00 Licensed Professional a7N OWNER-BUILDER DECLARATION APR 2ol1s 2 Q i I acro alarm that 11. exempt from tM CanmeciMr,License Law for the O o which re moron.(Scotian 7(131.!,contract.altar. and are,de ions Cadc:Any city err caumy $ which as issu•permit ac resthea@e improve,demolish,ri e stigmas any sarectustatement 5 00 _Ira prioM is ienwce.LLmmgo the lhespplmeof for Co mttee torileLaw(Clumenl p p Nwhectmol,with pmvitlwuofNeConuxmrsLkns¢LAw(Clupler9 Sq.Ft. Floor Area V go (commcndng with Srnian 7000)of Division 3 of the Resonant it Professions Code)or BUIL violon.of _ Scction 703exempt 1 3 by�app cam(a a permit objects the basis for sihedapplmaarn m a cin. vil penalty of - not mom than Rw hundred dollen(ML r Occupancy Type ❑L w owner of Ne prapa y.err my moployw with wager,w their sole compensadon, will do dmwotk.W Newuaure u not rounded m offered farwlo(Sec.7014.Redeem; and Praradams Code The Ca mmetres Lkaue Law does sal appy Nan owner of Required Inspections progeny who builder or ire proves theroon,and who does such wank ancestor through his awn employees,provided thatwch Improvements am notimended orolfered foreak.if. however.the building or improvement is sold within ane year ofccmpledon,the owner- builder will haw the binds of proving Nat M did Out bdid or Improve for purpose of sale.). ❑I.as mare r of the property aro inclemently commuting with accrued amoscwr,m canstroct the project(Sec.7044.Business and Professions Cade*To Commexces U. cense Law does not apply m an owner of property who builds or improve thereon,and. who command for such projects with o comamunr0)licensed pursuant to this ConmulorY License Law. ❑Run exempt under See .B d:P C for this reasen Owner Dam WORKERS COMPENSATION DECLARATION I hereby aRirm under penury of perjury one of the following denclanlions: , 1 have and will mainWn•CeNOamaf Consent an self-imwre for WorkcesCompen- wtion,it proviMA fm by Section 3700 of the Labor Code,for the perlormencc of tK wart for which this permit is iaeuM ❑1 have and will maintain Worker's Compensation Insurarcc,w required by Section 3700 of lha labor Code,for the performance of the wads for which am,permit is issued My WorYd Compenwtiav Wurencc ccan sad Poliry number am: - Cueer: f CaC_ Policy No.: (4 PC) CERTIFICATE OF EXEMPTION FROM WORKERT COMPENSATION INSURANCE I This ee ch m MW not he completed if the Permit u foram hundred callers($100) or less.) 1 certify that in the perfermem of Ne work fm which this permit Is Issued.I OWI not employ any person in say member an u m become wbject to the Work ewComposition Laws of CsiifomiA Data Applicant NOTICETOAPPLICANT':r'after making them CeAnesof of Labor Coca,you 0 became anompbjea y the Worker o ism s"this previsions mai of the Labor r Code,you muss forthwith comply with sOch pfovitlans w Nu Permit NOI be dOcmW tewkod r tiCONSTRUCTION LENDING AGENCY [-+ I hereby affirm than Nem Is comwaction lending agency for the performance of GL the words for which this permit Is Want(See.3097,Civ.C.) Wti Q Lender's Name 7 z Lender's Address U O I crnlry Nat 1 hew reed this spplirm..and seem and the above Information Is Ly F eonm I agree Or comply with OI city and county onliw¢es and sum laws relating le 0U buildingcontraction,and hereby anamire representatives or this city to toter upon the LL) above-memi.ned property for inspection purposes. 0. (Wc)agree to on,oriental ry and keep humlew the City of Cupeninu against fA liabilides,judgmcru.case and expenses which may In say wayacram agenst sold Cly U Z in concomitance of the granting of this permits RUr �--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH A .NON-POINT Issued by: Date ,--� SO C REGULATIONS. L.C_C,,Q �--P�v Zf 1(—O* Re-roofs ��— Signmum of ApplicwdComoomr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or finite building Ocampantnort m handle havardons material u denned by the Cupertino Municipal Code.Chapter 9.13.sad the Health and Safety Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the applicant or future building Occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hwardous air canuminanu as denOcd by dtc Bay Area Air Quality Management all new materials for inspection. Distdct7 D Ycs 0 N 1 have mal the Imeado s materials mquimments underChapter 6.95 of the Califaa nia Health k Safety Code,SOctirsu 25505,25533 mul25534,1 undersurel than from building door rot cmrtntly have•tenana duan it be my respeadiniby to nodfy the occupant of the . rtyu' menu wnlon muss met pnarm himmucoracciuncoccrocwpecy. Signature of Applicant Date l IycA.t j J-/ - (I—I:% All roof coverings to be Class "B"or better Owner m wthodvcd egem Dam Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: PERMIT# 2. � \/t� v d ,6 0 c�( oa 4 OWNER'S NAME: �� �, PHONE # GENERAL CONTRACTOR: T ,`we FAX # I am not using any subcontractors: ey 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 wb i v, r1 2? (o O Roofing Septic Tank Sheet Metal Sheet Rock Tile ` s If / N / off Owner/Contractor Signature Date CITY OF CUPERTINO am 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32619100 . 00 DATE ISSUED. . . . . . . : 04/11/2006 RECEIPT # . . . . . . . . . : 33924 REFERENCE ID # . . . : 06040048 SITE ADDRESS . . . . . : 21853 OAKVIEW LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CARTER DONALD B ET AL ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1145 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 • CITY OF CUPERTINO WATER HEATER CUPS RTINO PERMIT APPLICATION FORM AP N n co— l/''^ ^ 100 0v Date: 1 Buildi g d ess: 1 Owne 's Name: Phone#: (AWContr ctor . P\. i o License#: Conta t: Cupertino Business License #: Buildi g Permit Into: Bld ❑ Elect ❑ Plumb)p Mech ❑ Job D scription: Resid tial P Commercial ❑ Cost o Project: Strapp d Wh Platform vi e Bonded • New cation ❑ Replacement Qty. if A li able Fee ID Fee Description Fee Grou BPWHEATER I Water Heater/Vent BUILDING PPERMITFEE Plumbin Permit Issuance PLUMBING BENERGYEner BUILDING BUSLIC Business License BUILDING `►�1urnb - Y, --Rrne 3�� N1.Q.�rno �i.at pr.�►uo C��sta1 Lo�Ce l � LOOOILI act- 3031 �b 5-35� -oc9c43 �� �,��. kV-� o49-