06090135 CITY OF CUPERTINO
DUILDING'7IVISION PERMIT kCONTRACTORINIiORMAT,10 h.
BUILDING ADDRESS: PLUMB IN TIME INC P""ND'06090135
10108 RANDY LN
OWNER'S NAME: PERMIT SUE DATE
FRANK LIANG 360 MEMORIAL DR STE 140 09/18/2006
NE: SANITARY NO, CONTROL NO.
(866) 293-3031
ARCHMICT/ENGINEER: BUILDING PERMIT INFO
fiLDGO ELEC7fO PWM MECHO
lOo LICENSED CONTRACTOR'S DECLARATION Job Description
1 bunchy affirm Nos I am licensed under pmvila as of Chapter 9(commew ng p
?iW with Se co.70110)of tion 3 ofdm Basinecsand f Cwc,and teenseu
>>„ infullforceandare REPLACE WATER HEATER 50 GALLON
a t2 Z Lee
Lk.g
-Fre Dam Contractor
AR 1TECrs DECLARATION
4 w, 1 understand my plana shall W used as public records
LL H Licensed Professional
O OWNER-BUILDER DECLARATION
I hereby alarm the,1 am exempt from the Contractara License Law for the
COO following mason.(Section](131.5,Business and Profevaions Cade:Any city or county
m which rtyuims a Permit las construct,alcor,improve,demolish,or open,any structure
$500
-Z} prior At its issuance,allu requires me applicant for such permit to Ne a signed statement
'EG thatpursuant hcislicensedpursuanothepnvisionsofMeContractor'sLicenseLaw(Chapter9 Sq.FL Floor Area Valuation
11-0 (commencing with Section 7000)a Division 3 of She Business and Professions Cod,)or
ri Nat M is exempt therefrom and dm basis fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the Applicant o a civil penalty of rU U Occupancy Type
not moo than five hundred dallan($30r,
❑1,as owner of the progeny,or my employees with wages AS their salt cempensadon,
will dothe woW and theswmum b not intended or offered for saot(Sce.9014,Bastions Required Inspections
and Pmfeemms Code Than
The Cuacusrs Lt.Law don tet apply N comer an cer of q p
property who builds or improves memon,andwho doeasuchwork himaelf or through his
awnemployres,proWded that such improvements are notimended aroRered for sake U.
however,the building or improvement is Said within one year of completion.die owMr-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the propeny,am exclusively contracting with licensed contractors to
concoct the project(sec.7044,Business and Professions Code:)TM Contractors U.
cense law Ones not apply in an owner of prapcoy who builds or improves Nueon,and.
who cones for such projects with a contractor(s)licensed pursuant to the Contracwh
License law.
❑IamnemptunderSee ,BkPCfmthit000n
Owner Date
WORKERS COMPENSATION DFL RAT10N
I Mrcby AM.under penalty of perjury we of the following declaratimu:
1 bsm and will maintain aCmtiResm of Comeenun ac f-insure for WorkersCompen-
radon,u provided for by Section 37W of me labor Code,for Ne Performance of the
wad for which this permit is issued.
1 have and will maintain Workers Compensation Irsunau required by Section -
JTOoo(the labor Code,for the performance urine ooh for which this pcnnis is issued.
We,
r Com nation Intro nrtiu and Polity number AM
,
CERTIFICATE OFEXEMPTION FROM WORKERS'
Y COMPENSATION INSURANCE
(This section need not W completed if the Permit is future hundred dollars(SIM)
or less)
1 ceni(v Nat in Oc performance of me work for which this Permit is issued.1 shall not
employ any'person in any mem serso as At became subject w She Workers Cumpermtion
Laws of Califomis.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccm(icam of Eaem(aion,you should
become subject to the Wohcrs Compensation provisions or the Labor Cnac,you most
.JZ forthwith comply with such provisions or this Permit shall M deemed revoked.
z O CONSTRUMON LENDING AGENCY
'p+ 1 hereby Affirm Nat them is a concoction lending agency for Ne Performance of
Q'. the work for which Ods permit is weed(See.3097,ON.C.)
W A Undcrs Name
Z Landers Address
V 0 1 testify that I have mad this application and sum Lou She above information is
W f" correct.)agree to comply with all city and county ordinances and soon laws misting to
QU building conswetion,and hartby authe,,..,msamatives of Nis city to colt,upon the
W
above-mentioned d nu.propertycosts
for inspection mien Purposes.
H 4L (We)agree to save,Indemnify and keep harmless the City of Cupertino against
h liecoman,werce fSheeostsand eaperun which they in any way ammc against said City
()z IAnPPLn� ce aNDERSTANDS AINPe L COMPLY WITH A NON-POINT Issued by: Date
SOURC R LAT ONS. —
Si um i anUConmctc Re-roofs
HAZARDOUS MATERIALS DISCL RE Dalt Type of Roof
Wil applicant or future building acupant ss MndleharzAous mammal
AS defined by me Cupenino Municipal Cade.Cbap 9.1 and the Health and Safety
Cade.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs [2No
41 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
error JUMO100 air conumimams uJerred by She Bay Area Air Quality Management all new materials for inspection.
Dinrlcl7
0Yn Nu
I have mail the harardous materials oqulmmens under Chapter 6.95 of the Califor.
Pni Health k SafetCode,Seen.25505,25533 and 25534.1 understand Naz ifdm Wilding
=5CnLlycyh aw a moan Nat' rs y mzponsihility w nodl'y acupans of Newhimust be anctp' rw sSignature of Applicant Date
Ownornadagant D,m All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . 1 : 31623068 . 00
DATE ISSUED. . . . . . . : 09/18/2006
RECEIPT # . . . . . . . . . : 36094
REFERENCE ID # . . . : 06090135
SITE ADDRESS . . . . . : 10108 RANDY LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FRANK LIANG
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
•
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
16UPEkTINO
Building Department
JOB ADDRESS: 1 �Q, PERMIT #o/
D D
OWNER'S NAME: PHONE # p -
GENERAL CONTRACTOR: - #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin ormation
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
35�I�Iboot Sgt bb3.�
wt
C I i CITY OF CUp -PINO
WATEP, HEATER
APPLICATION FO
RM
FAPN
Ob$ Date:
Buildigig Address: ___�13► I ab
L I X0(0 --�I
Owners Name: Q ll��r Ane
Lij \rone ;:
Contrq r- �I O S• LI
— License #:
Contact: tf
�_ ` Cupertino Business License
Building ?ermit Info %C ,1
B;dg ❑ Elect
Job Ddscription: -- dumb IV Mech ❑
y}�
Residential
Commercial
1 Cost of Project:
I �ai�� �
� Strapped ❑ On C'lform
I � � Bonded ❑ �--
New• Rotation _ Replacement
i
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Qfygiif
Applicable Fee ID
BP ✓IiERTER Fee Description
I PPER-NIITF—E I Water Heater/Vent Fee Group
BENE- )'GY Plumbing Permit issuance BUdL LANG
BUSd.TC Er=er�y PLUMBING
Business d,icense BUILDING
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