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06040119 CITY OF CUPERTINO " '`�" pts BUILDING DIVISION PERMIT CONTIRACTORINFO` ION BUILDING ADDRESS: PLUMB IN TIME INC PERMIT NO. 06040119 11508 ROCK SPRING CT OWNER'S NAME: PERMIT ISSUE DATE ILAN RAAB 360 MEMORIAL DR ST 14 ONE: SANITARY NO. CONTROL NO. (866)293-3031 ARCHITECT/ENGINEER: BLDG BUILDING PERMIT INFO ELECT PLUMB MECH 0 0 ! 0 ice LICENSED CONTRACTOR'S DECLARATION lob Description wC 1 hereby affirm tat 1 am limessed under provision of Chapter 9(Commencing - p :iW wt Sator,7")of Division 3af No Buafm..and Prafcssiom Code.and my licence is in fall force and.ffat. REPLACE HOT WATER HEATER 50 GAL GAS TALL 12YR q_i uaense❑u. G-'DA Lie.x 9 Dow DEC RAW '� s�'-j' CHIT EC TS DECLARA 1 y 1�-s 1 understand my plans shall be uuJ u public mcnrt ,yV /� e u. Licensed pmfssional (_X(, .0 OWNER-BUILDER DECLARATION I hereby affirm Not I am acmpi Imo On,Contrxm eYfts Liecnaa Law far O o (allowing rtazon.(Sado,7B3 LS,BLLSlners and Profeti.ns CWC:Any city or[aunty m�+ which nation.a permit at conswct,aIle,.improve,dcmnlish.,r repair any saoc,me $500 -za prior to its issuance.also rcquims the applicant for such permit m file a signed statement FSG put Malicensed pmraanitodmProvisions oftoComrecohLicc=Law(CMpar9 Sq. Ft.Floor Area Valuation et- (commencing wit Scetion 7000)of Division 3 of to Business and Proressions Code)Or rj$ tat he is exempt tcmfrom and to baso far to alleged eaemptia,.Any violation of Section 7031.5 by any applicant fa a permit subjccu to applicant m a civil penalty of upancy Type not mote tan five hundred dollars(15110) 1,as owner of to property,or my employ[,with wages as their sole compnuadon, will dot,vwr sndteswaare4on,intended oraRew far ran, aoa4 (s .7 ,BudKa Required Inspections and Professions Cadae,The Cont uses Unarm law does act apply m anwr aax e of q p property who builds or improves tenon,and who does such work himself or trough his .we employes,provided tat such improvamsta are,not Intended arofrened(or sale If. however.tc building mr,unpmvement u.rold witin arc year of acmpleda,.tc owner- builder will have to handlers,of moving that It,did nm said Or improve for purpose of rale.). Q 1,u owner of to propcny.am aclurively co,uaming wit fiarumd Contrssmrs b canwct tr,prajea(Sec.7044.Basin.mod Pmfssons Cede:)The Contractees Li- cense Taw area not apply to an owner of property who Milds or improve tartan,and who Co..%far such projects wit a cavo rtmr(s)licaread pursuant m to Canvaeme. L'ecnse law. Iamaemp,aader See ,BAPcfoftiareason Owner Dan WORKERS COMPENSATION DECLARATION 41 1 thereby affirm under penalty of'do,1.of to following declarations: ❑1 ham and WI maintain a Cerdfisteof Consent to self-insure for WarkcraCompen- sasion,as provided for by section 3700 of the Labor Code,for to perfa,mance of the work for which tis prrmft is issued. ❑1 han and will mainuin Warker's Compensation Insurance,u mgohed by Sado, 3700of to Labor Cede,far to pcdormance of to work for which tis mantle bused My WorkeYa Compensation Wuranee emrier and Policy number are Carrier. AV Qui Policy Na.: -lig2- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissocdm nod not M completed if to pmmit Is(mane,Mndsea dollars(SIM) f or less) 1 comfy the,in to performance of to work rm which tir permit u issued,l shall trot employ any person in any mummer an he to baamc rubjat to to Warkeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.afar making this Cotficam of E tosptia,,you dmuW became subjen to to WotrerS Compensation provisions of to Labor Code,you a= .,z forthwith comply with such provisions or tis permit shall he doomed revoked. z v'vCONSTRUCTION LENDING AGENCY P . 1 hereby aRm that tem is a construcdnn loading agency far to p ffmarmace of Qv � to work for which this permit u issued(Sce.3M.Civ.C.) do landcrs Name - w7 z Lendee,Address U C) 1 certify Nat I have mad Nis application and sate to to aMve stuff a..tm u py P corrccL I agra to comply wit all city and coumy orcina,ss and SUm laws rtladng to DU Wilding construction,and hereby autorim mprceemativs of tis city to enter upon tC r0. above-mentioned property for inspection ponoses (We).,me to save,indemnify and kap harmless the City of Caperton.against liabilities,judgments.casts and erperra s which may In any way tame against said City U z in consequence of to$rami.&of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date I('— Z-(—,) L sou 'Lf-7-(-0, Re-roofs Signabore of ApplicandContracmr Data HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will do applicant or faart Wilding acupantarom or handle hamrdous material as defismd by to Cupertino Municipal Code.chapter 9.13,and to Hcalt and Safely [ale.salon 255324)?41 All roofs shall be inspected prior to any roofing material being installed. Will to applicant of future Wilding occupant tau compo[n.or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove omit hums us air Contaminants as dafircd by to Bay Area Air Quality Managemcm all new materials for inspection. D'suio? C)Y. CkNu 1 have road to hvudmrsma¢riaH mWimmenn under CWper6.95 of to Cablor- niaHealth SafctyCadc,Secuons35505,25533 and 25534.1 understood tmifto Wilding does trot curmndy hove a tenant.W,it u my meponsibility to hoary IM occupant of the ,[quirt c u which must M met prior m issuance art r...;fcae of Occupancy. _� Signature of Applicant Date Owner or wtamed.,ent �- 1 pare All roof coverings to be Class "B"or better ,o. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 OCUPERTINO Building Department JOB ADDRESS: PERMIT # `5 o ,V. C* 06 d Y O I OWNER'S NAME: �aQ.. PHONE # p n VLr GENERAL CONTRACTOR: C y FAX # I am not using any subcontractors: 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 v Plumbing �� T�^� ,Q 2 7 C� Roofing Septic Tank Sheet Metal Sheet Rock Tile 4-2J- &a Owner/Contractor Signature Date CITY OF CUPERTINO am 3 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36651032 . 00 DATE ISSUED. . . . . . . : 04/21/2006 RECEIPT # . . . . . . . . . : 34084 REFERENCE ID # . . . 06040119 SITE ADDRESS . . . . . : 11508 ROCK SPRING CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ILAN RAAB ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5124 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 • - - nc��o ► ISI CITY OF CUPERTINO i WATER HEATER CUP Rrnv© PERMIT APPLICATION FORM APN 3UU- 51-- 032 Date: Buildi g Address: y' 2 1 `G r; k c ownet's Name- Con ame: /� K(�R� Phone#: Contractor: � r �p���• License#: Con 't: Cupertino Business License #: Building permit into: 1 i Bid ❑ Elect ® Plumb Mech 11 Job Description: Resid tial c Commercial ❑ Cost o Project: y Strapped On Platform a Bonded • New ion El Replacement i Qty.J if A li able Fee ID BPWREATER Fee De tion Fee Grou PPERMITFEE Water Heater/Venen t BUILDING BENERGY Plumbin Permit Issuance BPLUMBING BUSLIC Business BUILDING License BUILDING I • i