06030143 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .a:
I Y .tet � € .°x�". S.b'$3L'3x
BUILDING ADDRESS: PERMIT N0.
10082 SENATE WY
OWNER'S NAME: PERMIT ISSUE DATE
GRERF, RICHARD 1000 N RAND RD, #112 03/24/2006
PHONE: SANITARY NO. CONTROL NO.
(866) 293-3031
HTIECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
iO0 LICENSED CONTRACTOR'S DECLARATION
w I hereby.firm the,1 am licensed under provisions of Chapter 9(commencing Job Description
iW with Section]00l))ofDivision 3ofthc Bulinus and Professions Calc.and mylicense is REPLACE HOT WATER HEATER 40 GAL GAS
Ln full force end cflec O�p O O
License Class
CC Lia.X A O ldS
_F� Dale rrEcTsContractor DELL Pe�RATION .b taw Iw7a+f
Nll W use DECLARATION
¢� 1 undersand my plans shall M used u public records
JyV
s o Licensed Pnsfessional
` 3OWNER-BUILDER DECLARATION
<I 1 hereby a0irm
that 1 am exempt from IW COnaacroYs License law for the
p O following maven.(Section RD 1.5.Business and Professiuu Calc:My city or county C 5 O 0
E
m which.quires a pe.I,.cnnsomct.eller,improve,demolish,m repair any structure Y
'lzt
pd.,in its ommuce,alsu require lWapplicam for such permit'.fileasigned smemem
< that he is licensed pursuant to Ne provisions of Ne Canuacans LicOme law(Chapu:r 9 Sq.Ft.Floor Area Valuation
YFG (commencing with Seelian TOM)of Division Sof Me Business and Professions Cam)or
Q $ Net he is exempt dvaefrom and Ne Was for Ne alleged cxemptian.Any violation of 31tMpno An
Section 7031.5 by any applicant far a Permit subjects Ne applicant to a civil penalty of Number Occupancy
net'.oro Nen five handled dollars(SSW). P Y Type
L u Or Of the property,Or my employees with wage as Nei,sole compensation,
will do Ne work,and the somehow,Is not intended or offered for sale(Sec.7014,Business
and Professions Code:The Comnc'.ks License Law does not apply to an owner of Required Inspections
property who builds or improves themon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,Me building or improvement is sold within one year of completion.Ne Owner.
will love Ne burden of proving Net he did not Wild or impress for purpose Of
salt.).
E)I,as owner of the property,am exclusively camncting with licensed contractors to
came,L t Ne project(Sec.044,Business and property
whoans ds,or i The Contractor's Li- -
cnue Law doe not apply'.an owner of property who Wilds or improv thereon.and
who contracts for such pmjeets u
with a eonactor(s)licensed pursuant to ntnmers
Mo Comai
lme Law.
0 iennlam exempt undo See. .B k P C for Nis reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ono of Me fallowing declarations:
have and will maintain a Certi0om of Commm mxlf-insure for .WorhtsCompen-
of.uprovided for by S,ction 3740 of Ne Labor Code.for the performance of the
for which Nis permit is issued.
;&j have and will maintain Worker's Compensation Insurance.as required by section
3700 of Me labor Code,for de performance of Ne work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Pk-HAC Policy N.Al)r— 34ZI44a
CERTIFICATE OF EKEMPfION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed iftbe permit is forone hundred dollars(SIM)
or less.)
I cenify Net in the performance of the work for which this Permit is issued.I shall not
employ any person in any mercer so u to become subject to Ih Workers'Comiscremon
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this COMEMm of Emmption,you should
became subject'.Ne Worker's Compensation provisions of Me Labor Cade,you muse
QQ forthwith comply with such provisions or Nis Permit mailed domed revoked.
'Z N CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm that them its covauction lending agency for Me Performance of
C the..,it for which this peomit is issued(Sec.3097,Civ.C.)
(y lender's Name
a z Lender's Address
U I I certify that I have read this application and state that Ne about information is
ly F correct 1 agree to comply with all city and county ordinances and auto laws relating to
pU building convection,and hereby mutative mprescnutives of Nis city to enter upon the
Na shove-mentioned preleny for inspection purposes.
(We)agree'.saw,indemnify and keep ham Ices Ne City of Cupertino against
.F-v rn liabilities,judgments.costs and expenses which may in any way accme against said City
C.>z A APPLICANT
UNDERf Me STANDS
of this Permit 2
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE�REGULATIONS.
41,(rteY '3-24-4 Re-roofs
Stgnazurt OTApplic HAZARDOUSOMATERIALS DISCLOSURE Dam Type of Roof
will the applicant Or future Wilding Occupant sore Or handle hvallons material
U defined by the Cupertino Municipal Code.Chapter 9.12.and de Health and Safety
Cale.Section 25532(a)7
❑Yns jaNo All roofs shall he inspected prior to any roofing material being installed.
Will Ne applicant ar future building arupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanimus air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection.
rict7
❑Yu KINo
I have mad Me hemNous materials requimmenu under Chapter 6.95 of the Califor'
nice Health 6 Safety Code,Sections nS)5.25533 and 25534.I understand Naz if Me Wilding
does not currently hale a tenant that it is my maponbility'.oraly the cecupsat of the
mq ;m cnta which mustx ch pdarmiuuaoce of a CCNRcam Of Occupancy. Signature of Applicant Date
�--�Fce�c-�-�c� 3-2
Ownc,oraaNnd,edagent Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: bethe
- COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32653009.00
DATE ISSUED. . . . . . . : 03/24/2006
RECEIPT #. . . . . . . . . : 33729
REFERENCE ID # . . . : 06030143
SITE ADDRESS . . . . . : 10082 SENATE WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GRERF, RICHARD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5710
RECEIVED FROM . . . . : PLUMB IN TIME
CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607
COMPANY . . . . . . . . . . : METRO MECHANICAL INC '
ADDRESS . . . . . . . . . . : 1000 N RAND RD, #112
CITY/STATE/ZIP . . . : WAUCONDA, IL 60084
TELEPHONE . . . . . . . . : (866) 293-3031
E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
B GY 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
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -____--___--______
CHECK 84 .02 21532
TOTAL RECEIPT 84 .02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
-M Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # LM8 9Q 09-r-7-
GENERAL
977GENERAL CONTRACTOR: ,, rr FAX #
I am not using any subcontractors: M
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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 p p9L9 rp 7 0`,/
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
yc-r,.t�� t 3 - 21-t
Owner/Contractor Signature Date
Plumb-In-Time, Plumbing Services
A Div. of Metro Mechanical, Inc.
360 Memorial Drive i lk4Q
Crystal Lake, IL 60014 CITY OF CUPERTINO
WATER HEATER
CUP OFlop PERMIT APPLICATION FORM
APN # Date:
3a6 -s3-o�9
Building Address:
lrt�'D �Q
Owne 's Na : Phone#:
r 2c� �- (a -0C(7"7
Contractor: `n License#: _
Cl iCQ �l�M cu1 f CI'12
Conta t '�Q� Cu rtio
no Business Lice a #:
�-�rrr� -� n �ldo��3- 31 'l
Buildi g Permit Info: v-x . logo Ica{2 .
Bldg ❑ Elect Ef Plumb Mech
Job Di scCriptiob--Q 1 k c
Residential Commercial ❑
Cost of Project: d sbo QO
�-C
Strapp d On Platform !s3 Bonded
• New cation ❑ Replacement-4i]
Qty. if
A li ab e Fee ID Fee Description Fee Grou
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING