06090136 7BUI�ING
CUPERTINO '''^%
NG DIVISION PERMIT CONTRACTOR,INFORMATION °
0.E95: PLUMB IN TIME INC PERMrrNo.06090136
SPANISH OAK CT
E: PERMIT ISSUE DATE
Ak CHING AMELIA Y 360 MEMORIAL DR STE 140 09/18/2006
NE: SANITARY NO, CONTROL N0.
(866) 293-3031
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I��
0 0 0 0
!cep LICENSED I am CONTRACTOR pookaIARATION lob Description
2 I oon 7 affirm Nal 1 am licensed under provisions Of Cbapmr 9(commencing
2ty with Section]gal)of Diviu Sof NC Buvnm and ( si an menwu
a<e in full fame am effett
REPLACE WATER HEATER 40 GALLON
�g1 Liccnu Cl
Lic.M
Jf-p LZ
Contractor
sE� AR gCTS DECLAIRATION
1 i V 1 understand my plans shall W used as public near&
1a� Lworded Pmr.mral
OWNER-BUILDER DECLARATION
<f I thereby alum Out I am exempt Wm Ne Cnnmamars License Law far the
COO O following reason.(Section Rn 1.5,Business and profession Code:Any city or roomy
<$ which mqui=a Permit w ennsuWoo.ter,improve, m
demolish.or repair any swelura $500
:4< poor to iix ismance,also requires the applicant for such permit to file a signed autunlem
EXO that Wolicensed pursuanuoNeprovisions ofd¢Contractor's lucvehw(Chapter 9 Sq.FC Floor Area Valuation
e- (center encingwWSanion T)00)ofDiv¢ion3ofthe Businmand Pmfminns Cndc)or
i?
that he u exempt thwafn m and the basis for Ne alleged eaempdon.Any violation of
Section 7031.5 by arty applicant for a permit subjects Ne applicant m a civil penalty of
not mom than five hundred dollars($SM. r Occupancy Type
wi 1ehrownarofdm thaimm,or myotimenanwithwagesu them sole compensation,
will da =ions and Ne he Commalnimm�dedoraw dee netstsa.]ou,Burirof Required Inspections
ed
and Pmlmiou Code:The Conuarcos,License Law ears not appy to an owner of q p
property who build. idedpavu himp,andwu=nowhwarkhimfe ar wW his
ownver.M Wilding
Provided NalsuchimprovementsarenotiamMmropIcur.themm B.
however.Ne Wilding or improvementg said within one year or improve
Nepose of
builder will have Um buten of proving Mat W did not Wild or improve for purpose of a.�
.., llygY)'t6�"§hV Y
1,as owner of Ne pmpery.am exclusively contracting with licensed ronmmars to /P g1�
mustrect Ne project(Sec.7(s4,Buswner Of and PY Who Ws Cade:)The Contractor's ral 4) p[/�)�7
Cense law does mol apply b an owner of prapeny who Wilds rs unpmvu Norton.ars
who se La afar such pmjecu with sconvacmr(s)licensed ptusmnrmthe Conlnnors
License law.
❑lam exempt under Set ,B&PC fw Nis rtswn
Owner Data //tiyry ar� Z 7006
WORKER'S COMPENSATy on DECLARATION 4(r),`w{)1�]!1}fftVl/(JjI ® �Qg(rq,�\�
1herebyalbum under penaltyof mperjuryone of lffollowing declarations: /� �U
Iho, hickal tlmainWna armednm ofCawenuoself-imurt far Workers Compere- OU
talion.as provided far by Sacu m 3700 of the tabor,Code,for Ne performance of Ne
work for which this permit is issued.
❑1 have shut will maintain Workers Compensation Iwrma,as required by Section
1700 of Ne labor Code.for Ne perfarmance of Ne work for which this permit is las '
W. e'9W—
do Inmran�`a/,Imoo,andPoltFynyp
B-Y--Rn.L�alivrN yICATE OF EXEMPTION FROM WORKERS'5lCOMPENSATION INSURANCE
(ibis section wed not be completed if the permit is forone hundred dollars(SIM)
nr less.)
I,citify Net in Ne performance of the work for which this Month n issued.I shall not
employ any person in any manwrm as to become subject to the Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cenifmam of Exemption,you should
Wcoma subject m the Worker's Compemtion provisions of dm Labor Code,you moat
.J aZ fanhwith comply with such pmvuiouw Nu penam,mail W dwmm revoked.
zO CONSTRUCTION LENDING AGENCY
(--t I hereby aObm Nat Vert u a construction lending agawy for Ne performance of
Ne work for which this permit is issued(Sec.3097,Civ,C.)
1 A
Leader's Nooc '
Z Lender.Address
U O 1 canary that I have mad this application and sate Nat Me above information is
Hcorrect.I agree to comply with all city and county ordinances and sum laws relating w
O(, Wilding communion,and hereby authorim representatives of this city to enter upnn lW
r W shove-menuanm pmpeny rue i cxNeson which may
(We)agree to save,indemnify and keep hamless the City of Cu"arn against
Fe ra/] incoimuni t,ofMecosy and of
may in any way scruc agai id City
C)z m PLIC we of Ne granting of Nis permit.
APPLIC UNDERSTANDS AN ILL COMPLY WITH NON-POINT Issued by: Date
S R EGULA'rIONS. r/
gnaw AppimanUCamrmmr Date Re-roofs
H=RDOUS MATERIALS DIS suaE Type of Roof
W I the applicant or Pardo,building accdpantsm handle hazardous..who]
as defined by Ne Cupenino Municipal Code.Chapter 9. ,and the Health and Safety
Cak,Section 25532(a)7❑Yes All roofs shall be inspected prior to any roofing material being installed.
41 If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant in fourt Wilding by
B.taw equipment or dcvicv which g
,mit hvardnm air conuminana az defined by Ne Bay Arta Air Quality Managcmcm all new materials for inspection.
Din cR
pYca ❑ya
1 have mad Ne Woudous materials mgdiremcna dntbr Chzpmr6.95 of Nc Califao-
ria Hcabh&Solelycade.Sttuos 25505.25533 and 2553J.l undc Ihatiflhc Wilding
does n t currently ham a mnart,that it'my rommaibiliy w ufy the ecemom nr be,ren which must he met pdo Issuance ora - am of upancy. Signature of Applicant Date
owne a to curmagem D,m� All roof coverings to be Class fBf or better
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34232084 . 00
DATE ISSUED. . . . . . . : 09/18/2006
RECEIPT # . . . . . . . . . 36094
REFERENCE ID # . . . : 06090136
SITE ADDRESS . . . . . : 10037 SPANISH OAK CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHING AMELIA Y
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 DESCRIPTION502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: /J PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: - N AX #
I am not using any subcontractor U
Signature Date
Please check applicable subcontractors and complete the q 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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date
35ywS99 4 S�` 6�3�
CITY OF C'UPER INO oucq DISU
c CUPEHEATER
�-�-� � PERMIT APPLICATION FORM
i APN -
3 _ —� — Date: —�
Bwfdit,g Address:
u
1 Owners Name:00D— � C
I Contractor: 4
License#-
C taci
.� Cupertino Business License 4-
9 Permit Info:
�3 i9
Bldg ❑
P5
Etect P ❑
O Description: Plurnb IV/ Mech
fniac ❑
( Resid�ntiaiLA6 Commercial fd
ICost of Project:
Strapped ❑ ®n Platform ❑ Bonde
�i New I;ocation ❑ _ Replacement
if
A pli able Fee ID
BPWFIEA ETR Fee Description
Water Heatcr/Vent Fee Group
PPER]V1ITFEE BUILDING
BEN_I:RG—Y-- t'4umhing Permit issuance
BL'SI.IC Energy PLUMBING
---- —__ Business "Xense — BUILDdNG
— — BUdLDING
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