06060173 CITY OF CUPERTINO `+eax r
BUILDING UI VISION PERMIT CONTRACTORINFORMATIONN
BUILDING ADDRESS: PLUMB a IN TIME INC PERMIT NOO 6060173
789 STENDHAL LA
OWNER'S NAME: PERMR ISSUE DATE
ERIC ZHOU 360 MEMORIAL DR ST 06/19/2006
NE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITECT/ENGiNEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
t� l� ff l�
u o p LICENSED CONTRACTOR'S DECLARATION
twF 1 Mreby affirm that 1 am licensed under provisions t f Chapter 9
Fencing
Job Description
SZto win Sectloo 7W)Of Dwisiort 3 of Ne Business and Profession,Co ,,�, l°c'enx is
n« inrwlmm aWarrct /�� �$ " REPLACE HOT WATER HEATER 40 GAL GAS
jai License us Lk.g&4::
Data L Contractor
A CHITECrSDECLARATION
1 understand my plans shall be used as public records
.
1U
aH Liccnsnd Pmressional
g OWNER-BUILDER DECLARATION
f I hemM1y air,.
Out I am roempt from the,Con.a.es License law for the
20 following reason.(Section 7831.5,Business and Profession Cade:Any city or county
9{ai which requires a Permit us COr6Wel,ilLL,.Improve,demolish,or repair any sanctum $500
_z< prior mise issuance.ales requires thcapplicantfa,such permit to file a signed swemcnr
that he is licenced innocent to tete provisions of the Contracmri Name Law(Charter 9 Sq. FL Floor Area Valuation
y�0 (commencing with Section 7000)of Division 3 of she Business and Professions Code)or
i $
that he or exempt therefrom and she basis for du alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicmr to a civil pcvhy of Occupancy Type
not mom Nm ftw hundred dollars(1500).
❑1,u owner of Ne property,w my emplayces with wga u Heir sole compevadon,
will do WeworL and due he Cumuruo',License
icar caw does not apply
an
sans." Required Inspections
property
artyPonwho ns,
Code:The ws dimmer.
and
who law dos not apply m an ower of q P
property who builds or in,that such impr and who daessuch work himxlfvthrough his
own emplayebuiprovided that such improwmanu are net ear o c aroQemd fordie own If.
havewnrhe building or improvementusaidsdid act
year of eomcom for theower.
builder will haw de burden of proving that K did trot NiW or improv for purpose of /?I tg g
sold.). rr/(//rJo�g�\91 pIFY{1G3[Wy1£T�4 LppWtJ��/Jy
❑I,u owner of dte property,w coclu rmly contracting wish lieerued cones cors to
covtmct the project(Sec.7014.Business and Professions Code:)The Coouacmis Li.
cense Law does not apply in an owner of property who builds or improves thereon,and _I,
who contracts for such projccu with a conewcou(s)licensed pursuant m the Canuacemes Y�C r{/_ 2006
Leave Law. ' o
❑I am tramp,undo See .B&P C for Nis mason
Owner D.tnG� B
WORKER'S COMPENSATION DECLARATION
40 1 hereby aIDoe under Penalty of perjury reof Na following dachntiov:
I haw and will maintain acenifiate or Consent to self-insure far Worker's Camper.
satian.as provided far by Saction 3700 of the Labor Code.for the No...of the
work for which this pemtit is issued.
1 have and will maintain Worker's Compensation Irssomme"u required by Sccuon
3700 of the labrr Code,for the perfarmaoce of dme work for which duo permit is tseuN, '
My Wor sea Compensate..In,unn 0 lie/y/�,y7m :�
Cam oil cy Nb.
ERTIFICATE OF EXEMPTION Flt
COMPENSATION INSURANCE .
musseetian need not be completed firth permit is(none hundruldoll(3100)
or less.)
1 cer ify that in the performance of the work for which this permit is issued,I shall not
employ any person in any musician ze to become subject to she Workenr Compensadon
Laws of uhromia.Data
Applicant
NOnCE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject he Ne Worker's Compavatiun provisions of na Labor Code,you most
.J,Z faMwith comply win such provision car this permit shall be deemed mwked.
z O CONSTRUCTION LENDING AGENCY
I Wrathy arfom dust Vert sea cross that lendingagevy roe the pcommanaof
a Ne work for which this permit is issued(Sec.3097,Ci,C.)
W�Q Lender's Name
=z Lender's Address
U C) 1 certify that 1 haw read this application and sure that the show information u
U.F correct.1 agree to comply with all city and county ordinances and sura laws relating to
pU building consuuaion,and hereby authorize mpresenudws of Nis city to enter upon the
ahuvc-me,judg dProperty for cx,,c son which may
F
ca. (We)agree to saw,indemnify and kap harmless Nc City of Cupertino against
rq liebilitles,judgmcnu,casts and expcnsn which may in any way accme against saidCity f
V z in camueq c of rte granting of Nis permit.
PPLI UNDERSfAN AND WILL COMPLY LTH ALL NON-POINT Issued by: Date 6^ y
RE ULATI N3 112_ -6
Re-roofs
ii a of ApplicanUCa ZOU Data
HAZARDOUS MATERIA DISROSURE Type of Roof
roll she applicant for=building axis utomorhandlchaumdousmamrial
as defined by she Cupertino Mu icipal Cade.Chapter 9.12 and she Health and Safety
Cale,Section 35532(1)?
❑Yes Na All roofs shall be inspected prior to any roofing material being installed.
will the itlicam m rain d ildin aces If a roof is installed without first obtaining an inspection,I agree to remove
pP g pant use equipment or dM...which g
emir hvaNnv air contaminnu defiad by Nc Bay Arta Air Quality Managcmcm all new materials for inspection.
Disai<tT
❑Yes Nr
1 have mal Ne hvardousmaerials rtquirtmmv umkr ChaPmr6.95 of dme Cali(or
iia HcalN&SafctyCodc,Sectipu25N15.255JJ anJ 25531.1 undcrstmd duatifNc Wilding
docs rmmly haw a um:L duce it u my onpouihiEty to noury the occupmr of de
ntr wnianm met pricer rat issaamx cera Ccrufica¢arSignature of Applicant Date
r or amhoriexd agent D,m All roof coverings to be Class "B"Or better
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37542041 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34931
REFERENCE ID # . . . : 06060173
SITE ADDRESS . . . . . : 789 STENDHAL LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ERIC ZHOU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4658
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
�EE 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
aM
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: q I LonPERMIT # 060 60
OWNER'S NAME: lEfl G PHONE # '
GENERAL CONTRACTOR: t✓ ,J, ;,. 4 -,V.2=nW FAX #
I am not using any subcontractors: a%�
Signature Date
Please check applicable subcontractors and complete the following information:
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
All 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
,:2
wner/Contractor Signa Date
cwoor73
CITY OF CUPERTINO
rrr WATER HEATER
CUP ftkTINO PERMIT APPLICATION FORM
APN
Date:
Build Address: �1 / 'Q6
7 9 5knA�gL ne CuQev
LaN88no ,Ccs 95OIy
Owners Name:
t C Z�np Phone#:
Contrictor, 1 cep$ 511 . 0 9 9 5
License #:
C�
Contact: �n,
Y. I b� Cupertino Business License #:
Building Permit Into: (�
I
Bldg j❑ Elect ❑ Plumb ' _
Job Description: Mech ❑
Resid 'ntial 40
Commercial ❑
Cost oProject:
i !� `C. .
Strappi d On Platform ff
Bonded
• New Location ❑ Replacement 15
Qty.l if
A pliable Fee ID
BPWHEATER Fee Description Fee Grou
PPERMITFEE Water Heater/Vent BUILDING
BPlumbing Permit I
ENERGY ssuance PLUMBING
BUSLIC Energy BUILDING
� Business License BUILDING
Ti,C�4
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