06080039 (2) CITX OF CUPERTINOP fro' 7 IN , '-mow ° " r '
BUILDING DCO
DIVISION PERMIT •. �II�TT+'(�1ItMl�'�°IQ�
BUILDINGADDRESS: PLUMB IN TIME INC PP"MITNO.06080039
19915 FIG T
OWNER'S NAME: PERMIT(ISSUE DATE
SARNO THOMAS 360 MEMORIAL DR STE 1 40 08/07/2006
NE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG E'IECr PLUMB MECH
0 0
upp LICENSED CONTRACTOR'S DECLARATION Job DCSCrIpIIOn
VZ 1 hereby aRirm Nat 1 un Ikcnred wooer per a mu of Chapser 9 commencing
< with Section7"")Af DivatI 3oftiu Business afessionsC mylkense is
lomOtahoe,ndeR EPLACE HOT WATER HEATER 50 GAL GAS
j z License Clan Lk.
nt- Dam - — Cmuseur -
CHITECTSDECLA A ION
m 1 undmvand my plans shall he used As public records
3y0
it,A,
Licensed Prvfcaional
0 OWNER-BUILDER DECLARATION
ig 1 hereby alTom that I am C,CMPt from Ne Contractor's Lactate Law rat the
y D a fallowing mason.(Section 7031.3.Business and Professions Cade:My city or county
which regulons a permit u consuuet,11W.improve.demolish.ar mpoir any sumuho $500
-zY prier to las issuance.aim requires the applicant for such permit m file Allgood maummt
< that heulimtucdpursuanttotheprovisionsofNeCommctor'sLicenseLaw(Chapter9 Sq.Ft.Floor Area Valuation
y D (co mmencingwiLhSwdan700MofDivision3af Ne Buainmvand Pmfmiomco )m
i 9 Nm he iseaempl therefrmn and she boll for Na alleged exemphan.Any Noladan of
Saban 7031.3 by any applicant far,permit subjects the applicant m a civil penally of Occupancy Type
net mate than five hundred dollars($300).
❑I.mawmrafthe property,army cmployceswlN ani vielrsoltrnmpenodan,
will do the work,and the smcluho 1,not imeMedmallered faruam(Sec.7144,Business Required Inspections
and Profeadons Cade:The Conmetoe e nsr's Lice Law dooat apply an an owner of q P
property who builds m improves the arm.and wha does such work himsel f or though his
menemployae,provided that such Improvements arc not Intended oroRered for We.if.
however,the building or improvement is sold within am year ofcompledm,the owmr-
builder will have dm burden of pi dui he did net bold m improve for purpose of
sale.).
❑I,As owmt of the property.em exclusively com azing with licensed comeanross to
construct the Pmker(Sec.7044,Business am Profession Cada:)The Commesers U-
cense taw does not apply An an owenr of property who builds or impmw theme.and,
who contracts for such projetns with a coarsuch U licensed pursuant he the Communes
License Law.
❑1 am mempt under San. .B k P C far this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby tlnm under penalty of perjury am of NC following dechummns:
41 I have sad will maintain a CeNBmu of Consent toself-inmm fm Whether.Conpcn
Won.a Provided for by Section 3700 of Ne labor Code.for the perimmance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Issuance,As required by Section
3700 of the labor Cock.ren the Performance of Na work for which this permit u issued
My o A Cam m I tori and Polley baa: L -
C �_ -��
/s�.�u r�� QI(m EXEMPTION R h WORKER
/�S '�OMPENSATiON INSURANCE
W
(lhisxNm n:W not ba comPleuA If to permit ts foam hunmed do0an(SIaO)
tor tem)
1 certify that in the perfarmaae of the were for which this permit is Wood.l shell no,
employ any person in my mmmr so as an became subject to be Woe a 'Cmnpevades
Law of California.Dau
Applicant
NOTICE TO APPLICANT:If.ager making this CeNBcate of Exemption.you Ali
become subject An the Workers Compensstian provisions of Ne IoM Cade you muss
.JO foMwith comply with such provisions or this permit shall be deemed invoked.
y CONSTRUCTION LENDING AGENCY
E••r Ihemhyallim that Nem is a combustion lending agency far the performance of
Cl.> mc wurk fur which this permit is ipmd(Sec.3097,Civ.C.)
4 Q Lenders Nemt
z Lender's Address .
U0 I certify Met I have reed this application and uan then dm above lot ormadue Is
U,F comet.1 agree to comply with all city and county oNlnances and sum laws muting m
0 building construction,and hereby authane,representative of Nis city to color upon the
W allow-mentioned property for inspection purposes.
gy (We)agree to a".indemnify and keep hamlets Ne City of CupcHino against
d3 Iiabilidm,j WgmenW tom ands expenses which may in Any way aceme agaiost said City
U z in consequence of the tna t of this permit.
... APP ANT UNDERSTANDS ANW ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ULATIONS. — q
_ 0 Re-roofs
gnmm ppR HAZARDOUS MATERI CLOSURE Dau Type of Roof
Will the applicant or forum Wilding act m Mndlc havNoer amurial
an depend by the Cupe rim Municipal Cade.(Witter 9.11 and be He1N and Safety
Conk,section 25532(a)i All roofs shall be inspected prior to any roofing material being installed.
❑Yen 35na
WIII Ne applicant of rumen building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmsrdnns air mnumlunm m dc0end by the Bay Arm Air Quality Management all new materials for inspection.
strictI
QYns olz
I have toad the haraoaonouriab mquitc new undcrChapur 6.95 of duCalifm-
nixHmImkS[rety Cade.Sectimas25505.25533 and 15334.1 understand 1stif Ne Wilding
J of c ly low a unmL Net my rnspomihilitY m no�041.ffthope hmastb mm teeumma(,C mSignature of Applicant Date
o eror, rized[seat All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
4Cupertino CA 95014
Telephone(408)777-3228
��Cl OF
������ Fax(408)777-3333
BuildingJ
Department
JOB ADDRESS: ��S / sr PERMIT " O a 3
OWNER'S N AZ PHONE # - Z 3
GENERAL CONTRACTOR FAX # -7 /
I am not using any subcontractors
Signature Date
Please check applicable subcontractors and complete the foll Dwing inf ation:
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
CITY OF CUPERTINO
�m 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Elk: Lot.':
APN . . . . . . . . : 31630081 . 00 .
DATE ISSUED. . . . . . . : 08/07/2006
RECEIPT # . . . . . . . . . : 35535
REFERENCE ID # . . . : 06080039
SITE ADDRESS . . . . . : 19915 FIG TREE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SARNO THOMAS
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
WEE 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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------- ------------------
CHECK 84 . 02 641
CHECK 168 . 04 639
TOTAL RECEIPT 252 . 06
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO
'NATER HEATER �
CUP RTINO PERMIT APPLICATION FORM
APN I
Date:
Buildi g Address: 0106
1 ^�G e Sb14
Owne'r's Name:
Phone#:
Contractor:
"�-�4a3�,g
License#:
1'
Conta't:
1rCi upertino Business License #:
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Building Permit Into:
I
Bldg i❑ Elect ❑ Plumb '
Job D4scription: Mech ❑
(
Oacp
Residel'ntial
Commercial ❑
Cost of Project:
00
Strappl d ❑ On Platform ❑ Bonded
• New cation ❑ Replacement
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Qnyl it,
A pli able Fee ID
I BPWHEATER Fee Destion Fee Grou
/ PPERMITFEE Water Heater/ Venen t BUILDING
Plumbing Permit Issuanc
BENERGY e PLUMBING
Ener y
BUSL[c BUILDING
Business License BUILDING
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