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06070011 (2) CITY OF CUPERTINO a +•: a^vs �' '� _-- "' �' 1*10 BUILGING-DIVISION PERMIT :GONrA%GTO'TIV'�UR VIAT,IU. s. r$.ax`.SfFx^,n. sx:tt - BUILDINGADDRESS: pLUMB IN TIME INC PERm"006070011 1322 FLOWER CT OWNER'S NAME: PERMIT ISSUE DATE ANNELIES WUTHRICH 360 MEMORIAL DR STE 1 40 07/05/2006 NE: SANITARY NO. CONTROL NO. (866) 293-3031 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ip0 LICENSED CONTRACTOR'S DECLARATION Job Description W bat 1 hereby affirmt 1 am licensed under provisions of Clamor 9(mmyenca, P with Secdon 7Elkl)af DIN' n3 afthe Business ( Cope_,aNfillli..la in fanfaraendoffen (r/ UX LACE HOT WATER HEATER 40 GAL GAS ig: Deme sec.« _ . pppp Dow - — cam sumo y pARCHITECTS DEC A N I undcrnand my plans shall he used an public rtconis e� Licensed Professional OWNER-BUILDER DECLARATION iM 1 Mmhy aRnn that 1 am exempt from the CoMeMemf f License Law for the OO fallowing reason.(Section 7101.5.Business and Professions Calc:Any City or County 5$ which mqulres a permit.conauwL dla.hopmew.demolish.or mpait any"elute $500 -zY prior.its isswnce,Wan requires lM applicant for such permit.Bkaaignalsuomant < that he isliccnudpwwant.Neprovisions ofthocmu amesLice. awpcIarmr9 Sq.Ft. Floor Area Valuation FCO (commencing with Section 7000)of Division 3 mire Buslnamand Pmfevinns Coda)or 3 that he h aurum therefrom and Use basis fes the alleged exemption.Any viclWon of Salon 7071.5 by mY applicant for a permit subjects the applicant.a civil penalty of Occupancy Type not Come than Bw hundred dollars(SM. ❑L u owner of the pmporty,ser my employees with wages u theirsole compenaadon, will do Newark.and thesuuc.mat nainanded oroffered format(Sm.Told.Buuness Required Inspections and PenfGWOns Cade:The C.MuscuNa I.know law does Cut apply 10 as canner Of q P property who builds ser improves thereon.and who does such work himself w through his Own employees.provided that such lmprowmenu art nmimwnded aroffttsd fora&If. hawewn the have t ng w improvement la that he a.,build of comormto,on.theowner- �� builder MB haw the huNen of Proving Wt he did not bWld w Mprow oar purpaw of ,(_� gam® ale.). N(f��Jyh\J IIIWiJpS—T ❑I.as awar of the property,am much aiwly contracting with licensed Connattom an construct the pmject(Sec.7044.Business and Professions Code:)The Com manes U. canse law dose oro apply.an owner of property who builds or improves thmms.and yy who Conmea fes such projects with a Conrammfs)licensed puraam.da:Conuaemis V�7r �_ 2000 License Law. U ❑I am exempt under Sea .B k P C far this reason � y aaa��f ,,yy ay 1371M eer Data WORKER'S COMPENSATION DECLARATION gbx}Y)'4'a1�✓1 UPf)01�\\`�r[r/1) 1 hereby elfiran under penury of perjury aro of the following deGantiom: I haw and will maintain aCerdOcaw ofCamant.self-alum for Workers Compon- an,u provided per by Section 3700 of the Labor Cade.for the performance of the k for which this permit is issued. 1 haw and will maintain Worker's Compensation hwrana,u required by Section of the Lab.Cade.far the performance of the anwk far which this permit u unwedicer' C.f9'm,lr/9wtiaoJwrane artier andPolley numb" ' Policy Na: ERIIF�IIC��CApppTEMMMOeFEXEMpPIa17�074N�q�FRRAOgM�W RES vfeA netMtdlh-SIlwB17 r1� 7Rmr mruacaion p tiwpe Ru hundreddo0ass151001 orless.) 1 cerdfy that In the performance of the work for which this permit is laved,I"I am employ any person In my man erns as.become"Isar.the Warkin'CumpemaBwt Laws of Calirtmea.Data Applicant NOTICE TO APPLICANT:If.after making this Caninnm of Exemption,you should become subject.the Wofte3 Compemadon provisions of aw labor Cade,you moa .,O forthwith comply wish=it provisions or this permit shall be deemed revoked. z r~N.. CONSTRUCTION LENDING AGENCY [-+ I bertbyaRnn that Nem is a construction lending agency for the per(urmace of a> the work for which this permit is trued(Sec.3097,Civ.CJ �W Q Lender's Name z Lender's Address U 0 1 certify Nat I haw read this application and saw that the show information is Iy P Comm.I agree to comply with all city and county ordinances and saw laws nladnt us QU building construction.aM hemby auNarin representatives of this city to enter upon the >4 [71 above-mcmiuned pmNriy fort iNction purposes. OL (We)em a.to sew,indemnify and keep harmless the City of Cu mo against rEi'AA Iia IIiB".judgmemu.Cosa and expemea which may in my way aceta ohne said City U Z in ontcqucmcc of Jan grating of that pOrmiL ^' AP I UNDERSTANDS AND WILL COMPLY W ALL NON-POINT Issued by: Date SOU EG LAT70 S. /J/l i Re-roofs ignm rt ApplicmVC ARDO Dae HAZARDOUS MATERIALS DI DsuRE Type of Roof Will the applicant or future building occupant rehandle heaallons material as de0ned by the Cupertino Munidpel C .Chep. 9 13,and the Hetlth mJ Ss(tty Code,S"Uon 25537(.)7 All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hasardous air conuminana U flood by the Bay Area Air Qualhy Man49CMCM all new materials for inspection. Diwict7 Ayes a I haw mad the harardom materials mquimmenuundcr Chapmr6.95oftheCalifor- nuHealthdsSafmyCode,Satiwts75505,25533 ad25534.I understand Jwlflhe building does t eumendy haw a Mumtligalit u my responsibility to sadly,the=Up=Of the to Im.nisyshiclinvulobe t 'oraissu IsCertificate of - Signature of Applicant Date rwau@ariatda cot sew All roof coverings to be Class nBn or better CITY OF CUPERTINO sm 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 ' Sec : Twp: Rng: Sub: Blk: Lot: APN . . . : 36618041 . 00 DATE ISSUED. . . . . . . : 07/05/2006 RECEIPT # . . . . . . . . . : 35104 REFERENCE ID # . . . : 06070011 SITE ADDRESS . . . . . : 1322 FLOWER CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANNELIES WUTHRICH 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 �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 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 168 . 04 24022 TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • F Community Development 10300 Torre Avenue i /" Cupertino CA 95014 11 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'CUPEkTINO Building Department JOB ADDRESS: 13�Z PERM�� I Dal 44 OWNER'S NAME: PHONE # GENERAL CONTRACTO : F I am not using any subcontractors: SignatureinformDate Please check applicable subcontractors and com Tete the followin 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 CUPERT'INO 000100 WATER HEATER CUP IZTINO PERMIT APPLICATION FORM APN t Date: Build. g Address: 6 a7I ob 13ad 1-owec- eT Ownef s Name: keno 1�1 epi e S Phone#: Contr ctor: k cLu VIo$ • gala �., License#: Conta t: Bv�Cupertino Business License #: Building Permit into: �' I Bld j❑ Elect fy �/ _/ Job D$scription: Plumb `1M Mech p� i t Cl Resid tial ` i_ Commercial Lj Cost o€Project: lbo Strapped ❑ On Platform U Bonded ' New LIbcation ❑ Replacement I Qty. if A li able Fee ID BPWHEATER Fee Description Fee Grou I / PPERMITFEE Water Heater/Vent BUILDING BEN MITF KU Y Plumbing Permit Issuance PLUMBING BUSL,IC Energy BUILDING Business License BUILDING I V-1 )\ tt.!✓S� I °