06120057 (2) CITY OF CUPERTINOt ... -
BUILDINtDIVISION PERMIT ..G�IYTRACTCQRIlV1i'URMA.TION.',-
BUILDING ADDRESS: PLUMB IN TIME ,INC PERMfr No' 06120057
10756 LINDA VISTA D
OWNER'S NAME: PERMTr ISSUE DATE
MIRIAM TSUI 360 MEMORIAL DR TE 140 19' /11 /9006
NE:
SANITARY NO, CONTROL NO.
(866)293-3031
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
iC p LICENSED CONTRACTOR'S DECLARATION lob Description
m hereby reby affirm that I am licensed under provisions lir Chapter 9(commencing P
�Ic, with Section 7IX111)of DMioo Sof Ne End nev and f arW y'e,ac is
!may in ranTomsandof= i REPLACE HOT WATER HEATER
,2 x License s Lie M _
Fp Da¢ Contractor —
CHMEC'I'S DEC R T ON
i 1 uWcrsund my plans shall M used as public records
iyV
:0 Licensed Pmfcal
ione
OWNER-BUILDER DECI-ARAMON
1 hereby alRrm Nexempt 1 em exempt from Um Convmtofs License Law for the
p o following masa..(Saito.7(131.4 Buaiku and ere,de um Code:epa city or county
Pi which mquis a a permit to construct.a alter.improve,dcesmil t lir¢pair any svueum $500
.iy prior¢iuissuedpuralso mtto tho roepions o for such ConvcrmitmfilcaSigned mumcm
i s (commecingwiit pursuant totho provisions or Neconaanssa:«nmluws Codc)r9 Sq.Ft. Floor Area Valuation
j
(commencing fougwiNSection70nd of Divisionr dof eNeeged Business and Professions Ca an of
that io u exempt umrefran and or bath far,be alleged eaempuan.Any violation of
Section]divan five
airy applicant.(aPermit subjects the applicant to acivil penalty of r Occupancy Type
out mom Nan fire hundred dollars(5300).
❑1,as owner of Ne property,or my employees with wages as their sole compenauon,
will do the work.and Ne awnuu Is not mounted or affeed forsale(Sec.7044,Busumst
and Prefeaimu Code,The Conuanoh Liana law,does rot apply 0 an..cr of Required Inspections
property who builds orimprowu thereon,and whodacesuch work himseRar Wough his
ownemploye s.Provided thatsuch improrcmcnu am not inuMed oroQerW for sale Ir,
however.the building or improvement is sold within ore year of compledon,Ne owner.
builder will have the burden of proving Nal he did nos build or improve for purpose of
sale.).
❑I,as owner of the property,am eacluvvcly convecting with llceramd COnaacmr3 of
convect the pmjem(Sec.7044.Business and Profession Code:)The Contractors U.
ec ue law does not apply to an owner of property who builds or improve thereon,and.
who Co...for such projects with a contracmf(s)licensed pursuant to the Contractors
License law.
❑lameaemmundo See ,BJt PCrm0fds amn
Owner Dau
WORKERS COMPENSATION DECLARATION
1 hm
chy afErm umler penally of perjury aro of Ne folbwing d it om:
I ham and will mainuin acer Timm of convent to mir.ins=ror WarY escompcn-
amon,a provided In,by Section J70o of um Inbar Cade,far the,performa,a of da
wm/I�for which Nis permit is ismed. _
❑I have and will maintain Workers Compcm cion Insurance,as required by Section
3700.(ft Mbar Code.for on,performance of Ne wort for which this penitis is Issued.
My Workers Com/p/ensairamc caniu an Po: tit rr
Greig CeI CA:1E s/•M
C CATS($ PITON FRO S'
COMPENSATION INSURANCE
(Thu section reed nothe completed if dm Permit u two=hundred dollars($100)
or leu)
I canary Na in thc perfermane.of the work for which this parrots is issued.l shall not
employ any parson in my manner m as b became subject to use Worteri Compensation
Laws of California.Dam
Appnanl
NOTICE TO APPUCAW.If,after making this Cur ifcam of Exemption,you should
become subject to the Workers Compensation provisions of the labor Cade,you most
,7 O foMwith comply with such provisions or this permit shall be deemed rooked.
? CONSrRUCnON LENDING AGENCY
[-� 1 hcmhy aRrm that Nem is a construction lending agency for the performance or
6i > Ne work Tor which the permit is issued(Sec.]097,Civ.C)
ALunates Name
7 z Lenders Addmsa
U Q I certify that 1 Mw read this application and sum that the shove information is
D. collect.1 agree to comply with all city and county ordinances and sum laws misting to
O[) building construction,and hereby authorise repesenutiwe of this city to enter upon the
abovct es pdned properly Lor ire fuimn1.,purposes.
F G
(WO)agme to save,indemnify and keep harmless the City of Cupertino agaimt
UTA liebilities,judgmcnm,cosu end exthisre it. mey in any way acemc against said City
()z in eomeque egradingor this permia
^ APP CA UN ERSTANDS A WILL COMPLY WI ALL NONPOINf Issued by: Date
SOUR I.ATfONS.
Z" Re-roofs
Si roto of plicanUCa Dam
HAZARDOUS
US MATERIAL$ t LOSURE Type of Roof
Will apConsurefuture Municipal
oult.Chants orandd tic Heardond Safety
u de,Sud io the 32(a)?nes Municipal Code.Chapter 9.11,and the HesIN and Safety
Code,Suction Z53J2(a)? [�+a All roofs shall be inspected prior to any roofing material being installed.
[:1y.
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
mit hsnN.a air contamimna defined by Ne Bay Area Air Quality Ma agemcm all new materials for inspection.
N trn7
❑Yrs No
I have read the ba.coutamem". h.,cimmemsunder pur6.95arOmGlifor-
staHeal Saktycese.Swoma23505.25533 md25534. dNmifive building
oro cu nay new a mums.that
it h my maponi y m notify Ne,eceupam of the
m when lte ` ra,ia a cenirm,marlpat .O Signature of Applicant Date
Owner authouirrledagem Dam All roof coverings to be Class "B"or better
_..w Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
11100 LI►10b vil&tn n1P19-0,15-1
OWNER'S NAME: it m � PHONE #
GENERAL CONTRACTOR FAX #
am not using any subcontractors- Z-
Signature Date
Please check applicable subcontractors and com Tete the follow'n information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
-
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: Blk: Lot :
APN . . . . . . . . : 35608016 . 00
DATE ISSUED. . . . . . . : 12/13/2006
RECEIPT # . . . . . . . . . : 37033
REFERENCE ID # . . . : 06120057
SITE ADDRESS 10756 LINDA VISTA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MIRIAM TSUI
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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 252 . 06 2708
TOTAL RECEIPT 252 . 06
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
________ _____________________=______
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITE � Up_,E_RTI_No
CUPER,TINO W TER HEATER
PERMIT APP
•
FP 1-1
FORM
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Building Address: R—�–P-.l Bate:
Owners Name: ,h V�S
Contrar'ctor: , �–S u, Phone #:
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COnta T�
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� � License n:
Building Permit Info: Cupertino Business
License n:
! Bldg
I lobDescription: LI `t -- Plumb
Mech Q
Residential • L
Commercial C SO
Cost of
, Project:
+ .Strapped hoOn Platform Q
Bond o
New Location ❑ I
Replacement
Qty-I if-
Ap ,cable Fee ID
BPWHEATER Fee EEEDescri
t I PPER1�fITFEE Water Heater/Vantpt�on Fee Grou
BENERGY PtL,rn btno $UILBING
BUSL,IC Pertn�t Issuance
Energy PLUMBING
I Business License BUILDII�;G
BUILDING
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