06060174 (2) CITY OF CUPERTINO �
`BUILDING DIVISION PERMIT n k.CONTRAGT,OR INFORMATII N ,
BUILDING ADDRESS: PLUMB IN TIME INC PERMITNO'06060174
10382 ORANGE A
OWNER'S NAME: PERMIT ISSUE DATE
Allk MARTIN SHEILA _ 360 MEMORIAL DR
NE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITECOENGINEER: BUILDING PERMTT INFO
BLDGELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION
w I hemby affirm that I am rimmed under provisions of LTapter 9(opm ming J
�ZR widenll Come and
3afthe Businev�wyPrafcX�a�/mTCa ar�fyliccnm is afJtl�t�p(jyWaa;, tl L9
^may in cull forte and offices U// REPLACE HOT WATER H A } It! S `lY
v�x Licenu
is
Lic.g V
r, Date Conine.,
CHITECTS DECLARATION JUL i I undcrs indl my plans shall he used ss public records JV L .500
talo,0 0
Licensed Professional
3 OWNER-BUILDER mexeexempt
DECLARATION
I hereby Not I em.xempl from tic Comm Cod :Any c law for Ne
C o following mason.(SCNen]1131.5.Business and improve,
demol Cat:Any city or county pspt
4 which requires a premie to conLrneL anter,'vnprove,dcmolW,or repair any structure
$500
prior ter its issuance,also requires the applicant for such permit in file a signed Statement ��
-
?< thatheisfm:
licensed ueenseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
YFG (commencing with Section]000)of Division 3 mthc Business and Pmfes'ma Code)or
y
that M is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant(m a permit subjects the applicant a civil penalty of Occupancy Type
not mom than firs hundred dollars(SSW).
I]I,as owner of the property,or my employees with wages as their solo compensation,
will do the work and the structure u notintended mattered Carrot(Sec.70th,Business
and Pmfecdosu Code.The Characters License Law Eros mal apply a an..of Required Inspections
property who builds or impmmoe dismon,and who doessuch work himselforthrough but
awn employees,proNded Nat such improvements am not intended or offered forsme.If.
howessr.the building or impmvemrnt u sold within one ye.r of rorapletion.the owncr-
ble.). wi0 have rhe burden of proving Nat he did one build m improve far Purya¢of
saale.).
O 1.as owner of ft property am exclusively cmivarf.g with lid contractors a
construct the project(Sec.7W.Business and Professions Code:)M Carmichael,Li-
made law dors not apply a in owner of property who builds or improms theman,and.
who contracts for such project/with a comnsar(s)liremed psommi to the Contractor's
License law.
Ej 1 am exempt under See. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby=lino under pcmWty of perjury oro of tk following dcclantiam:
1 hsm and will mainuin a Certificate of Comcnuo self-insurt for Worker's Compcn-
when,as provided car by Secdan 3700 of the Labor Cade,for use performance of the
work for which this Permit is issued.
❑1 have and will mainuin Workers Compensation Insurance,as rcyuired by Section
3700.ffakdy�m/LaIWrnCode,for the per(arommee.oaafss'thee work fon which this permit u issued. '
owmance
on
Do
cash
My Wf 'L'!IC`rAn l(.IfM�r_L � cr c:
Cav-r
C RTIC FlCATE OF EXEMPTION FROM CERS'
COMPENSATION INSURANCE ,
mmiseellon need nolbe completed if the Permit is fromm hundrtddollus(SI00)
or mase)
I certify Not in the performance of the work for which his permit is issued,l shall not
employ any person in any manrcrso as to become subject in tis Workers'Compensation
Laws of California.Date
Applicam
NOTICE TO APPLICANT:IL afar making this Certificate of Exemption,you should
become Subject to the Worker's Compensation pmvisioru of the labor Code,you raw
.J z forthwith comply with such Imovisinm or Nis Permit shall he dcemcd mwmkcd.
z O CONSTRUCTION LENDING AGENCY
h
I h,mbywhip thi Outtherei is.noted(ecf 097.Ch,
agcmy for NC performance of
W'7 the work for which this permit u issued(Sec.JfN],Civ.C.)
0 Lender"Name
Z:) z Lender's Address
U0 1 certify that I have rtad Nis application and state that one above information is
U, F Cnr¢OL I agree in comply with all city and county ominmass and state laws relating to
pU building construction,and hereby authnn,representatives of this city to enter uPnn Or �(e�/y�[�/t,/1y(/, //
[3] ahovomenlionetl property for inspection pumPoses. �/`^�J lLV
(We.)agree to 5]ve.indemnl fy Nd keep ha(RIIeV Nc City of Cupertino against
rF.i h liebilitia,ludgmenu.casts and capemes which may in any way acrncagmnstsaiit City
U z in consequence
PLIC QnencDLINDERSTANDintong f this
WILL COMPLY WITH LL NON-POINT Issued by: Date
S GULATIO
r. Re-roofs C,7
igrtazum Applicarotmnur.W, Delta
HAZARDOUS MATERIA D CLOSURE Type of Roof
INcappliantorfmumbuildingacu(D
remhaMl. soomemma¢rod
as defined by Ne.Cupenina Munici 1 Cade.Ch .12,and the Health and Safety
Code.Sec don 25532(=)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne.applicant or future buil g occupant use ea Air Quality
or Mara which P g
Dist hazardous air conuminanu as nod by Nc Bay Arca Air Quality Managemcm all new materials for inspection.
District? ll
❑Ya LyNo
I have rest the haaan ous materials resryimmen a umber Chap orti.95 ofthe Califor-
.is Health&SafctyCodu Seco.25505.25533 and 25534.Iundcrsamm thmifthe Wilding
docs no rmmly lime a anon at it its my rospomihility a...1,the occupant of Ne
ai uwNch a he t ' rtassaaneearacertira arCcupan Signa[ureofApplicant Date
own r as hmcz 2=sal te_ II
D All roof coverings to be Class "B"or better
CITY OF CUPERTINO
!m 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35719114 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34931
REFERENCE ID # . . . : 06060174
SITE ADDRESS . . . . . : 10382 ORANGE AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MARTIN SHEILA
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
4kEE 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 . 02 110
CHECK 84 . 02 23664
CHECK 84 . 02 23672
TOTAL RECEIPT 252 . 06
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
'Iz 10300 Torre Avenue
o Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OCUPERTINO
Building Department
JOB ADDRESS: PERMIT # O6G
o a O I
OWNER'S NAME: JC/I cr 4 S 1 c PHONE # '
GENERAL CONTRACTOR: l nib } FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
6bwner/Contractor Signa Date
CITY OF CUPERTINO
CUP RTINdR
HEATER
PERMIT APPLICATION FORM
APN
�� -• `a `�/.�— Date:
Buildi g Address: &fey rob
' 0 38
Owner's Name: 5014 -225'
Q 1 h Phone#:
Contractor:
Conta
b. _ �� License #:
ct:
Cupertino Business s License #:
Building Permit into: (ri
i
Bldg 11❑ Elect Plumb
Job Drrscription: r Mech
Residential \ Commercial Lj PCI. r
Cost o Project:
CIO .tb
StrappI ed On Platform Ca' Bonded
• New cation Q Replacement
i
QtY.I if
Appli able Fee ID
BPWHEATER Fee Description Fee Grou
PPERMITFEE Water Heater/Vent BUILDING
/
ENERGY Plumbin Permit Issuance PLUMBING
BUSLIC Ener BUILDING
Business License BUILDING
t
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