06060063 (2) CITY OF CUPERTINO
BUILDING,DIVISION PERMIT -,CONTRACTOR INFORMATION 0
BUILDING ADDRESS: PLUMB IN TIME ,INC PERMIT NO.06060063
20086 PACIFICA DR
OWNER'S NAME: PERMIT ISSUE DATE
JINMING GU 360 MEMORIAL DR ST 2006
E: SANITARY NO, CONTROL NO.
(866) 293-3031
ARCHITECUEIIGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0� LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 rmmmencing .10'AS
1 is
with Sc c�oodomm'
Business P al
'MC
,aM mYliccnseu 4..:J
!Z� mmn Pa ' REPLACE HOT WAR HEAT$) �L GAS
nse DabCTSDECRA JUL
i e< 1 undrscadull be
end my plans used u public records 7o06
aiU
.off Licensed Pbfcssianal b
3 OWNER-cmrDER DE CU RATION
I<f 1 nasoereby.(Sec thm I am,Bumps s An the Comrazmfn r:My c Law for the [lty`a.J—y'Y
-O O following mason. eauto 7 continues.
Business and ve.dem demolish.
Code:Any city os Cnunre I�
which requires ti permit re eaves the alter,improve.wermit,m,a&sig any srmebm $500
-I6
prior bits cense ealsoutochs dcapplkxmuse for sahpenn;tbicensegaJscakmcm
calla:iaBartsedpnrawntbumproNsi.es.rthec.nuxmr'AIxmrocLaw(Chapter 9 Sq. Ft. Floor Area Valuation
R (cmnmcncing with Section 7(00)of Division 3 ofdc Businruand Prefessiom Cook)or
that be is exempt therefrom and the basis for the alleged exemption.Any violation of
Scratch 7031.5 by any Applicator for a permit wbjccu the applicant b a civil penally of r Occupancy Type
Am mom Nan five hundred dollars(SSW1.
D L As owner of de property,m my employees with wags as their Ask comperoadon,
will do the work.and the structure is not intended re oRerM f.,sate(Sec.7014,Business
and Proressimts code:The v
Conan.ts Liane b raw does ant apply .n miner of Required Inspections
propertywhe builds or improves theman.and whodoeusmh work himself.,through his
own mnployees,provided thstsuch improwmnnu Am or intended aranertd farsak.lf.
builder Ne buildingorimproverovinucoldwithinone year orcompletion,thrposeo-
bale.). will have de burden of proving that k did rot bold m improve for purpose of
sate.).
D 1,as owner of on,property,am exclusively convazsing with Bcemed conwcbm to
motions the,project(Sec.7044.Business and Professions Code:)The Conumer's Li.
cense raw docs not apply in in awre r of property,who builds or improves them.n,and
who contracts for such projects with a c u acbRs)licensed pursuant b the ConOutofs
Licenz law.
D l Are exempt under See ,B&PC for this maven
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury onto(de following declamtimu:
1 have AM will ma;r amt a Cerullo¢.f Conscnl b self-insure fmwmkefseompcm
satin,As provided for by Section 37M of the labor Code.for the performance of the
works for which this permit is issued.
D 1 have and will innocent Workers Compensation Insurance,As required by Section
37M of the Labor Code,for Ue performance of Ne work forwbich this perosis is issued.
My mlice C mpsm_adaq hand Policy n m era ��>y,1
Polity No r1�(1
E CATE OF EXEMPTION FROM WORKERS'
nFl
'
COMPENSATION INSURANCE
('Dsusection need not be completed if the permit Is for one hundred dollars($100)
or lms.)
I cemfv Nat in the perform...of the work for which this permit is issued.I shall nm
employ any Notion in any mannerm as in become subject o the Workcri Compcnsadon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL uRer making this Ccnificate of Exemption.you should
become subject in the Workers Compensation provisions of this Labor Code,you most
O forthwith comply with such Provision or this permit shall be deemed revoked.
'Z'� CONSTRUCTION LENDING AGENCY
[-� I hereby aRtm that there is a comwNnn lending agency for the pertornance of
C> the work for whim this permit Ia issma(Sec.3097,Cie.e)
aLenders Name
gl� z Lander's Address
U Q 1 certify Net 1 have mad Ude application and Auto,that the.hove mfonmatiun is
I, f'^ Corea I agree b comply with all city and county ordinances and scale laws relating to
0U building convection,and hereby minions,mpmxmmivns of this city to inter upon the
C above mentioned pmpc costs
fm;espcction purposes.
(We)agree to save,indemnify and keep harmless the City of Capetian,against
inconsequeceofth,casuand expcw_awhicb may in any way aernu against said City
U vZ in I consequence of UNDERSTANng of DS AND
D WILL
// (7
'--' so ICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (j— t'T-Z-�
SOU EG Lnno
- Re-roofs
naz f pplicanuCam IDD Dak
HAZARDOUS MATERIALS LOSURE Type of Roof
Ute applicant or
I.
Wildinga:u me m handle ha>ardow material
As defined by the Cupenioo Munkipal code. 9.11,and the Health and Safety
ewe,Section uvzra37 - / All roofs shall be inspected nor to an roofing material beim
❑Yea � P P Y g g installed.
Will the applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
-asit ha undo air contaminants u JCGned by Ne Bay Area Air Quality Management all new materials for inspection.
District,
Dy.
1 have mad the barxudeus mvcrials mquimmenu under Chapter 6.95 of the Califor-
toe Health&Seely Code,Sees=255(15.25533 aM 25534.1 undenarb dug if Ne Wilding
d m ndY have a Naz it u my rtaµauibilitY m nwfy do occupant of this
m wnichm.n orb ora rNate.(O Signature of Applicant Date
ow nuNori>ed ag nt Date All roof coverings to be Class "B"or better
Community Development
0 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building I? partment
JOB ADDRESS' ? N PERMIT # O
OWNER'S NAME: / / PHONE # VQ
GENERAL CONTRACTOR: FAX # /
I am not using any subcontractors4
Signature Date
Please check applicable subcontractors and complete the fol1owmg 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 2 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36928025 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # . . . . . . . . . : 34747
REFERENCE ID # . . . : 06060063
SITE ADDRESS . . . . . : 20086 PACIFICA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JINMING GU
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
i
CITY OF C'UPERTIN® ow6vob3
c;" or WATER HEATER
CUP kTINO PERMIT APPLICATION FORM
APN �
q— 2-�— 025 Date:
Building Address: S 1160 6
aoo 6
Own ef's Name: cxc:
i r Phone Il:
Contractor: . Ib L108
Contact _ T1. License #:
j Dn�� C ;t b� Cupertino Business License ;#:
Building Permit into:
I
Bldg ❑ Elect f� Plumb
Job Description: Mech
Resid'tial Commercial eek � so n as
Costoroject:
ti0 .CSO
Strappi d Q/ On platform
Bonded
• New Location � Replacement
i
I
Qty.!if
A pliCable Fee ID
BPWHEATER Fee Description Fee Grou
PPERMITFEE Water Heater/Vent BUILDING
BENERGY Plumbing Permit Issuance
SLI Ener y PLUMBING
BUC Business License BUILDING
BUILDING
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