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06040118 (2) CITY OFCUPERTINO BUILUING DIVISION PERMIT *a1c%RTi^ `"ANF"FO TIO'N'- " - BUILDING ADDRESS: PLUM13�^ IN TIME INC PERMITNO.06040118 20338 VIA NAPOLI OWNER'S NAME: PERMIT ISSUE DATE NEIL BIMS 360 MEMORIAL DR STE 140 04/21/2006 ONE: SANITARY NO, CONTROL NO. (866) 293-3031 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C= !op LICENSED CONTRACTOR'S DECLARATION JobDescri [ion wC 1 thereby affirm that I w en licensed under provisions of Chapter 9(Commencing P zW with Section 70110)of Division 3a(d,c Business And Proesmas Code.aM myliccnseu ;may inrwllrmmeanenrr l� REPLACE HOT WATER HEATER 50 GAL GAS TALL 12YR )„vj? License Class Dam —GamEC D A HITECTS DECLARATION I¢< 1 undersand my plans dull the used u public records >yU .off Liccmcd Pmfcssimnal S 3 OWNER-BORDER DECORATION C 1 thereby a(Trm that 11. exempt from tc Cclimas o :My C Law for to s following mason.(Section 713 I.S,Business and improve. da uv Coco:Ani city Or caumy which mquima n Permit re crwm0.alcor,improv,h Permit t or repair any avumum **"$500 E Chad W is censed c.Mae cament a theres tovisio s of for such Permit to Lie aus,La cd sammcm < (cuminbingedpraction 7")of Division of the COnrazmr'and Proc Laws,Code)or Sq.Ft. Floor Area ?006Valuation E (commencing with Semonnt and of Division 3 the the BusAlleged exempt on,fAny vi Code)of that m la exempt thcmfrom end the baso for Ne alleged eumpdors Any violation of Section 7031.5 by arty,applicant for a pernll sWjttu the applicant In a civil penalty carr eeupaney Type not mom than five hundred dollars(01)(1).0 1,ss owner of the ryopwy,car my wployw with wage u they sale cwpewthon, 1141JINj#^ willdo the wodt and theswmum is nolinmuded or offered forsale,(Sec.7014,Business Re aired Inspections and Prorevlov Code:The Convaemo rs License Law daoat Apply m an Comer or q P yropeny who Wildsmimpm sthemon.andwMdocssuch mark nimulf orNmugb his own employees.Provided Inas such improvemenu w not iwnded Craffemd forsale If. however.the Wilding ar improvement is sold within Cee year of Compktion.the awrcr- builder will have the burden of proving thus he did Out Wild or improve for purpose of ole,). 0 1,v owner Of Ne proerty.Am exclusively Canonical,with licensed emramars In construct the panned(Sec.7(114.Business and Proreuiov Code:)The Conuxmi s U. Cove Law does oat apply As an Ower Of property what Wilds or improves thereon,and w W contracts fm wen projects witha comnmor(a)licensed puwant us tax CnnuscsoeS License Law. O lamemAniomder See ,BAPCfcb Ihdt wn „ Owner Data WORKERS COMPENSATION DECLARATION OIL~ 1 mrtbY aRim oder evity of pr�ury Cne of the fallowing delaradmv: 0 IhswaMwtimalnWoaCm rscamof Coventmself-insumfw WOrh esComNn- mtimn,v provided for by Sedon 37W of the labor Cade.far Ne perfowane of thin work for which this permit is issued. 0 1 haw and will maintain Workcr's Compcvuion Inumarme,u acquired by Savo. 37W ofthe Labor Code.fer the performance:ofthe work for which Nis permit is Wood. ' My Workerspoo thou lnaranec aria and Policy number am: /�(a� Grticr. � POIicyNO.: es 4 l I L((R O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This xmien need not the complemd if to permit is before hundred dollars(5100) a or ICU.) I tumfy that in Ne Performance of the work for which this Permit is issued.I shall nm Coffin;any person in any mannerm As an become subject to the Workma'Compensation Laws Of California Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you shwm become subject as the Waiters CompcvAtion provisions of the Labour Code,you mus ., O forthwith comply wit such provisions or this permit all m dccmcd om mkcd. 'Z" CONSTRUCTION LENDING AGENCY t-s� 1 hnehyoRnm that there iea Construction lendingagency fortmne e im(oraor E the work fur which tis Permit is unwed(Sec.3097,Civ.C.) �W A Lenders Name z lenders Addleas V Q 1 conifY that 1 have read thio application and saes:than the move information is ly f" Comet.I agree to comply with all city and county ordinances and sum laws relating m p0 building conesmCdCft.and hereby authomc representatives orris city m emrupmn lm ra ahem-menuuned properly s for inspection purpose (we)agree to tart,indemnify and keep harmless de City of Cupertino agalest ti h liabilities,judgmenu,costs and Capt.which may in any way aCCNt against said City V Z in consequence of the graming of this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. Date SgURGE REGULATI S. 4-7 V-06 Re-roofs Signatum of ApplicannCombcmr Dam ' HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum Wilding occupant from or handle nvardov material As defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety Code. 0y.ection �Na zss33(a)+ All roofs shall be inspected prior to any roofing material being installed. 40 ❑Yes If a roof is installed without first obtaining an inspection,I Will thin applicant or future Willing aauWm sax equipment or devices which g agree to remove P emit hammons air entamivnu u defined by to Bay AMA Air Quality Management all new materials for inspection. Dimmer? 0Yes SN. I have mal the hauardnns materials rtquimmcou under Chapter 6.95 ofthe Califor- niaHOO"SaICIYCode,Seetioru25505.25533 and 35534.1 undersand to it the Wilding Ones not currently haw•mount,that it is my nespomihility m notify the occupant of the rcym' mems which mnslm mel priCrmissuanceo(a Ceni&amorOcapaneY Signature of Applicant Date �C�CcSLc_LP 1 n� 40--1 I-©(� owner orautorircdAgent Dam All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Its t 9 •y. Cupertino CA 95014 '� Telephone(408) 777-3228 CITY OF Fax(408)777-3333 OCUPERTINO Building De artment JOB ADDRESS: PERMIT # 033 06o � occ OWNER'S NAME: 4Zi PHONE # L(6)g ,- -j -2ok GENERAL CONTRACTOR: FAX # I am not using any subcontractors: L 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 Qh �ti. �'' 2-7 Co 0 7 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 06m 2 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31601133 . 00 DATE ISSUED. . . . . . . : 04/21/2006 RECEIPT # . . . . . . . . . : 34084 REFERENCE ID # . . . : 06040118 SITE ADDRESS . . . . . : 20338 VIA NAPOLI SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NEIL BIMS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 • OboH 0 CITY OF CUPERTINO . c, 'o� WATER HEATER CUP VINO PERMIT APPLICATION FORM APN t� ' n ^ ' Date: G ��1 G/-2 l qBuildi Address:ame: Phone #: : License#: (S, 6i .� CtI _ ib� Cupertino Business License`#: ermit Info: Bldg ❑ Elect e8 Plumb — Mech B— Job Description: Resid ntial 4 Commercial ❑ 5 a Costo Project: Strappl d On Platform Bonded • New Lpcation ❑ Replacements Qty. if A li able Fee ID Fee Descri tion BPWHEATER Fee Grou / PPERMITFEE Water Heater/Vent BUILDING Plumbing Permit Issuance PLUMBING BENERGY Ener y I BUSLIC BUILDING Business License BUILDING 4�[�, kuk--1� IloLACQ-