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07060025 CITY OF CUPERTINO BUILDING DIVISION PERMIT +Co. ALOR II OV:t}RMAtT� : ; PERMIT NO. BUI T '/T"AbLLINGER RD PLUMB IN TIME INC 07060025 OWNER'S�N/AME.�S PERMIT ISSUE DATE CHEN CHIOU-FENG AND HSU 360 MEMORIAL DR 06/05/2007 T SANITARY NO. CONTROL NO. (866) 29-',-3031 BUILDING PERMIT INFO ARCHITECr/ENGINEER: BLDG ELECT PLUMB MECH 0 0 a a c p LICENSED CONTRACTOR'S DECLARATION Job Description V(= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Scction 7000)of D''sion 3 of the Business and Professions ,agd m I' is INSTALL WATER HEATER <y in full fore and effect t ? License ass Lic.# tp Date — Contractor RCHrrECTS DECLARATION i a a I understand my plans shall be used as public records ryV u,y Licensed Professional O a OWNER-BUILDER DECLARATION 3< I hereby affirm that I am exempt from the Contractor's License Law for the .p C following reason.(Section 7031.5,Business and Professions Code:Any city or county Ow which requires a permit to construct,alter,improve,demolish,or repair any structure ?z} prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation =a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Ll- $500 a F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3592204'.:t�U' Number Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required fired Ins eCtI011S and Professions Code:The Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a conuactor(s)licensed pursuant to the Contractofs License Law. . ❑I am exempt under Sec. BRP forthis reason Owner Date rD WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Copefo the performance of the work for which th' Permit' issued. My Wa ani crane My W77ecatricr and Poliry nuf - Policy No.: CERTIMC,41750F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of pC > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Le LeName a Z Lender's Address U 0 I certify that I have read this application and state that the above information is LL"" correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction.and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �•c• ►'� APPLI UNDERSTAN Date ND WILL COMPLY WITH ALL NON-POINT Issued by: 6 Ac�l �PffULA NS 5 U 7 Re-roofs SignalUV f Applicant/Contractor Date HAZARDOUS MATERIADISCLOSURE Type of Roof Will the applicant or future building acs tstorc or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? / All roofs shall be inspected prior to any roofing material being installed. ❑Yes JZNo If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air con7;NN-o as do d by the Bay Area Air Quality Management all new maerials for inspection. District? C]Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health ety Code,Sections 25505,25533 and 25534.1 understand that if the building docs no urently have a tenant,that' is my responsibility to notify the occupant or the s h'ch must be met o issuance of ficauc of cupancy._ Date S Signature Of Applicant All roof coverings to be Class"B"or better 0- r Puthorized agent Date CITY OF "-UPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35922041 . 00 DATE ISSUED. . . . . . . : 06/)5/2007 RECEIPT #. . . . . . . . . : BSO)0001544 REFERENCE ID # . . - : 07050025 SITE ADDRESS . . . . . : 7573 BOLLINGER RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CHEV CHIOU-FENG AND HSU TERESA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4334 RECEIVED FROM . . . . : PLUMB IN TIME CONTRACTOR PAUL HENDRIXSON LIC # 27607 COMPANY PLUMB IN TIME INC ADDRESS 360 MEMORIAL DR CITY/STATE/ZIP . . . : CIRYSTAL 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 REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 84 . 02 51163 --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF +CUPERTINO WATER HEATER CITY Of CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Addr 2 / �� ✓( / Owner's Name: Phone#: i Oe, — Contractor: /l Phone, License#� Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect �� Plumb Mech Job Description: Zuc? Residential ❑ Commercial ❑ Cost of Project: Strapped On Platform - Bonded New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER eater Heater/Vent BUILDING PPE FEE Numbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `-UPEf�TINO Building Department JOB ADDRESS: PERMIT# 7S73 &UmGec QooA 6 OWNER'S NAME: C.'ci I bUU \N e r PHONE# Ll o$ 153 qq S) GENERAL CONTRACTOR: Q , ' h c FAX# I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following ' 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 �u b. `,,., . m�. a 607 Roofing Septic Tank Sheet Metal Sheet Rock Tile S l-�)k1o7 r/Contractor Signature Date