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07060219 7777777777777 CITY OF CUPERTINO MD BUILDING DIVISION PERMIT I � BUILDING ADDRESS: PERMIT NO. 11569 RAINTREE SPRING CT PLUMB IN TIME INC 07060219 OWNER'S NAME: PERMIT ISSUE DATE CHIU KUEI R 360 MEMORIAL DR 06/25/2007 DNE: SANITARY NO. CONTROL NO. (866) 293-3031 ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing e Z w with Section 7000)of Djvision 3 of the Business A�oflessioCo ,aye mylicenseis REPLACE HOT WATER HEATER; 50 GALS. Hin full force and effec ,License C sLic•Date ContraJ A HITECTI DECLAWATI[bilf Z 1 understand my plans shall be used as public records )aU L1.t- Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Profcssimn Code:Any city or county `t which requires a permit to construct.alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement z x o that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500 y 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 of �l Number Occupancy Type not more than five hundred dollars($500). 36654040 V ❑1,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 Inspections 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.). ❑I,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- ccnse taw does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the contractors License law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]1 have and will maintain a Certificate of Consent to self-insure for worker's compen- sation,as provided for by Section 3700 of the tabor 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 Code,for the performance of the work for which thipe itis issued. My Wor om ns7ti n nsu ante carrier and Policy nu bei s/q C /�7� Carrier: r44,; lXX I/ CERTIFICATE OF EXEMPTION FROM ORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) I cer ifv 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY tom. 1 hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name z Lenders Address U C) I certify that I have read this application and state that the above information is 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 nWi above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F' liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in cone a of the granting of this permit. ►- APPL A UNDERSTANDS A WILL COMPLY WITH ^NON-POINT Issued by: Date s0 LA _ Z Re-roofs Signat A plicandContractor Date HAZARDOUS MATERIALS ISC OSURE Type of Loof II the applicant or future building occupant s om or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)7 o All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant mture banding occmpant use equipment er devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminan defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building does of cure dy have a tenant,that it ism risibility to notify the occupant of the reyui m ich ust Ix prior ' uarice of a Ccnif1c Oce an ignature of Applicant Date All roof coverings to be Class"B"or better wren a orircd agent "" Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B11:: Lot: APN 36654040. 00 DATE ISSUED. . . . . . . : 06,'25/2007 RECEIPT #. . . . . . . . . . BS000001782 REFERENCE ID # . . . : 07060219 SITE ADDRESS 11569 RAINTREE SPRING CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CH:EU KUEI R ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : SKtATOGA CA, 95070-4224 RECEIVED FROM . . . . : PLUMB-IN-TIME PLMBN CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PL'JMB IN TIME INC ADDRESS . . . . . . . . . . : 36 ) MEMORIAL DR CITY/STATE/ZIP . . . : CI:,YSTAL LAKE, IL 60014 TELEPHONE . . . . . . . . . (856) 293-3031 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 38.37 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_ ' #51648 --------------- TOTAL RECEIPT 84. 02 Y Community Development '" 10300 Torre Avenue x Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 r,UPERTINO Building Department JOB ADDRESS: 11VY PERMIT # OWNER'S NAME: PHONE # 69 — GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ' Z��0 Si mature Date Please check applicable subcontractors and comn,:)lete the follow' 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