07030053 �CITY OF CUPERTINO
BUILDING DIVISION PERMITIRMATIf�N.:
PERMIT NO.
BUILDING ADDRESS:
11606 CEDAR SPRING CT PLUMB IN TIME INC 07030053
PERMIT ISSUE DATE
OWNER'S NAME:
LONG CHANG-SHONG AND HSIOU- 360 MEMORIAL DR STE 140 0 8/2007
SANITARY NO. CONTROL NO.
.JNf?:LT T
(866) 29_ -3031
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
C p LICENSED CONTRACTOR'S DECLARATION Job Description
uF I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zU with Section 70110)ofDivision 3ofthe Business an ons Code.and mylicense is REPLACE HOT WATER HEATER 50 GAL GAS
r>y in full force and effec
y Z Licen 1 Lic.#
p Date Contractor
E U ARCHITECTS DECLA A l0
� a
< I understand my plans shall be used as public records
)4U
U.y Licensed Professional
OWNER-BUILDER DECLARATION
g<m I hereby affirm that I am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
<
.9 which requires a permit to construct,alter.improve,demolLch,or repair any structure
rn prior w its issuance,also requires the applicant for such permit to rile a signed statement „ Valuation
-?< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 >q.Ft.Floor Area 5 O 0
>S
�F� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 3 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 Number Occupancy Type
not more than five hundred dollars($5M). 36654064 .)V(
0 1,as owner of the property,or my employees with wages as thew 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 docs not apply to an owner of
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.).
0 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 contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec. B&P C for this reason _
Owner Date _ -----
WORKER'S COMPENSATION DECLARATION
N.reby affirm under penalty of perjury one of the following declarations:
hsve and will maintain a Certificate of Consent to self-insure for Worker's 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 Code,for the performance of the work for which this permit is issued.
I/v�y,)Worr/ke Js�CERTI
WAF
e[�/a►tter and Policy n
CJrfiel ��WfrTi No: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,I 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
E.r I hereby affirm that there is a construction lending agency for the performance of
(Ya> the work for which this permit is issued(Sec.3097,Civ.C.)
W A
Lender's Name
Lender's Address
U 0 I certify that I have read this application and state that the above information is
S, correct.1 agree to comply with all city and county ordinances and state laws relating to
U building 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 oC Cupertino against
H liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in con uence of the granting of this permit. Date
►" PPL NT UNDERST S AND WILL COMPLY LL NO
Issued by:
NT-
S., c
Re-roofs
Sig of App rcandConlractor Dare Type of)'.00f
HAZARDOUS MATERI ISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as dertncd by the Cupertino Municipal Code.Chapter 9.12,and rhe Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Ya
Will the applicant or future bu tng occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants fined by the Bay Arca Air Quality Management all new materials for inspection.
District?
0 Yes 0 No
1 havc read the hazardous materials requirements underChapte .95 of the Califor-
nia Health&Safety Code,Sections 25 33 and 25534.1 undo d thaz iC the building
�dnotcurmmntly havca tcnan4 th u' y rcsponsibili tit'y the occupant of the
hk must et or ce of a c r of
pan �� Signature of Applicant Date
All roof coverings to be Class"B"or better
Owne or rixed agent Data
CITY OF CUVEjZTpj0�
Cay ' @
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bate:
ess.
4 wnci's N
ame::
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Contr4.ctor: ��ILI _. +
s �lo� 61 b• `�3bb '
Contact: "' License n:
Buitdig Permit Ifo: Cupertino Business License
Bldg j Q
.lob D4scnPtion: Elect Q
i Plt�rnb Mech Q
S
f Pesidotial
,f Commercial
Cost of Project:
I S�77
On Platform ❑ Bonded
New ,
' ew Location Q
Replacement
i
Qty-!it
Appli6blc Fee LD
r BPWIiEATER
Fec Description
PPERMYTFPE Water Heater/'Went Fee Group
EIV} ,
PGY
B ; Plur, inc,
_Q Permit Issuance BYI�LDi1�1G
i BUSL.YC Ener�i PLuIV{BING
---- __ Business I.,icense 13UILDrN,
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CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 36654064 .00
DATE ISSUED. . . . . . . : 03/08/2007
RECEIPT #. . . . . . . . . BSC00000636
REFERENCE ID # . . . : 07C30053
SITE ADDRESS 11E06 CEDAR SPRING CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER LOYG CHANG-SHONG AND HSIOU-CHI
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5139
RECEIVED FROM . . . . : REC'EIPT INTERFACE
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 INOUNT 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 2266
---------------
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING