00120042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT. CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO, 1
1.8375 CHELMSFORD DR.T,VF_ BUDGET PLUMBING 00120042
OWNER'S NAME: APPLICATION SUB DATE
I
JT
F_ANNE YF_E 28695 ROANOF.E ST 7.2/06/2000 •
ONE: SANITARY NO. CONTROLNU
(510)303-7847
Q�ZO ARCHITECTIENGINEER: BUILDING PERMIT INFD
�<
BLDG ELECT PLUMB MCCH
I IJ I� 'CI lel
Z O h
= LICENSED CONTRACTOR'S DECLARATION Job Description
Z_� I hereby atlimt that Iran licensed under provisions of Chapter 9(commencing
P=te with Section 70M)of Division 3 of the Business and Prnfexvions Code,and my license '
z 6 in full force
Licama,Class and effeea. LiaX
so 1)11L ARCHII12CT'SDECLARATION WATER HEATER REPLACEMENT
I understand my plans shall be used as public records t s
to o O Licensed Professional
Py OWNER-BUILDER DECLARATION
1 hereby off that 1 an exempt form the C ntract License Law for the
t Y following rearrion.fSection 90315 Business d Professions Code Any city or county - -
Fm isbch requires apermm to constrict.star, p dermlish,or repairy senscaums '
3_ perm poo t ts'.: I: requiresm 1 the appl car each t t file igned tenement
mann used criminal, the pro,,qomol n Commode,i Liceno,Law(Chapter 9 Sq. Ft. Floor At Valuation '
(commencing with Sectio 7")of Division 3 of the Business and Professions Coast
or that he is exempt thcrefme,and the basis for the alleged exemption.Any violation
of Seamon 7031.5 by any in lift of for n panni,s„bjectx the.,pi cam u,a civil Penalty
of a,,,mon;atom eve hundred aollms 15500)„ , APN Number, OccupagcT fWe
❑hasrof the property.or any employees with wages as their sale coepenm,inn,
will do me work,and me smacere is not intended or offered for sale(Sec.70.14,
' Rusin'.and PmfeWearo Cede The Comforter's License law docs non apply m,as 37522 0;,8, (Woquired Inspections
owner,of property WI mild,or Itnpmves(hereon,and who docs such work himself - -
or through his own emplryees.provided that such improvements arc not intended or '
offered for sale.Ih however,the budding or impmvemcnt is sold within nae year o1
completion,the awnerhuider will have the human of peeving that he did not build at 502 — FTNAL PLUMBING ENERGY -
improve Sir NaTuveofsale!). - - ,
506 -- GAS TEST
❑I.as owner of Inc property.an,Business and
d Pmeessi •vim licensede Cor ,ors no -
mmuse Law oesn,rsppl toanowneroataPitywho,nsCuae:rlrrcnnthrm;a 507 — FINAL PLUMPING
License Lawdacefil not Inc aanownerrf a apenrwhohu idsorimprovesthereon,
uta wbn cs Licers far such pmjens with a enn,ruemrta)li<enn•A pursuant to he -
01 ter,exempt
Law. -
❑I am exempt under Sec. ',B&P C for this reason -
Owner Date
WORKER'S COMPENSATION DECLARATION ♦'
1 hereby a0irm under penalty of perjury one rf the following Jecluatims: ,
1hove nnJ will maintain a Cenifcale of Cousin, In w1f...wrc far Wnrkds
Co.
as provided for by Section 3700 of the Labor Code, for the
perfrr annum of the work for which this permit is issued.
❑I husn:md will maintain Worker's Compensation Insurance,as requi,cd by Section
3700 of the Latin,Code,far the pert'eraname of the work for which this permit is
sued.My Workers Compensation ho mneo cater end Policy number are: ,
Cartier: Policy No.:. -
CERTI@CATION Of EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE s
md,xC[It..need not be mmpleed if the Permit is for one hundred ddlan
(E loo?or lass.)
1 certify that in the performance of the work for which this permit is issued,I
shall nm employ any person in any manner m as to became subject to the Workers'
Compensation Laws of California.Dane
Applicant
NOTICE TO APPLICANT:IL after making,his Certificate of Exemption,you should
have.subject to the"ImUes Compembtion pmvis airs of the Lehr u m
Coca.year Z0 0 forthwith comply with such provisions or this posit shall be domed revokes, -
CONS'TRUCTION LENDING AGENCY -
I hereby random that,here is a monamOmn lending agency for the performance
W of the work for which,his permit is issued(Sec.3397,Ci,C.)
0.t Q Lender's No.
a7. z Lender's Address -
V 0 I certify than I have reed this application and state that the above information is -
correct.1 agree no comply with all city and county ordinances and state lows aiming
0 U to Wilding construction,and hereby andione representatives of this city to enter upon -
y k] ,he ahavc,ncmioneA properly fm inspection purposes.
re, y (We)agree to save,indemnify and keep homeless the City of Cupertino against
W liabilities jedgmemr,areas and expenses which may in any any accme agoimt said -
(,) 'Z City in cnnaquenceofine granting of this Penni,. -
'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: + Date '
SOURCE REGULATIONS. y'
Signature of Applicant/Contractor Dec Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE Will the applicant nr Tatum huildia,,m'upamshare or handle hamab us mmna d Type of•Roof
as defined by the Conanine,Municipal Cade,Chapter 9.12,and the Health and Safety
Code,Section 25332(4)1
°vet 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment ordevices which. If a roof is installed without first obtaining an inspection, I"agree to remove
mit hazallous air contaminants as define!by the Bay Area Air Quality Management
cadet? - all new materials for inspection. Applicant understands and will comply with
❑Yes ON. all non-point source regulations. ,
have read the nazardoes materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 255}1,l understand that
if the building does not curently have a tenant,thin in is my responsibility to notify the
annom of the rcyulrements which must ha mat prior u,I vane of o Cenifico,of
°"° °`y' Signature of Applicant Date
Ownerar rommi,ed again Dane _ All roof coverings to be Class "B"or better
OFFICE
~MSEC. 5.2000 4:18PM NETCLERK INC NO.725 P'.1
TO:EPERMITS
W.-J, 720 Dubuque Ave., South San Francisco, Ca. 94080 irermit
YY•
• ; " a i pIu ! Application
'Ba47 '� FII'YII!i ' Government Services: 888-330-1777 App
ti
;trr ;LLl Fax: 877-846-5888
II`kl .I" 41 ' ' I_.wWMtlYu9nnJ
Email
To:Cupertino Permit Handling Instructions
Building Mail
City Hall 10300 Tone Ave The approved permit will be mailed to you.
Cupertino
CA 95014
4087773333
C o n t r a c t o r In• £ ormat1on
Company:Budget Plumbing Worker's Comp Carrier. MIH America Compensation
Address: 28695 Roanoske St. Worker's Comp: WC701.0000433 Exp. 01/12/2001
City: Hayward State Contractor's License:769745 Exp. 10/31/2001
• State/ZIP: CA 94544 Exp.
Phone: 5102641113 Ems'
Fax: 5102649291 Business License #: Exp,
Email: budgetplumbing@home.com
Credit Card Information .
Credit Card Number. 4802099260046275, Visa: ❑✓
Expiration Date: 3 /2003 Mastercard:
Card Holder Name:Brandon E.Clark Other:
N o t e s
Pre-reg: YES Attachments:
Payment:VISA WC❑✓ SCL❑✓ SASE❑✓ AA ❑✓
Agent Authorization:YES Permit Type:
ORG❑ NOTE-] FV-171 Permit ID: 66405
I,
Project Address:18375 Chelmsford Drive
Comments:
DEC. 5.2000 4518PM NETCLERK INC N0.725 P.2
CITY OF CUPERTrNO CONTRACTOR
➢VII.DINGATY1910N INFORMATION;
nl DINO ADDIMS: PL'RN(IT NO:
• 18375 Chelmsford Drive I Budget Plumbing
OWNIIC9 NvsMI7: APPL5CAT50N SVB pAYP:
rag Jeanne Yee 28695 Roanoake St.
�8 PIdONBI SANITARYNO. CONMOLNO.
RN 408-725-1371 Hayward 94544
9 Acmrf=Tyl0YO5NffiL .. ➢I.>x BVI�{R7C PP]tMT7 t�PO.nl H
5102641113
Leda, I oCONTINCIOReir pm[ADAIION lob Dosedpdm
I Amber .deur Ibr I ter Ileeesd Adds Anidei.( of Chapter 9 (arm-reuinp
3 in alwm 7000) ler Dlaldm 3 or NA ewer. Add Ra&mm. cAok ani my m.e Water heater replacement
in fall dempd gl&rg
opo Del,: 11 19/ LIarnow 9 4� .
D,,,; 11/1912000 r.'rm@las I
8 Y ARndiern.r.,A.rtDN
Yp�tbnu be weed,As Pabllonmal.
Y5 0 &fes
raauluml
II--'�1I OWN AmAIaCs, nom be ComaN valaaif08
L5 [ M1raby Ammn dean 1 m sernp from ds CmmaCade, LAsaw Y Por Wo Sq.Pt.Floor Ates
while t eine, (srdm 7031x) Dm4m ed Proarmm Ii Aro dA or lowly 750.00
hicM1 ndv'ua a pomb b marYC4 da, impar derAllw, a reply Any I6venat _ OCan M 7
J pin m »G irvam,tem egoM1c dG ygtirm ler Ivch pKmll ro rdu .epl�M Gml.mml p oy YP°
$d dv be Y deemed Wma�in 0e pav'�ont Olde CmnanY users,Lmt(060.0(mmmtmam
:rI wile Seam TOM of Dhddes3ofAle BallaW and Pra6®n CAN As ern As 4rmp doody" I
W W bads be Ads Aimed evunpdon.Amviib(wo of&cm
oon 7031.5 by my ipl'lled for a
I twines de sWHIM,n A awl penalty of An,mow lead Rvt hundred dollars(000).
L v oa7kr of de pmpvly.or m erp)p5n1 emit wn9r d Ibte Ade r-IprvnSiq wDl leo twereired hispopdons
elk kWje,and dee ttuwoe B nr bnmded or dPtend rd All.(go,Mae.DnimS W ProsAA ms
Cade:7h,(b,11111"cane Law deem se,Apply m m rarer or popery%5w builds c impraad
deem.And ad a,,dAdds wile himself rat derange We awn employkh provided Over Add
be wwmwwe rest bsmldd maP Ad by wn It,www.ell abad As Imp.6 Mb emhbl
an.her a Gmploam on,owmrerllda will hive uw bmdee of peeved,end An Q Any build
g ImpN m far pwpoet ler Na).
Q L As oW,, of psopany, Ise wdulWGly mmenotbat wilb IIAmd wotrWa d b
Grm-an de milli (o.c. 70,4• Undue, and Profnti. Cartel Ties Commodore'.
Lia-i Va, does set Apply in M Awmr Or Prenedy We iddes or ®movrA menmhl
ad wen mnleme, W tach peg4au wbs a emtAdmi.) liiemtd p-mento NA
durmast Lia.Lew I '
T ern tempi tmdec S B&PC 10ns4 mss A.
ty
O tr Dom
,• WORKM'S COWIf(SATIUN bllcLA 10re
I hKney Ammo undo penallya peduey ons of d-buo.vinr,doeDmdomc
1 have and will .mint a Conduit. AI CHM, no wlfmsvm rm Woke.
Clord.d. As pmvlda per by golden 5700 of the Laboe Cadk or Ill
gAdm Af dee well n,-dens rhoperms4Dla0.
I h p PAO xh ®mum Waka't Oompm+won lalvmnn m eeryhwl by &dm
7aa Af de Labor Cook for the pmrmm0we of de week fit whlah this pewit it
irud,hdy Woe6ti A Compm,aVOn Irso.mtdr And Polley mere"mel
HIH America CompensationpglkyNG:WC701-000043
CUR➢[GABON) AVON 1113 Y C WORKLRa'
CO hien AM WSVMNL9
mds t I"need we b weird if Ne pemdl k foe ons handed dDlIWe Permit(5100)kwad,I
1 atfy end Ip de pn Any ran of a-wok art whi<M1 bit , Wb Warne 1
IMI/ na employ W ewtlan bt my mems w a m beaam auken w NG Wodur4
Cmmtdmlw lax of Calubmn. '` ,
falrll/19/2000 App mA
NOTICE bb nbP1 t Ada ]4 n c mp pe Cetfkm of ole ca, Sia resit
ad
Lemur wwep b IM WA oris Co As this Pontne Ane orday460 (p5e. You sell
[..twig'Aampb with Add p NMU K this oes INll A denied mvokmL
e d CONSTarn I.
t elfdolNG AGfn;nye
Y [huoby IlOm cher den it A aHlhl Ci, Ir;d'mg a9wey[or dk pr&www
arts woe&(weed dhpvmit a Ksud(Sm 3097,Civ.CJ
S Ltnden Nome
a Leaner'.Add.
I Alto deny 1 ban tend%h4-Pplimica and—M47 gm ebony bralwediq,is,
u G Gaeme f leo, w Comply wide all city W acerb stirrer and neerili'vu'"rrdal`p,
li btdtleg Amelmdane. W welly -knew npletm'Intl of Ad, udy be sma APnl
Ns+bavbt6endond Penpeny fn beepbei p padwa. i
(W,)odea k toys,Indemnify tAd kap hmAl,s, IM CAY of CePmW.pdnr
litbild, plowsb, Auk W -R-As while may In my way slow AyJnp, Wd
Cil,in tompams-Aide-'wh,;of w4 pemb.
APPLICAW1,01 ' m„'v'----'D V CQWLYWf151ALLNON40W730VRCa
Recaunor7s ,f�f� 1 111 912 0 0 0' Ro-wos
9ignana nynppeam/Geese.-r 7ypQfROd
Pk
IIal An D e Anion occupied
fool 0 h
Wbl on ymhew a [wore C-AIA«.spur%erose m suet-hnator dS" All goo➢l tri be M1ki ihou fiat b my j;ad In IantCrml ening idh511ed.
C t,Md.by b Cupertino 6,L-1Al CoOu,OO tr 9.11 and RA Hal'h md�Stfrr Up rooris p:6.16 far
eagw ,fust obmhimg eA bupedtion,(WAo m rcn;)w
[auk Seddon 2552(Ay7 Yd�J NA � ill nen•makridt fes Inepecdao.ADplirant ondetrwds rd wDl comply Mlh
Will deapoldm of". building wmman
feen e alpa-d 01 devise .tkb e6 pOp•�i ufAA reNlotiona,
mit ,odow We mom-®Y 154rdm1 " BOY Ana No QtiD mnwgemmt N/NiLt.CL 11/19/2000
114ried Y.1 I No
• 1 ban- rad the bad our-Aam4 rea-mys. leader Chanter 6.95:of the
CALal, ]WIN A "W Del, 5utdil, 35505. 35535 W 15454. 3 and-mead the; 91gnlNle or Applinnt Date
Ir de bdld-•ate. d••h. -%want on, h 4 mer eawaibillw m nAdfy Use
windows ah was be mit prier V Ismsme of , OGNpak of - All mofwveringt bbe Clay,"e"orbetwv
Costumer 11/19/2000 '
Oxr-ewhodrd-em
en%d OFFIC6
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lo[:37522038.00
DATE ISSUED.......: 12/06/2000
RECEIPT 4. . .......: 14200
REFERENCE ID # ...: 00120042
SITE ADDRESS .....: 18375 CHELMSFORD DRIVE
SUBDIVISION .......
CITY . ............: CUPERTINO
IMPACT AREA .......
OWNER ............: JEANNE YEE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM .. . .: MAIL-IN
CONTRACTOR ... . . . . : PATRICK T GOMM LIC # 22131
COMPANY ..........: BUDGET PLUMBING
ADDRESS . . . . . . . . . . : 28695 ROANOKE ST
CITY/STATE/ZIP .. .: HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510)303-7847
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
--"----- ------------- ---------- ---------- ---------- ---------- ----------
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
PERMIT : 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 45.51 VISA
TOTAL RECEIPT 45.51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
v
v502v a FINAL PLUMBING ENERGYne • fc•••L9--a
506 GAS TEST c•--•=--
507 FINAL PLUMBING
•