06050206 CITY OF CUPERTINO �f*,�Tx� ��,{ ' "u'+ -
]BUILDING DIVISION pF,'RjV]IZ' + i,S°-r4§ OR,11NFOlfuYlATION
BUILDING ADDRESS: PLUMB IN TIME INC PuMIT"°'06050206
10717 AMULET PL
OWNER'S NAME: PEREQI ISSUE DATE
QUENIE FUNG 360 MEMORIAL DR 2006
NE SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITEC(ENGINEER: BUILDING PERMITn O
BLDO EI ECT PLUMB NECH
3Oo LICENSED CONTRACTOR'S DECLARATION Job Descrition
FC I bemby"m,ave I w Il +odea pavbi.,a C],- 9(romlaxlni P
2 W wi`bS.tion70D0 aDivWon3dit BLLdneta mylieensb
±qq nraurmaad w REPLACE HOT WATER HEATER 5�;(/0 }{GAL
D�j®GAS
=a D'L�meG RECISC.DECLARATION - % 1 '�..Y ins
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'03 OWNER-BUILDER DECLARATION
f I lxrthy affirm Nal I am eaaWt I.Ne ccm a s liana�far 0n ,
p 0 folnwinG moos.(S"fi.7031.5.Bu a,b Pmfeuloa Cade:MY ci1Y a wumy
$ hits mgam.I it b canawo.bw,hopmw,dalmduh,m mpw any auumum _ $500
=y piaraoiulaauanca,al,amqulru Nc,pplicw for ouch pamilnrikadircd.,,i",,,..m
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e 3 dw M la ermp tbuefr r me bad,fa t alkid, mpdm Any Halation of n
Sealoo 70313 by arty WPliam fa a pumh WhOl Ne.pp W civil Mmhy of fJgpy®® Occu anC
na mma N,n nw bwdmd amus fssoo> � ^ IST� � �.' Y Type
p Lnawmof Ne pmpmq,amy employed wdN c+ uNctrvelem .Bw o..
Jlp Neamt.0 - munartbno %Lk=darafw fa ratapplyIm=,B d #��j�
aM Pm(esHom coat:7ba CanrmM,LImIe L.o•am wt apply b,o ay.c ar Required Inspections (�
poPNY"d bWtl,aimPrmea Nvwn,and rlbodm t.b wort hva,tlfmthmaGh hl, �.'z _
earn empMy WWnjwa p amS 4npaarmmuin mfinraof mpr m.
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buiMer m8 hart Ue blvdm o<pmHRG aur be aid na ddM a inpo.c fa PmP^b N
c I.u owner m Ne p 704,B¢dvmwly ftfcl dni a,itC* )Tb d wnu,mon b
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W ORKFRS COMPENSATION DECLARATION
I bemby affirm mbar pa ry of pe* me of Ne f mil daluatl.e
I haw and w01 manuN,CNI:Ihr.of Coven m aeO-iuurt fff wm e ,comp
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om a povMd fm by Sembn 3700 of We Ubm Code,Im Ne perfamnu,a or the
fm vhi b Ni,pmnir b ias dlove vId niB majw Wtes Camptaudw Infur,na.u bq ird by Swdoof Nc Lab+Code.fm Nc Pc+rm of Ne aauh fa�bkE Nin pmmir iaW ,Cmn . a�niv and Pdlrynue:L/'/�-�- IIVI�N fir.No L
CERTIFICATE FMPnON PROM WORKERS'
coMPENsnnory msuawNCE ,
mataa .a dvel be ampkld Ir Nc ph la fan.h. do0,n(5100)
m ku)
I ardfY lhm N Ne pcfo.ula of Ne wt fm wtieh NIa pmmh b ivoed.1,1W I na
wpby any pe®oio any mamcrm unhccar.wbjeclm Oe waYua'Compew0m
App
Im of Califvrma Due
NOTICE To APPLICANT:If.,fur matin[W,Ccrdli m of E mpd..you a)nuM
bl'LV IOC wbjt C'1 b NC Wct sGanX=O nprOVL aM"J (.' YOu mm
.J O faM M wmply v0b a pravldam a Nb permit"I d dwmed mokd.
zN CONSTRUCTION LENDING AGENCY
[-. I hmeby alarm Nu ftm Is.wvauN.I.mni,GllcT fm uK ICRmmana m
W> the sorb fa vtwb W3 peamh b lmaed(See.3119'/,CW.C.)
QL.cnacfa Name
.,7 z Lcdcet Ad
U0 I waify N.t 1 lure and lbb,ppllcalkn ad...r.Nu Ne above Nfom.doo b
IL.F. c Iair¢bcmply� all city and countycmlim<a and uue Ws mWintm
OU WiMinGconvuc0.,andhcmbyauOMmmpm u0wsof N4cilym.mrupnnM
7' Wato ,mcnd.N pmpcny IW ivpcmian p rpo
(We)aim.m taw,idemniry and Y p humku Ne Gry of Cupertino aiailul
FZ IiabiliJn,}gimctbzz andapwawbichm,ybmYwy.atucaialnuuidGry �^
U Z AP%.ICANT UNDERSTAND AND lLL COMP WITH ALL NON-POINT Issued by: Date J' 2-
s REDUI.ATIONS.
Re-roofs
SI AppO1rnHAZARD0U5 MA DLSCL.OSURE D� Type of Roof
WW 0n applicavt a ruuva hAwnG occupua avec a bad baa amaa
u ddL d by 0e Cupwi.Municipal Code,@apv 9.12,ad do HaIN ad Safety
Caaa.Smi.v53ua)7 All roofs shall be inspected prior to any roofing material being installed.
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wB Nc k pliant«mmm ddw��ilGGalrccmddG naap,a w,r e9abmwt a&,i.wbicb If a roof is installed without first obtaining an inspection,I agree[o remove
omit ha,a .air..i by u by a Bay Ma Air oWily Manaicmrnl all new materials for inspection.
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.t wy haK.a.uu am It b my rapovl wtify ae oaupul m W
me khmaRbcmcl 1ufaamear rnmof _ Signature of Applicant Date
oamW m �. a Dae. All roof coverings to be Class "B"or better
1
CITY OF CUPERTINO
�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 32643063 . 00
DATE ISSUED. . . . . . . : 05/24/2006
RECEIPT # . . . . . . . . . : 34534
REFERENCE ID # . . . : 06050206
SITE ADDRESS . . . . . : 10717 AMULET PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : QUENIE FUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
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
WEE 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
•
CITY OF CUPERTINO
WATER HEATER
CUP( CTINO PERMIT APPLICATION FORM
N#
Builds g Address:
�o
Owner's Name: Phone #:
_ a
Contr etor: License#:
191,� v' .
Contal t: Cupertino Business License #:
�
Building Permit Info:
Bldg ❑ Elect �G Plumb ' Mech
Job 13 scription:
eCA Er
Resid tial Commercial ❑
Costo Project:
ciO •00,
Strapped ❑ On Platfo Bonded
• New cation Re lacement ❑
Qty. if
A li able Fee ID Fee Descri tion Fee Grou
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BEN ERGY Energy
BUSLIC BUILDING
Business License BUILDING
F Community Development
�y 10300 Torre Avenue
r 1 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: Z/(/ PHONE # 0*-&24P
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
jile
Owner/Contractor Signa Date
CITY OF CUPERTINO
om 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: B1kLot :
APN . . . . . . . . : 32643063 . 00
DATE ISSUED. . . . . . . : 05/24/2006
RECEIPT # . . . . . . . . . : 34534
REFERENCE ID # . . . : 06050206
SITE ADDRESS . . . . . : 10717 AMULET PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : QUENIE FUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
*EE 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