0612005561
I
CITY OF CUPERTINO n*,gT
3
f
y
<
p
Oforthwith
rjI
z
Q
f'^
U
W
W
to
z
F -a
N
CONTRA.CT(),RINF,ORMATION
BUILDING DIVISION PERMIT
a •.:. ,,
f same. ., •:� : �_ ... a
BUILDING ADDRESS:
PLUMB IN TIME INC
PERMIT No, 06120055
OWNER'S NAME:
PERMIT ISSUE DATE
ZHONGPEI CHEN
360 MEMORIAL ng qT7. i4n
NE:
SANITARY NO. CONTROL NO.
866 293-3031
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
'
BLDG EIPCT PLUMB MECH
O O 0 O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
P
with Section 7") of Division ]of Jsc Businm.n f b CoM, yllecnson
in fun fore and cflc
!OZ
REPLACE HOT WATER HEATER
L'c. g -
Dam Contractor
Dow Cd
ARCHITECTS DECublic= N
I understand my plans shall W used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby aflirn that I am exempt from to Comncso's License Law for the
fallowing mason. (section 7(D I.S. Business and Prefevsioas Cade: Any city m runty
which mquira a permit to cnnstnmt. alter. improve, demolish, or motor any structure
_
prior 0 its issuance, also requires the applicant for such permit w file a signed statement
dwheIslicensed the ofthe Conoxchu'lUcenxLaw (Chapter 9
Sq. Ft. Floor Area
Valuation
mormantroprovisions
(commencing with Section 7000)of Division 3 of the Business mad Professions Code) or
Nat M u exempt thelefmm and the basis for the staged exemption. Any violation of
Seed.. 703IS by try applicant fora permit subjects the applicant to a civil penalty of
F 0
Occupancy Type
on, mom than Aha, hundred dollars (5500}
❑ Lasownerof Nm propmy, employees withwagesasthew sok wmpevadess
Required Inspections
n is 0/4, Bes;nw
will do Newark and Nc is not intended,
he Com
rev, du t Out apply t
and Profetiotts code: The Controomon. License law doe not apply lf an owner or
property who and m aressuehware AimxlfmNrough his
m pronvi;mprov*sthunprwaborended marfaW fnethe ale.IL
ees. provided thm such imP
ho wo. m sold wts of note
however, Ne Wilding or improvement u hath within one year of completion. the owner -
builder will have the burden of proving that he did not build or improve for puryase of
sale.),
❑ 1, as owner of the property, am achrowly contracting with licensed cmmractnrs m
cunamet dx project (Sec. 70x4, Business and Professions Code:) The Commuters Lt.
come taw docs not apply m an owner of property who Wilds or impmw thereon. and.
who contracts for such projects with a contrxmrts) licensed pursuant m the Cantracmer
_
License law.
❑ Iamaemp,mura See ,B&PCfmdmia,e.han
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby air= must pctalty of perjury one of the following declarations:
1 h.w and will maintain aCerol of Consent m self -imam fm Workers Cmopen.
scion, u provided for by Section 3'7(10 Of the labor Code, for Ne performance of the
we far which Nu permit is issued.
1 have and will maintain Worker's Compensation Insurance, u required by Section
3700 of Ne labor Code, for the peolmm,nee of the work fm which Nu permit u issued.
r
s.CpprNor.Ga I e ea and Polley number
L¢/!\�
licy N
C RTI G PIION FR M WORK S'
COMPENSATION INSURANCE
(ITuseetion need amt W cmnpiexd if Ne permit u forone hundred dollars (SIM)
or less)
1 cerdfy that in to performance of Um work for which this permit u Trued. I shall not
employ any person in any manner so as w become subject to ted Workers Compensation
Lem of C3bfimmia Dam
Applicant
NOTICE TO APPLICANT: If. aper making this Ccnificare of Exemption, you should
become subject m the Worker's Compensation previsions or the Labor Code, you must
comply with such poraismm or Nu Permit shall be demoted mmked.
CONSTRUCTION LENDING AGENCY
1 men, span Wt dt . its construction lending.gene, far the performance of
Jm work for which this permit is issued (Sec. 3097, Civ. C.)
Lancers Name
Lenders Address
I certify Nat 1 have mad this application and sure Nn the above informed.. is
correct. 1 agree to comply with all city anc county ordinances au sure laws relating to
Wildin,,mstmction and her:b,.whon. rcpmscntmivcs of this eo,r. cmc, upon the
ahove-mejudgmorop
.ned for i purposes
t
(We) agree to ave, indemnify and kap harmless the City of Cupertino against
cpecdmn
ort
,cmuand of may in any vnyattmc against said City
in
in comegrence of Ne grantinL of Nis permit.
this mit.
PP ANT UNDERST NDS AND WILL COMPLY WITH ALL NON -POINT
1
Issued by: Date •t
REGULATI /
1�
?Will
Re -roofs
nuanrDareNAZAADOUS
MATERIA DISCLOSURE
Type of Roof
the applicant or future building ottupamsion, or handle lovartlom material
u defined by the Cupertino Municipal Cade. Chapter 9.13. au the Health end Seely
Cale, Section 23533(.)?
El Y. �
All roofs shall be inspected prior to an roofing material beim
P P� Y g g installed.
Will the applicant or future b 'Iding occupant urs cyuipmcnt or JeWms which
If a roof is installed without first obtaining an inspection, I agree to remove
g Pe tie
emit hvarmus air cmmtaminto dehned by use Bay Area Air Quality Management
all new materials for inspection.
District?
P
QYm ON.
1 have mal the harmines materials mquimments under Chapter, 6.95 ofNe Califor-
maHealN&Safety Code, rasions MW5. 25533 and 75534.1 Ordersun ifdm Wilding
Ccs rot Jy hats a rename Nat a u my,esponsibilty as y de occupant of the
mcnts�rvnich retired pct missuanc Locant
¢ cup
—�
(fi;p nature of Applicant Date
7 All roof coverings to be Class •B" or better
Own authmdpad agent Dare
CITY OF
4JUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:' i ,z -W ^ Dom^ &V�n w .
rC.� i
PERMIT # O(P120o5
OWNER'S NAME: S
PHONE # -` !-,
GENERAL CONTRACTOR: 'n T
FAX # '
)<I am not using any subcontracto Z -1.3-e 6
Signature Date
Please check applicable subcontractors and complete the f 1 information:
•
60
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
Date
em 1 of 3
�wrr�• y+ wIR191
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36617036.00
DATE ISSUED.......: 12/13/2006
RECEIPT #.........: 37033
REFERENCE ID # ...: 06120055
SITE ADDRESS .....: 1426 ROSEGARDEN LA
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: ZHONGPEI CHEN
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
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
•FEE ID UNIT
BENERGY PERMIT FEE
BPWHEATER PER HEATER
PPERMITFEE FLAT RATE
TOTAL PERMIT :
QUANTITY AMOUNT PD -TO -DT THIS REC
VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
0
1.00 34.86 0.00 34.86
1.00 10.79 0.00 10.79
1.00 .38.37 0.00 38.37
-----84 02 ------0.00 -------02
NEW BAL
0.00
0.00
0.00
----------
0.00
VOICE ID DESCRIPTION
506 GAS TEST
•
New
9
CITY ()F CUPERTIIV0 CV 12 00 55
r WATEP, HEATER
FIT APPLICATIOS
_FORM
'J
3uiidi'dd I I
�o Address:
I�la6 �— �Z151o6
}wner's Marne: -e � Q
oniracior die Phone #:
LJ°� y9a 7��k
Lice
>nt ct j License #:
01
Elect
Fee CD
!
C
tile"")LAY
!1.
Plumb
Fee
Mech
Flo t-,, I
Fee