No preview available
06040092 CITY OF CUPERTINO �' BUILDINV DIVISION PERMIT CONTRAGTQRI,NFORMATVAW. a BUILDING ADDRESS: PLUMB IN TIME INC PEaMITNO.06040092 20663 CHERYL OWNER'S NAME: PERMITISSUEDATE KRISHNA YELLAMILLLI 360 MEMORIAL NE: SANIRY NO. CONTROL NO. (866) 293-3031 TA ARCHITECTIENGINEER: BUILDING PERMIT INFO 8O ELECTO Priagma O 3o j LICENSED CONTRACTOR'S DECLARATION Job Description �u 1 hereby in.that I sumd Hada under pmvions dof 0sa vor 9(commencO ing p E� with Section 70(101of livisan 3ofthe Sum.and Profeauuns Code,and my licenses in Tall farce andeURQgViGag REPLACE HOT WATER HEATER 50 GAL GAS gz License Clw Ric.R Dam Canlr"Wr HITECI'SDECLA ATION 4 I understand my plans shall be used as public records y c Licensed Professional OWNER-BUILDER DECLARATION COO hereby.(Tian that 11. exempt from ti r fesnunal Co License Law for 0te O O fallowing mason.(Section 7f13 s5.Business and Pmlwiuns Cade:Any shy m county 5 9� which require S permit m cnorwet alcor.Improve.demnluh,or repair any structure $500 _z>„a prior ae its issuance,alae requires Ude applicant forsoch permit m Bk a signed oammcm €Q pan hesliccmedpursuant tothe,pdvisonsofthe Conuacturrli"mcLaw(Chapter9 Sq.Ft. Floor Area Valuation $ (commencing with Sudan 7700)of Division 3 of the Business and ProfeWans Code)or con he s exempt therefrom and tie bull for the alleged exemption.Any violation of 1A if Als, Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of 3APIPT695AF UU V#11QUcy Type net mom Nan five hundred dollars(550)). 0I,uownerof0 pmpaty.wmywploycownwrAmh wlemmpew0on, will do the work and theauumure h nainmMW reoffered foraale(See.70/4.Business; 129 and Profession,Cade:That Conuaoo's License Law don not apply to an ower of RP�UIre a ons2#65 Property whobuildaarimgoser thereon,andwha daesmh workhWseifor through his V 1/ own employee,provided that Such irepmvrmem+sure not Intended molfered image.if, ■ 9>taa, however,the building or improvement Is Said within am year of completion,the owner, builds wig have the burden of proving that M did not Wim ser Improv:for purpose of sale.). O 1,a owner of the property,am exclusively conuutul with licensed conuanms In destmet the pmjem(Sec.7044.Business and Professions Cod¢)The ConOacmrS U• cense law dead mot apply W ao owner of pmpeny who builds or Improved thereon,and who contracts for such pe jecs with a contractor(s)licensed posuut W due Carriacou, License law. ❑Iameemptuna See .Bl PCformisreuoa Owner Das WORKER'S COMPENSATION DECLARATION 1 hereby afMn under penally of perjury one of tis following declarations: IhiwaWwllmainWna Cat flmmof Comentlonil-usumforWorkees Compere ration.as provided f"by Section 3700 of the labor Code.Tor the perfams.of the work for which this permit is issued ❑1 have and will maintain Workers Compensation Iwrance,as required by Sedan ' 3700of dm labor Conn,far the performance of the work furwhmh this permit IS issued. My "Workefff�s ompemation Insurance carrier an Policy number m: Cartier. flc policy No.: '34 2 14140 CERTIFICATE OF EKEmirnON FROM WORKERS' COMPENSATION INSURANCE (Thal section and tial hecompmtetl KIM permit Is fmano hundred dollen(f100 or lcra) •. 1¢oily,that In me performance or the work fm which this Permit Is Issued.l,hall not employ any person in my manmrw as m beounembject W tbe Workers'Compensulan ' Laws of Califams.Data Applicant NOTICE TO APPLICANT.If,Spur making this Certificate of Exemption,you should became mbjeo to the Worker',Compensation provisions of the Labor Code,you mus Oforthwith comply with Such provisions or this Permit mail be deemed rewked. z.~� CONSIRUC ION LENDING AGENCY . [—d I hereby Mmm dict them IS a commuetinn lending agency for the Performance of C4> lM work for which this permit Is Issued(Sm.3097,Civ.C.) . W�Q Lenders Nurse z Landers Address U O 1 cemify dust I haw red this application and sum then de Sow information h D. f"' comet I agree W comply with all city and county ordinances and arm lasso relating W OU building consuucrion,and hereby authorize representatives of this city W enter upon circ W above-mcntianctl property for lnspecoonpurpML LL (We)agree to taw,indemnify and keep harmleu dm City of Cupertino against r to Ilebilialea,judgmens,coss and expense which may W any way same against said City U',Z in consequence of the granting of this Permit / 7 .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date y06 sopRrt<�te � Re-roofs Signature of ApplicanVCantraw r Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building otcupanemre or hander hewdous material as defined by tie Cupertino Municipal Cade.Chapter 9.12,and tit Health ad Safety Conn.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yta [3!n, Will the applicant or future building occupant use equipment"devices which If a roof is installed without first obtaining an inspection,I agree to remove malt huardnus air mnurnimns as defined by tie Bay Ams Air Quality Management all new materials for inspection. DisWm? ❑Ye Nu I have mrd the hazardous maWsalsmquimmens under C'hapterb.95 of he Califor. ria Heal&Safety Cade,Stations 25505,25533 am125534.1 understand thetifthe building data not currently have a lent Ow It s my reaponsthility W notify the occupant of the �a�mouwhehmube priarWssusecafaeenifeamafoccuyutey. Signature of Applicant Date Lr- 17-06 All roof coverings to be Class"B"or better Owner at authorized agent Dam Community Development 10300 Torre Avenue ✓' Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: Cn PERMIT # OWNER'S NAME: l� PHONE # GENERAL CONTRACTOR: .YL.,— FAX # I am not using any subcontractors: ' �' (I /(-T (C)6 Signature Date Please check applicable subcontractors and complete the following 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 V Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO .gem 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35915039 . 00 DATE ISSUED. . . . . . . : 04/17/2006 RECEIPT # . . . . . . . . . : 34018 REFERENCE ID # . . . : 06040092 SITE ADDRESS . . . . . : 20663 CHERYL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER KRISHNA YELLAMILLLI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2909 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 QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ----L-------- ---------- ---------- ---------- ---------- ---------- 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 NUMBER ----------------- ------------ ------------------ CHECK168 . 04 22239 TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING i CITY OF CUPERTINO WATER HEATER CUP RTfrv© PERMIT APPLICATION FORM APN 35q- Date: Buildi g Address: Own e 's Na e: Contr ctor: License#: Conta t: Cupertino Business License #: Build i g Permit Into: Bid ❑ Elect ❑ Plumb ` Mech ❑ Job D scription: C Resid tial - Commercial ❑ Cost o Project: dd� Strapp d Li On Platform LJ Bonded • New cation ❑ Replacement ❑ Qty. if A li able Fee ID Fee Descri tion Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE PlumbingPermit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING 1�,rvrb - yl -T t � LC(Dic4 toL