06080038 CITU OF CU.PERTINO
BUILDING DIVISION PERMIT '(l " 'Re�.CT4R`IIVFUItIATIUI�k
F„'�,'Ra +m'4•? a #S ..n'i�aa a Y4.. E i°.. 'A'
BUB.DING AgDRESS: PLUMB IN TIME INC PERMITNOO 6 O 8 O 038
10,
R'S NAME:FINCH A
PERMIT ISSUE DATE
MARTIN WOODROW 360 MEMORIAL DR STE i40 08/07/2006
ONE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT
PLUMB MECN
uoii LICENSEDCONRACIOWS DECLARATION lob Description
1 hceby M.Nu I an Hameed under pmvidons of Chapter 9 fencing P
with Section]Ofkl)af don 3af Ne Badmen f '-M mylkense is
no PTI in ren race and eR - (y -32 EPLACE HOT WATER HEATER 50 GAL GAS
q z manse Cl Lic.d
e Dam ContractorAj P1
AR HTIECrS DECLA A 0
W` 1 rndenland my plana dull W used as public records
�6Vr
p Licensed Professional
^ 5 OWNER-BUIIDE0.mDECLARATION
Ea I hereby affirm that 1am 1. .umpt from the Conumols :My c law for tie
4 n O following umenn.(Satrw 701.5.not Budmas and Pmfde ons Cole:Any oily m county
u$� which regviea a permit re consuucc dot,knprow,demolish,or repair sig ed m ormot $500
_i y prior m s Rene e d pormort to Ma tMvision of roreathe Connector',
petit to Ola a signed(Cha mens Valuation
F Wukulimmcdpueed..7 lMpmvidannt3of eBuecrosandPr ressm(Chapter Sq.Ft.Floor Area
egg ths,he ,erg with SecJon,andtfDivuionr Ma alleged
Business and Anyons CUM)or
thu io u campy any applicant
li and the baso(m Ne tatted eaempro.Any violation of
Section than by airy red dont fora permit subjects the applkant to a rival penalty of r Occupancy Type
not mart than Rw hundred dollen(S5W).
D L u awn of Ifo propmy,or my employees with wags a thetr aalc campeumdon,
willdodneworkmdth.s m. mtinmndndoroffeedforsde(Sa.7044,Buima, Required Inspections
and Prefesdona Code ss The Contravenes Lp+"e law donot apply to an owner of 9 P
property who build,a improsva thereon,and who dos such work himself or through his
own employes,,provided that arch Improwmenb are not intended conRcred foram IL
hownuer,the building or improvement H sold within one year of completion,the owner-
builder will have the burden of proving Na Im did ma build or improv for puryo®of
eek.).
D 1,as owner of Ne property,am exclmively contracting with licensed enmrsoters to
construct the project(Sec.7044.Businea and Profusion Code:)The Committees LL
certain law does not apply to an owner of property who builds or Improves themern.and,
who contracts for such projects with amnuulor(s)licena.d pursuant M time ConuacyorS
License Taw.
D l am secmpt under See ,B k P C for this mann
er
Data
WORKER'S COMPENSATION DECLARATION
I batch,trams under penalty of perjury,arta of the following dalenylans:
1 haw and will neral a Cetificau of Consent m self-lnsuro for WarkemCompen-
alien,u provided for by Section 3700 of the Lobar Cade.for the performance of tie
work for which this permit u inner.
I have and will maintain Woftf3 Compensation InevlaneC.a required by Section
3700 of Nc labor Code,for the performance of Ute work for which this pmmit i,blued.
y W Com nsatio Inwnnce corder and No
55u CE— RTIF UAfEOF EXEMPTION FROOMWORKERS' qty(/�/
I(1T�MPENSATTON INSURANCE
mile Under seed oil bo completed if Ne permit Is ferao hundrndda0an($100)
m Ws)
I cenify,that in Ne perfermaoo of the work for which did,permit 41mmd.I Nall not
employ any person in my remorse an an become subject to the Wort Compensation
Laws of California.Dam
Applicants
NOTICE TO APPLICANT.IL afar making this CenlRcau of Esempdon,you should
become subject to Ne Workers Compensation provisions of the lobar Code.You must
O forthwith comply with each pe t idans or Nu permit shill he deemN rooked.
z 4CONSTRUCTION LENDING AGENCY
(~ IMemo,alTiro,Nat siert is.mnsouNnn lending agency for Ne Performanceof
CC> the were for which this permit m issend(Set 3097,Cih,C,)
Q LenMls Name
z [entices AMWU%
U O 1 artily that I haw cad Ws appliwion and mum that Ne show,InfomlWun is
If.E correct,1 ar ee in comply with all city and county oNiruncd and aur leaf elating 0
0U Wilding conumction.and hereby authonto reprasenmiva of this city to enter upon the
r L2I alcove-mcntiuncd properly for inspection Perfume,
(We)agree to ave.indemnify and keep harmless,tin City of Cupertino agsius
aF.t y liabilities,judgmenu,costs and expenses which may In my way aCfine against said City
U'Z in consequence of the granting of this permit. ��..7y/
^ PPLI NT UNDERSfAN ND WILL COMPLY ALL NON-POINT Issued by: Date �� 7 —A/
;d,,.Rn,cd
EGULATI S.
Re-roofs '�—
fApplicanuconu meter Date of Roof
HAZARDOUS MATERI DISCLOSURE TyPe
Il the applicant or futon building nee t seam or handle hazardua methods]
by Ne Cupertino Municipal Code.Chapter 9.11,and Ne HcsiN and Safety
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
YaWill the applicant orlulum bullJing«ctrpant sou eyuipment or devleu whichIf a roof is installed without first obtaining an inspection,I agree to remove
heard..air emnaminsnu as defined by Ne Be,Ana Air Quality Management all new materials for inspection.
Disuicl7
Dy.
I ban mad the haardotermu nets requirements under ChapW 6.95 of the Cdifor.
me Sefcty Care.SeCdam255US,15533and25534.1undcnmodiestifum building
J mendt k,how a u mot.N. my responsibility Imull'y Ne acupmt of
a bleb met at rancor. tale^ tip Signature of Applicant Date
own rauNorivud.cot Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
SCITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: h/4e, PERMIT #
Q6b X 00? F
OWNER'S NAME: Y PHONE #.
GENERAL CO CTOR AX # G
I am not using any subcontractors: O —�
Signature Date
Please check applicable subcontractors and complete the following information
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37540052 . 00
DATE ISSUED. . . . . . . : 08/07/2006
RECEIPT # . . . . . . . . . : 35535
REFERENCE ID # . . . : 06080038
SITE ADDRESS . . . . . : 10455 FINCH AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MARTIN WOODROW
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
'REE 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 1
Cup RTINO PERMIT' APPLICATION FORM CNo
APN Q
Date:
Buildi g Address: U b6
! 4ss �rc4. c��e C , . � Lk
Ownel's Name:
NN ; w Phone#:
Contractor: b ' a - LISd9
- License #:
Contact:
1r Cupertino Business License #:
. i ��
Building Permit into: �'b
Bldg !❑ _ Elect ❑ Plumb" ((� Mech
Job Diiscription: r ❑
Residential Commercial ❑
Cost of Project:
Strapped On Platform ❑ Bonded
t
New Location ❑ Replacement
i
Qty- it_
A liCab e Fee ID Fee Descri tion
Fee Group
BPWHEATER
Water Heater/Vent BUILDING
PPER1�fIT'FEE Plumbing Permit Issuance
I BENERGY PLUMBING
Ener y BUILDING
BUSLIC
Business License BUILDING
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