06090137 CITY OF CUPERTINO �s "tt.n3-.� ��T"y� �1��"�' "'q
BUILDING DIVISION PERMIT �CONTRACTOWNFQdRM,AT4JON ;q
BUILDING ADDRESS: PLUMB IN TIME INC PERMrrno.06096137
10204 BRET AVE
OWNER'S NAME: PERMR�IIE DATfi
URS MADER 360 MEMORIAL DR STE
NE SANITARY NO. CON 01_NO,
(866) 293-3031
ARCHT ECr,`ENGINEFA: BUILDING PERMIT mm
BLDG ELECT PLUMB MECH
±Oo LICENSED CONTRACTORS DECLAUTION
Z oJC w IMacby.fN that)w 1. ena
.. der ovlii.or Ch.p.•r 9(croor n3 Job Description
UU Im xeoan wr>u)oroi.wo.Yoru,<B�.a� e�nm yllxe�D
±L1_z is
yz L;.o.rir,i and REPLACE WATER HEATER 50 GALLON
.,.. Lc.J
'F• Dam T's DECLARATION
EC
` CNDECTS DELLA A 1 N
e e O 1 undcrsutd my pbn shell 4 uad u public rteortL
`o I-i0o.d Pro fe4rion.I
e OWNER-BUILDM DECLARATION
<� 1 hcmby,Irian Jut 1 w v..vtp1 I.de Cmtraton.Ilcrna law In,the
00 folbwing rcuon.(Scum 70313,Bua....A Pmfuuom Code:Any city on caaay
$ which mquiocs.,omit b cotserat,ilmr,inpro e,demur W.a ri my t ounve $500
prior b its lsv.nca.wo mquirn the.pplionl(a nch parnil to r3m..iencd wlemmt S FI. Floor Area Valuation
Jw he t liccamthe
ad por .nt to MAN cbu of Ne ContnMl orl Lircri (Chmo r 9 q
(comotctteing with S,ction 701If1)aINW,bn 3 or the Bu.Ineu W Pmlculna code)or
e _ riot k I.easpt tbmrlmm rd ate bait for the illogod a Pdom Any violation of
SeMbo 70313 by my'.ppllam for.permit mbjcw the.pplicau b.CIQ pmulry of } u u Occupancy Type
Mx ma,ro.n rom w.ema aolbn(ssmt
❑1,u owaa of tk PoPat1,a mY empbya wbh v.gn u their sok eompettuJm, ,
wN mo� wort ued We stc CcretrotulI= aoffal fa uk(SaeW rio Btsdn of
w Pmraaoa code rhe emb.ebr.L;casa U.dam.nt.pqy n m amrr a Required Inspections
prope y who huBN or impure,J ,ed who douwchworthimalfa Wrough hL,
owe cmpbym pmvlded too,uCB Imps 000ct ue mtintenmd aoffered for s>dc,1f.
bavevv,the btultl,a bnpm.emrat b HNirt arc Y cf .pleda4 Ore..
t
bonder wi0 lure tk buAm of,coving hat he did not duly a Improve for pupae a
on
13 1.u arnerojthepopeny,.mictini vely ctfroPnrf ng Cour,)TheCoto"boro. s U.cmurvcttk roor (See.tom Bu a molop Pyworlau Cade:)The Cmoreon.u.
cebo law dao.at apply b m oh. a....(y who built or oo tc. thereon..od
who mMncb for such pvjeoa rhh a mvu.na(,)Bcrtad gvmut n the Camrrtat,
Liana law.
Alun aevtp mdm See ,0&PCfa Nb rusan /
Dor,
/
WORKERS CO.MPEri9AT10N DFLLARATIO C�
1 brooby.ff.o"icr potlty a P-joO'a of Ibe r-u rtg—:.�=-..
❑ I"
wW milwin a Cerureve of Coach b alt-dmrt fa Worttl,Compco-
solm.a provided for by Seh labor Code,3700 of tCode,fa th,perfomm of rho
Cat for which Nis pros it IS ivad.
❑I love aur will mtlaWt Warkey Campewtim Iamnnm,u rocImred by Sectim
3700 a Jc labor Code•for tic pAamma athr wart W whkh bis,omit i.Ivtrt4
W , ¢ B4yuyq ytl' �Pol"numbs�a���9
FlGTE OF IXFM NINN FROM E EA
PFNSATION INSURANCE
frit aalm nod not be mvtplecJ if the pewit t fans hulled mons(SIU%
I anify that u the ptroon.of the.mrt for which N, emil t'.. .I All not
emplo,to,Noma In my moor m to b become rubject to tie WMi='Contpcuuim
law4 of Coliform..Doc
Appliam
NOTICE TO APPLICANT:If..f ,touting Jur Cenirsue of Esemptlm,you,hwW
baorne wboem b the
.Jz foMwitb mortify with WWith port
or this perront 001 lic
0lh the tabor Ctsd�You nttnt
tl¢mcd mwilcd. .
zO CONSTRUCTION LENDING AGENCY
PrzI I hucby.lfirm NO Jere its,mnumctlnn ktding.pmcy for the prfam+mcc of
ce 7 the wort fa which dtu,rood t oma (Scc.)017•Civ.C.)
W A undcff Noor
Z Lmd,f.Aches+
U O 1 cerci,dot I Nrc rod tht.,,Healon ad sur Jut Je.hove infomoum It,
Il. t.. eanea l.grte to comply with ill city it county oaitu trot.uk l.ws rthu.,to
� U building cormmctioq W brmby mthorim mpmsrnuu.cn of Nis city to court upon the
W ,hove-mcntiasd poprty for imprcvoo purp,scs.
a (We).gme to uw,indemnify and tap hornless the City of Cuprtim.g.iMt
rn HWHOu,fudimcM..case andupmuu whkb m.y In my way—11 inn vid City
Uz In can qoe a the grodng of lhb pmll
n. APPLIC UNDERSTAND WILL COMPLY W ALL:NON-POINT Issued by: Date
UR EG TIONS.
Re-roofs
Appll H.wWCa3zAaRDOUSMATEKIALS I Qsou oae Type of Roof ,
til th.ppllcut or rutmc buiWmg scup or hutAc h.uNmu muvi.l
u&and by tie CuPmlm Mutucip t Cock. 1 ar
Ch.ger,9.1il the Holtlt mJ S.(ety
mSaml
Co . m25533(.)i 2rNo roofs shall be inspected prior to any roofing material being installed.
❑Yn Y nn
WBI ft ,liulor(mum building acup,m um egWpw to dcvkn wh¢E If a roof i5 installed without firs[obtaining an inspection,I agree to remove
unit hvarmu air conummturns u cI by the Bay Am Air QtWlty Mw tri all new materials for inspection.
Dc n7
❑Yn
I hoot red the hoodoos rou ole is correwualcrch.pn6.95adeCillfa-
ni.HWth S.F yCodc,Savarn 15505.25533 vu125534.1 urdmd thu
unlf Je bulkling
Jon no bete tM1... Nut' y mgoaldllty b ttaufy tk occup.nt of the
hmu.,rbem, ancmJr o D Signature of Applicant Date
mm. All roof coverings to be Class"B"or better
CITY OF CUPERTINO
am 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37511034 . 00
DATE ISSUED. . . . . . . : 09/18/2006
RECEIPT # . . . . . . . . . 36094 .
REFERENCE ID # • : 06090137
SITE ADDRESS . . . . . : 10204 BRET AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : URS MADER
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
METHOD OF PAYMENT AMOUNT NUMBER
-- - - - - - - - - - - - - --- ---------- - - -- ------- - - --
CHECK 84 . 02 596
CHECK 84 . 02 601
CHECK 84 . 02 602
------------
TOTAL RECEIPT 252 . 06
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408, 777-3333
#UPEkTINO
Building Department
JOB ADDRESS: /6 Z PERMIT #
OWNER'S NAME: PHONE # - OD
GENERAL CONTRACTOR - - # ,
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors com lete the following tion:
SUBCONTRACTOR BUSINESS NAME ftSINESS 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
35`146039 SF uJS
CITY ()F CUP
cs��r WATER HEAVER
Ct1 �kfI at3 PERMIT APPLICATION
APiv'
I � — 11 - 0 Date:
BuHdi,h Address: b6
7 kP, O i C3fCf Q
Owner's Name:
U QSY�last•r Phone 4-
Contra�ctor: ulo$ • a53 900
I i - License #:
Conta;,t:
Cupertino Business License 4:
Building Pe �
o rmif Info:
I
Bldg ❑ Elect ❑
Job Description: Plumb ''N/ Mech
Residential Commercial ❑ — So �` ( 6aS
Cost o Project
Strapped On Pfatform ❑
Bonded
N ❑
��ew Location _ Replacement
(hY1 if
A hoable Fee ID
BPWREATER Fee De ti
ateon
Water Her/Vent Fee Grou
PPER1bITTFEE BUILDING
BENERGY Plumbintr Permit Issuance PLUMBING
BUSLIC, Energy
Business License BUILDING
_ BUILDING
• ���.. ���.� � 1 owe