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06010130OF CUPERTINOriias BUILDING DIVISION PERMIT 4CONTRACTORINFORMATION ICITY BUILDINGADDRESS: ALL VALLEY PLUMBING PERMIT No. 06010130 1026 PENNINGTON LA ,OWNER'S NAME: PERMIT ISSUE DATE GOTTWALD RUDOLF H AND LEE 170 BRANNON DR 01/24/2006 NE: SANITARY NO. CONTROL NO. (510)376-4816 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONnRACnderpDECLARATION 1 hereby affirm that I am liamce under provisions of 9 Job Description p Code. with Scotian 7akB of Division 3 of the Busine� and Profession Code. and my license u my license, In mu rano ane erce=tom, g 8- License Class Lac.. WATER HEATER REPLACEMENT ` ��® Dam /� Can or 'sal Cl ARCHITECT'S DECLARATION 1 understand my plans shall W used as public records e/ (` 1"D 76 2006 Licensed Professional OWNER-BUILDER DECLARATION 1 hereby offirm that I am exempt from the Contractor's License Law for the ' fallowing reason. (Section 7031.5, Business and Profession Code: Any city or county to emamc4 improve, demolish. fff�� d �^^'' which requires a permit ehe'.ar repair any stremmae tp1 ik91f7A f!) prior to its imumce, also requires the applicant forsuch permit rile a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Sq. FL Floor Area -Valuatioitf (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he u exempt therefrom and the basis for the alleged cumption. Any violation or Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type not more Nan caw hundred dollen ($5110). ❑ I, u owns of Ne pmpeny, m my employee with wage u Heir sole rompewtion, will do the work and theswnure u not intended oro@rad fm We (St. 7014. Busimes, and Profession Cade: The Convacmrs Li. Law does not apply m an ower, of Required Inspections property who builds orimpmwass Hereon, andwho doessuch work himsel(orthrough his own employces, provided that such improvements art not intended oronered for We. IL however. the building or improvement is sold within one year Of completion, the most- builder will have lie burden of proving that he did Out build or Improve for purpose of ale.). ❑ 1, as owner of the property, am exclusively contracting with licensed romrtmmrs to Construct the pmjcct (Sec. 7094, Business and Professions Cods:) The Contractor's Li. comm Law does not apply to an owner of property who Wilds Or improve thereon, and who Contac%for such projects with acontractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. B sk P C for this reason Data WORKER'S COMPENSATION DECLARATION 1owner 1 hereby of nom under penalty of perjury ore of the following decimation: 1 ban and will maintain a Certificate of Canons m self-imus far WmkeesCompen- atian. u provided for by Section 3700 of the M Labor Code. far the perforanof the Z1 for which this permit is issued. ❑ 1 have and will mammin Workers Compensation Insurance. as required by Section 3700 of the Labor Code, for dm performance of the work for which this permit is issued. My Workee/efss Compensation Insuan¢ arrar and Policy number are: Can11C,/G �D/fll� Policy No.: O Ory 665- ZOOM ' CERTIFICA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed irthe pmmit is fmoao hundred dollars ($100) or less.) 1 certify that in the performance of He work far which this permit is lamed, I shall not employ any person in any manner an m as become subject to the Workers Compevafion Laws of California. Dam Applicant NOTICE TO APPLICANT. If. after making Nu CcnificaM of Exemption, you should become subject to she Worker's Compensation pmvisiom of the LaWr Code, you most raMwith comply with such pmvuian or this permit shall be doomed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that thea is a convection lending agency for the Performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Leader's Address I certify that 1 have read this application and sow that the above information is Correct. 1 since to comply with all city and county ordinances and state laws relating to building convection, and hereby authorim repres=mmises of Nis city to enter upon the property for ie penes purposes. ahovices (We) agree to save, indemnify keep and harmless BM City of Cupertino against judgments, andexpensesNa which may in my way attnuc,gaimt WO City in consequence m consequence of Ne granting of skis permit. or the Pe APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT souR�cu n ;. ISSUC(I by; Date -0�- .. Re-roofs / Data Slgnatum of Appraavcan� HAZARDOUS MATERIALS DISCLOSURE Type of Roofs Will the applicant or future building Occupant store or handle haloes material at de0ned by the Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety ode. Section 25532(a)? ❑Ye, FN. All roofs shall be inspected prior to any roofing material being installed. Will thea applicant pP or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove II ha> rdnus air contaminants u dcrined by the Bay Area Air Quality Management all new materials for inspection. strict? p Ycs pm I havereal Heh 2msmatmialsmquiamcnuunder Chaper6.95oftheCxlifor- niaHealth&Safe'yCo .Savour25505.25533md25534. 1undsommol thaifthe Wilding not currently hart a Masai, Hat it u my mspomiality H notify tar occupant of the �docs arramfl�.r�mn apdormisseasxc ora cmnirMaM of Ocapanry. Signature of Applicant Date All roof coverings to be Class "B" or better Owner ar,athoavcdagent Dam F K CITY 0, ,UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department I am not using any Please check applicable RV te . Signature Da and comr)lete the followine information: Owner/ Contractor Signature Date 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 s 0 • CITY OF CUPERTINO aTyor WATER HEATER ObO1013D CUPEKTiNO PERMIT APPLICATION FORM Qty. if Aoolicable Fee ID Fee Descriotion Fee Groun BPWHEATER Water Heater / Vent BUILDING Date: Building Address: PLUMBING Ownerame Phone #: Contractor: License #: ef 36 71?yBa Contact: BPERMFEE Bldg Permit Fees Pho e #: Appl icant/Contractoc Housing Mitigation Fee BUILIDNG S Building Permit Info: BUILIDNG Bldgum ec Job Description: . 7-4,e �orac E��mc<: .6pr esidential: Commercial: Sq. t. loor Area: $/Sq.Ft.: Architect/Engineer: V aton: o Type of Construction: Occupa, Group: Qty. if Aoolicable Fee ID Fee Descriotion Fee Groun BPWHEATER Water Heater / Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BPERMFEE Bldg Permit Fees BUILIDNG BMITIGAT Housing Mitigation Fee BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG