06040069 (2) CITY OF CUPERTINO
BUIIAINGDIVISION PERMITCQI .IZ,t�-k;�T,��',R�II„`,,�„RION ;
r° .+ ^F2', W.,
BUILDING ADDRESS: ALL VALLEY PLUMBING PB"MITNO06040069
• 20275 NORTHGLE
OW NER'S NAME: PERMIT ISSUE DATE
TIM KRIEGER 3345 SELDON CT 04113/2006
NE: SANITARY NO. CONTROL NO.
(510) 376-4816
ARCHITECT/ENGINEER; BUILDING PERMIT INFO
BO EO 17-71 MECH
3 S LICENSED CONRed under
DECLARATION Job Descriptio
I 1 hereby affirm Nn 1 am licensed under nd Pmons rt Oule. 9(commencing �al�e
with Sectionande of Divhion3ofNe Buanw and Profeadum Code,and mylicenseb
'oes mmnresttmaerrea y WATER HEATER REPLACEMENT
i$z LicemcCWf l.k.g
D.0 % ^Conuxbr 2
ARCli ECI-S DECLARATION
lI understand my plana shall be used u public records F`
7�U
sed Licensed Professional BUILD
5 OWNEon exempt
DER DECLARATION ConTION ®■��I
1k Ile%
I Mrcby aRm Net I am sumps from the Canlracmes License law for da C®Rl
D O (allowing reason.(Section 7101.3.Business and Professions Calc:Any city or county
S$ INAV
f which require a permit to an.roc4 altar.Improve,demolish,or repair my museum 7)0
si prior as its ivame,also require the applicant forsuch permit n file asi;wd statement
p G (c me dngwi pSwdottothcpmvialnns 3offt surae vAPmelaw(Chmm9 Sq.Ft.Floor Area Valuation
ERE
Mm,.I..with sermons andM basisonl it theegeineuWerofMyvi Code)or
Net he V campy thmefmm seri tha aper far be alleged emmprim.Any l lemon of
Section 7031.5 by any applicants(a permit subjects the applicant n a civil penalty of r Occupancy Type
not more thus five hundred dollars(5300).
❑1,u away of die pmpm y,u my amploym withwgu u the4 wlc cwpenudon,
will do da work and deawcm¢u out uundedaahfared forsae,(Sa.7aa4,Business Required Inspections
and Profession,Cade:The Communes License Law Meantset apply n an e owner of q P
property who builds orimproves thereon,and whodoesouch work himselfor through his
awn cmplayee.provided Nuamh improversmb,are not Intended araRmrd possum.If.
however,the building or improvement I.sold within am year ofmmpkti m.the owna-
Wilda will haw tie hardern of proving slut he did set land.improve far purpose of
tau.).
i ❑1,as owner of the property,am exclusively continuing with licensed conmmus as
coubum Ne project(Sac.7044.Business and Profa9ana Cade:)The Comaenr's U.
1
an law does ant apply man owmr of prolartY who buima ar improves thereon.and,
who cmmcu for such projects with arnmrenm(s)licensed pursmm W me Contra bees
j License law.
§f, ❑Iameaemptunder Sac. .Bh PCfor Nismamo
Owner Data
WORKERS COMPENSATION DECLARATION
I ihe¢hyafrom under penalty of perjury one of Ne following decladmoV
'o
01h...and will..truth a Cerifiau or Cement In self-ImurefarWmime.Compen
-
series,u provided fa by Section 370()of the Labor Cade,for the performance of the
work for which this permit if issued.
❑I haw and win maintain Worker's Compensation Insmar :.a m4amd by Salim
3700 of Ne Labor Code,fa the performance ofNe work for which this permit is issued.
My Workees Compensation Insurance carrier and PORcy number arc:
Carrier.. Sr9,4 /'� �� Policy No.: 00 e
CERTIFICATE OF E%EMPTION FROM WORKERS
COMPENSATION INSURANCE
v
(Tab scam need set becampkud Irthe permit Is reserve hundred drum(SIM)
or less.)
I«mfy Nat in We Performance of Ne work fa which this permit is issued.1 stall oat
employ anyperson in my mmmrm a as become subject n tw Work of Compevaim
Laws of Califomts.Dau
Applicant
NOTICE TO APPUCAN'D If,after making this Certificate of Exemption,you should
become subject in Ne Worknes Compensation previsions of Ne labor Code.you most
wJ O fanhwidt amply with arch provisions a Nu Permit"I be deemed mvelm&
EM CONMUC7ION LENDING AGENCY
[-+ Iherehyafrmn that More o k cmmmctinn landing; for the perfomanceof
a the work for which Noy person Is issued(Sec.3M.Cis.C.)
aQ La rices Name
PE Landees Address
U Q 1 entry that 1 have read this application and sum that the above information if
U, correm.[agree to comply with all city and county ordinances and sue laws mlating re
0(, building cabswction,and hereby authorise repaacnmives o(this city to enter upon the
[27 above-mcntoned Property fat napedon purposes
(We)agree m m
taw,indemnify and keep hasuless the City of Cupertino against
L,) Iiabiliuu,judgmeoo.cosu and expanses which may 4%my way acaa agalmt std City
C)Z to consequence of the granting of this permit
t--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs �--
Signaro of ApplicanVContracmr Data
HAZARDOUS MATERh S DISCLOSURE Type of Roof
Will Ne applicant a future building aaupantuorc or handle haardaus materiel
as defined by the Cupertino Municipal Cade.Chapter 9,12.and Ne Health ad Safety
Cade.Secdanvs324)7 All roofs shall be inspected prior to any roofing material being installed.
❑YuGrhs-
Will that applicant ar future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardam air cusum tare,as deBmd by tie Bay Area Air Quality Management all new materials for inspection.
Dimicl?
❑Yes -ErNe
I have mad rite meardoua maurials requiremeam under Chap crd.95afde Califor.
nia Real"SafctyCedc,Sadao 23303,23333 and 25534.1 undcruand not Wilding
Mara oat currently have a errant Nat it b my repomiblnty n nwry the m quo,of the
requiremenuwkh moil be pdorni ars Onci ,ser Occupancy. / Signature of Applicant Date
owner a smharixeda est 91-13 Dau' ,./ All roof coverings to be Class "B"or better
CITY OF CUPERTINO
Oem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31639011. 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT # • • • • . . . . . : 33969
REFERENCE ID # . . . : 06040069
SITE ADDRESS . . . . . : 20275 NOPTHGLEN SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : TIM KRIEGER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0517
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 376-4816
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 49 . 16 0 . 00 49 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 49 . 16 7148
TOTAL RECEIPT 49 . 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Vevelopmem
10300 Torre Avenue
Cupertino CA 95014
i Telephone(408)777-3228
Fax(408)777-3333
OUPERTINO
Buildin De artment
JOB DRESS: PERMIT
AD # O(o��OO(PR
r
OWNER'S NAME: PHONE # d ' r3�''
GENERAL CONTRACTOR FAX#
I am not using any subcontracto Date
Signature
Please check a licable subcontra rs and com Tete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS'LICENSE #
Cabinets&Millwork .
Cement Finishing
Electrical
Excavation
Fendng
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
0
CITY OF CUPERTINO
WATER HEATER
• CUPEI,TINO PERMIT APPLICATION FORM
APN # Date:
/ � - 39- a // q ocr
Building Address: 020o77.5 N -
Owner's Name: Tim Phone #:11or-m _ 78e�
Contractor: License #:
ef 6' 90
Contact: Pho a #:
Applicant/Contractor:
Building Permit Info:
Bldg Elect u Mech
Job Description: 1&4rae
esidentt : Commercial:
Sq.FF Tloor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: pd U _
• Type of Construction: Occupancy Grou
(L-1
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BPERMFEE Bld Permit Fees BUII IDNG
BMITIGAT Housin Miti ation Fee BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
•