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07020150 CITE'OF CUPERTINO �d)�iT ��R I�T*UI� r4TIE)N• BUILDING 01VISION PERMIT PERMIT NO. BUILDING ADDRESS: 07020150 10450 N PORTAL AVE PLUMB In TIME INC 0]0 2 015 0 PERMIT ISSUE DATE OWNER'S NAME: PETER KLEIN 360 MEMCRIAL DR ,STE 140 02/28/2007 SANITARY NO. CONTROL NO. INE: (866) 29--3031 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1 cd ZO LICENSED CONTRACTOR'S DECLARATION Job Description vI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Di''on 3 of the Business and Profcssi Code,an m lice REPLACE WATER HEATER y in full fora and c[Cec Y v�z License _ g Contractor F t%uARCHITECTS DECLARATION j < I understand my plans shall be used as public records )yU w�M Licensed Professional < OWNER-BUILDER DECLARATION ,0_1 1 hereby a17rm that 1 am exempt from the Contractors License Law for the pc following reason.(Section 7031.5,Business and Professions Code:Any city or county `<m which requires a permit to construct,alter.improve,demolish,or repair any structure Valuation prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $500 r=— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Q that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ,�1 Number P Y YP not more than five hundred dollars($500), 3162901 1V 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cerise Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sea B&P C for this mason Owner Date _- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fallowing declarations:.. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- sation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My WA%�EWTI Compensation Insure a carrier and Policy number arc: CarniPolicy No.: CA F EXEMPTION FROM WORKERS' JGs,�J_"`e,¢ COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code you must 2 forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F.r CA I hereby affirm that there is a construction lending agency for the performance of a✓ the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lcnder'sAddress U 0 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ,F liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date �. APPLICANT UNDERSTA ND WILL COMPLY W ALL NON-POINT ssued b SOU E REGULATI0 D Re-roof: Si p t c r Date Type of Roof HAZARDOUS MATERI DISCLOSURE YP Will the applicant or future building occ p store or handle hazardous material as fined by the Cupertino Municipal Code, p 9.12,and the Health and Safety Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed. 0Yes /dNm If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building d not currently have a tenant,that it is my responsibility to noufy th occupant of the Date Icy' which must be met r issuance of a Ccrtific of cu Si matin e of Applicant All roof coverings to be Class"B"or better Own or thorixcd agcm Date CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31629014. 00 DATE ISSUED. . . . . . . : 02/28/2007 RECEIPT #. . . . . . . . . : BS000000564 REFERENCE ID # ,. . . : 07020150 SITE ADDRESS . . . . . : 10450 N PORTAL AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PETER KLEIN ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2325 RECEIVED FROM . . . . : RECEIPT INTERFACE 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 168. 04 2116 --------------- TOTAL RECEIPT 168. 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CYTY O ` t TII� 0 0-70201150 004 WAT-E`�%o HEATER KTINO PERMIT � T0FORM APnY� I la ^� ,'Date- p9 Address: o11 ►a1v� Owner's tv`ame: 6 Sb 1J Po e.L �� IC i ontractor: Phone#: ; s ' Ll 14 gas- as�y Contat: Licens'e n: I 0017 r u i �' pertino Business - BuildinC g Pern3it Info: License 8 Begk=t 'Yob Description: Elect Q Pl >mb 01 Meeh ❑ l Residtial ; Commercial [j FCOSt of Project: j Strapped Oil Platforrn ❑ Bonded ; N I 1 ew Location ❑ replacement 161 i if- Applibable Fee Yt3 ' BPV4�IATER Fee escription PPER.MYTFEE 'mate".Heater/Vent Fee Group —�— --BENZ-ZPGY PIUM" znaPcrinTt 1SSuanCC BUILDING i �USLIC Erer'y I',-'UIVLBINCr ----- BuS3nL'ss I.,icense gUIL G -BUILDING 36D csi tai ` '�•� ,��`- .��="� r