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07020098 CITY'OF CUPERTINOMA BUILDING DIVISION PERMIT � RT� �� PERMIT NO. BUILDING ADDRESS: 672 STENDHAL LA PLUMB IN TIME INC 07020098 PERMIT ISSUE DATE OWNER'S NAME: ANIL DEORA 360 MEMORIAL DR STE 7 SANITARY NO. CONTROL NO. ANE: (866) 253-3031 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH !00 LICENSED CONTRACTOR'S DECLARATION Job Description V F- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Section 7000)of Division 3 cithe Business and Professions Code, nd ensc is REPLACE WATER HEATER 4 w in full force and ef 711 r v�z License ass LIC. _ l o Date Contractor UJ CHITECI'S DECL-ARATI N 7 a< 1 understand my plans shall be used as public records )yU e u.HLicensed Professional y< OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county am li which requires a permit to construct,alter,improve,demolish,or repair any structure _zr prior to is issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 q• $500 a t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of trT Number Occupancy Type not more than five hundred dollars($500). 375400-: 2 . V V ❑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 Contractor's License Law does 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.). ❑1,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- cense law does 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. ❑I am exempt under Seo. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the w 'for which this permit is issued. ❑1 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. adol surance carrier and Policy n-umbos a� C rlicy No.: ((,(n C K0CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY (.r►C/l-+ I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(See.3097,Civ.C.) Wfs�Q Lender's Name Lender's Address U C) I 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 nV building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned properly 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 V Z in consequence of the granting of this permit. Date APkLICAT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: wit SO R GU ATIDNS. Re-roof; �.'-.`.. gnatulithe re Applicant/Contractor DaT e of Roof HAZARDOUS MATERIALS ISCLOSURE yP applicant or future building occu L store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof s shall be inspected prior to any roofing material being installed. ❑Yes �o Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes .cf N° I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand that if the building knotdcurrently have a tenant,that it is my responsibility to notify the occupant of the cnts which in et 'or to issuance rtificate of Occupancy. Signatui e of Applicant Date All roof coverings to be Class "B"or better Own r authorized agent Date Community Development 10300 Torre Avenue 3s; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTIN0 Building Department JOB ADDRESS: (0-11,2- PERMIT # OWNER'S NAME: ftni I E)61-a PHONE # Q93-303 1 GENERAL CONTRACTOR: FAX # )Gm not using any subcontractor �0 SiE,nature6 Date Please check applicable subcontractors and com lete the folio 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 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37510032 .00 DATE ISSUED. . . . . . . : 02/20/2007 RECEIPT #. . . . . . . . . : BS000000493 REFERENCE ID # . . . : 07020098 SITE ADDRESS . . . . . : 672 STENDHAL LA SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER ANIL DEORA ADDRESS CITY/STATE/ZIP . . . : CUEERTINO CA, 95014-4656 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : PAt'L HENDRIXSON LIC # 27607 COMPANY PLUMB IN TIME INC ADDRESS 36(l MEMORIAL DR STE 140 CITY/STATE/ZIP CRYSTAL LAKE, IL 60014 TELEPHONE (8(16)293-3031 FEE ID UNIT QUANTITY ;MOUNT 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 ------ -- --- ------- TOTAL PERMIT 84 .02 ------0. 00 84 .02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 84 . 02 1835 --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------ --------------------------- -- ----------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY CU .�t, opcj�MI � 0702 0098 pNAPPLICATION address: Date: 6 a ow 66 ame: �%, C'ontrar'ctor: Phone#: 1 s •� License 1 RUIldtngperm it In Cupertino Business Lice yyy�a nse 4:c'3a�b Lj Job Description: Elect ❑ Plumb Resid ntial' Mech ❑ � �. � , i J Commerciale❑ - Cost of project: r J Strapp6d Oil Platform ,� Bonded ' 1 ewQ Cation Ieplacetnent Qty-j if' h`ppli6ble Fee ID, E BPlif r: R�'ER PPE Fee DescriptionDescriptionII1'Rh� Fl✓E Wa:et Neat'Gyer/'Vent Fee Gro up jul n per►r�it IssuanCe BUS I);h7� gIISI.IC Ere-� y LU INC, B�!s:ness License gU ,I)NG ---___ BUILDING o t'LCL IL ~ � - lb A c t `