07020035 CITY OF CUPERTINO
BUILDING DIVISION PERMIT EURM�4TION'
BUILRIN ADDRESS: PERMIT NO.
1543 BETLIN AV PLUMB IN TIME INC 07020035
OWNER'S NAME: PERMIT ISSUE DATE
MAURO SOLVEMINI 360 MEMORIAL DR STE 140 02/07/2007
)NE: SANITARY NO. CONTROL NO.
(866) 293-3031
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
[= I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zU with Section7000)ofDivision3o cBusiness d, of i�nsC an y'cnscis REPLACE WATER HEATER
t y in full force and effec
? License Q Lic.
F Contractor
ARC 1TECTS DECIA ION
i < I understand my plans shall be used as public records
)yU
u.in Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that t am exempt from the Contractors License Law for the
p O following mason.(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
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
rac
uF— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500
L 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 ,Q��N Number Occupancy Type
not more than five hundred dollars(5500). 36927022
V V
❑1,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 q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended to 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 Sec. B&P C for this reason
OwnerDate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
j2rfhave 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
work for which this permit is issued.
❑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.
W e Co tion Insurance carrier and Policy number are: T
Policy No.: (�
C1~RTIFICAT'E OF EXEMPTION FROM WORKERS'
NSATION U4SURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued,1 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z'' CONSTRUCTION LENDING AGENCY
E~t►N— I hereby affirm that there is a construction lending agency for the performance of
ty the work for which this permit is issued(See.3097,Civ.C.)
WCs.Q Lenders Name
Z Lender's Address
U C) I certify that I have read this application and state that the above information is
V. coned.1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
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
t"^
APPLICAVT UNDERSTANDS A LL COMPLY WITH ALL NON-POINT Issued by:
OUR L ON .
Re-roofs
Sign reof licant/Contractor ate
HAZARDOUS MATERIAL I LOSURE Type of koof /
Wil c applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mun'ipaI Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
E]Yes No
Will the applicant or future building occupant use equipment or devices which If a roof:s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
1 havc read the hazy ous materials requirements under Chapter 6.95 of the Cali for-
niaHealth&Safctycodc, ctions25505.25533and25534.lundcrstandthatifthebuilding
does not currently have a tenant,that it is my responsibility to notify the occupant of the
req ' ich must be t priqpc6lssuancc of a Certificate of t up D ignature of Applicant Date
wn aDare All roof coverings to be Class "B"or better
or uorizcd gent
Community Development
` 10300 Torre Avenue
; .: Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB jADRESS: / PERMIT #
OWAME: PHONE # _
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot:
APN . . . . . . . . . 365,27022 .00
DATE ISSUED. . . . . . . : 0207/2007
RECEIPT #. . . . . . . . . : BS000000411
REFERENCE ID # . . . : 07020035
SITE ADDRESS . . . . . : 84:, BETLIN AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAITRO SOLVEMINI
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4546
RECEIVED FROM . . . . : REC'EIPT INTERFACE
CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607
COMPANY . . . . . . . . . . : PLUMB IN TIME INC
ADDRESS . . . . . . . . . . : 360 MEMORIAL DR STE 140
CITY/STATE/ZIP . . . : CR"STAL LAKE, IL 60014
TELEPHONE (8(-)6)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 84 . 02 806
---------------
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY
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