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07020151 CITY OF CUPERTINO --7777,7777.7777.. BUILDING DIVISION PERMITMAN10N' BUILDING ADDRESS: PERMIT NO. 1052 BUBB RD PLUMB IN TIME INC 07020151 OWNER'S NAME: PERMIT ISSUE DATE SID NANDI 360 MENORIAL DR STE .)NE: SANITARY NO. CONTROL NO. (866) 293-3031 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 10 z LICENSED CONTRACTOR'S DECLARATION %m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description rul z m with Section 7000)of Divisio oJJltc Business and pdc,and my liycnsc is REPLACE WATER HEATER y in full force and effect t' Y//�/ (J/r�� D(/ j v2 z License ass Lic.8 E w DateZX Contractor RCHITECTS DECLA i a e I understand my plans shall be used as public records >yu 'u.y Licensed Professional Oy, OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county `<W g which requires a permit to construct.alter,improve,demolish,or repair any structure u Z prior to its issuance,also requires the applicant for such permit to file a signed statement a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation F (commencing with Scction 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 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of t��rD#�.T Number Occupancy Type not more than five hundred dollars($500). 3620401 4 . 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 or 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 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. ❑1 am exempt under Sec 8&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the follolying declarations: L]1 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 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. My Ws 4TIFICATE nsation Insurance carrier and Policy number r pnlicy No.: OF EXEMPIION FROM WORKER �A �ro�rq ATION SURANCE (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,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 ,J Q forthwith comply with such provisions or this permit shall be deemed revoked. z V) CONSTRUCTION LENDING AGENCY E.r I hereby affirm that there is a construction lending agency far the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Lender's Address U 0 I certify that 1 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 rclating 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 ,may Uj liabilities,judgments,costs and expenses which may in y way accrue against said City V in copse ucnce of the granting of this permit. Date �f APP ANT UNDERSTAN AND WILL C PLY WITH ALL NON-POINT Issued b) C REGULA ON �� Re-roofs Sin f ApplicanUCo ac Date HAZARDOUS MATERI DISCLOSURE Type of Roof Will the applicant or future building or; pant store or handle hazardous material as fined by the Cupertino Municipal 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. Cl Yes ❑No If a roof.s 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 Area Air Quality Management all new r,laterials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534. nderstand that if the building d not cogntly have a tenant,that' my responsib y to notify the occupant of the rc ' n w It c me r issuance of rtifica Occu anc _ Signature of Applicant Date All roof coverings to be Class"B"or better Owner authorized agent Datc CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT' RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN 36::04014 .00 DATE ISSUED. . . . . . . : 02/28/2007 RECEIPT #. . . . . . . . . : BS000000564 REFERENCE ID # . . . : 07020151 SITE ADDRESS 1052 BUBB RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER SID NANDI ADDRESS 1052 BUBB RD CITY/STATE/ZIP . . . : CUERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PLUMB IN TIME INC ADDRESS . . . . . . . . . . : 36 ) MEMORIAL DR STE 140 CITY/STATE/ZIP . . . : CRYSTAL 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING Community Development 10300 Torre Avenue �` - Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Buil4jng Department JOB ADDRESS: / j ZAe 1919,64 PERMIT #�O�1� , A OWNER'S j PHONE # GENERAL CONTRACTOR: tom, ,'[ FAX # I am not using any subcontractors-6 Si;nature 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 11TY OF, O0102C 10 % P, WAT�FR HEATCR d1 �1 PERMIT A J[ ICATIO i ; J\' ]FORNI , Bui=digigAddress: Date: fhb I Cne wr's Name: Contractor: Phone#: taut: Licenser: E0017 r, Building Permit Info: Cuperrino Business Lice me rr_ f _ Bldg lob description: Elect ❑ t Plumb Mech Q Pesid ,tial f Commercial Cj O 4 j Cost Of Project: 3 Strapped r On Platform Bonded ded New Location Q Replacement n. pliable Fee } BP�HEATER ee3escription PPER]✓IITFI;E matereeater/'4lent Fee Group ' Plug, B£IrlrP,Gy gin¢Permit issuance B�lliT1G BIJSI.YC Ener�V PLUM BINC BusinE:ss License LDNIG B UILDFNG CO C4Q- `