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07080162 CITY OF CUPERTINO BUILDING DIVISION PERMITINEIORMATION.; BUILDING ADDRESS: PERMIT NO. 10980 KESTER DR PLUMB IN TIME INC 07080162 OWNER'S NAME: PERMIT ISSUE DATE COMPASS MANAGEMENT 360 MEMORIAL DR08/17/2007 NE: SANITARY NO. CONTROL NO. (866) 293-3031 • ARCHITEC/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH c_p LICENSED CONTRACTOR'S DECLARATION Job Description LU F- I hereby affirin that I am licensed under provisions of Chapter 9(commencing z,U,I with Section (dteStrsinessan r ionsylicenscis REPLACE WATER HEATER, SO GAL GAS y in full force and effect ��? Lice n Lic.# _ Date — Coma IZZA ARCHITECTS DEC A ON i a a I understand my plans shall be used as public records ;WU w ti Licensed Professional 1y OWNER-BUILDER DECLARATION I a I hereby affirm that I am exempt from the Contractors License Law for the :in Oa following reason.(Section 7031.5.Business and Professions Code:Any city or county Li 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 =o that he is licensed pursuant to the provisions of the Contractor's License Law(Cha ptcr 9 Sq.Ft.Floor Area Valuation F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $700 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 APN_Number Occupancy Type not more than five hundred dollars($500). 35602801 D 0 I,as owner of the property,or my employees with wages as thew sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractors 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 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 Contractors Li- ccnse 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 Co iracwrs License Law. 0 I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- 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 Wor s Compensation Insurance,as required by Section 3700 of Ute LaboWaFmcrP"olicy ce of the work for which this rptit is issued. M War nd Poli �t m r //b/`�No. FIC OF EXEMPTION FRO IV( 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 mast Oforthwith comply with such provisions or this permit shall be deemed revoked. Z . CONSTRUCTION LENDING AGENCY (-� I hereby affirm that there is a construction tending agency for the performance of (Y, the work for which this permit is issued(Sec.3097,Civ.C.) Dw Q Lender's Name 2 Lcnder's Address U 0 I certify that I have read this application and state that the above information is Hcorrect.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against fn liabilities,judgments•costs and expenses which may in any way accrue against said City �r (�� U z in co quence of the granting of 's permit. Date r� ` r / ►� AP ANT UNDERSTA D WILL COMPLY WIT ALL NON-P Issued by: G L TIO r n U Re-roofs sin m of Applicant/Contractor Datc HAZARDOUS MATE LS DISCLOSURE Type of Roof Will the applicant or future building upant store or handle hazardous material as defined by the Cupertino7N. I Code.Chapter 9.12•and the Health and Safety Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ED Yes 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 ed by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building doe not currently have a tcnan n is my r sibility to notify the occupant of the req n w ich mu be of a Certificate en Signature of Applicant Date All roof coverings to be Class "B"or better 19 Owner r umnrizedagent Date CITY OFCUPERTINO lam WATER HEATER CUPEkj1,NO PERMIT APPLICATION FORM ,, N# Date: ui Address: a C er Building 41�07� o Suly Owner's Name: Phone#: OoncA c\ �Aoe.LS gyne*1r L-lo� -%7-6916 Contractor: Phone: License#: L.0 b- -yl-lk me %66'293- 3� x t oy SAS1143 Contact: Phone Cupertino Business License#: Building Permit Info: 77607 Bldg ❑ Elect ❑ Plumb C Mech Ev Job Description: Residential (T Commercial ❑ Cost of Project: 7c Strapped On Platform ❑ Bonded C New Location ❑ Replacement Qty, if pli Fee ID Fee Description Fee Grou BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY lneMy BUILDING BUSLIC E usiness License BUILDING CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN . . . . . . . . . 355028012 . 00 DATE ISSUED. . . . . . . : 08 /17/2007 RECEIPT #. . . . . . . . . : BS)00002410 REFERENCE ID # . . . : 07)80162 SITE ADDRESS . . . . . : 10: 80 KESTER DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUERTINO IMPACT AREA . . . . . . OWNER COMPASS MANAGEMENT ADDRESS . . . . . . . . . . : 10980 KESTER DR CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014 RECEIVED FROM . . . . : PLI)MB-IN-TIME CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PLUMB IN TIME INC ADDRESS . . . . . . . . . . : 360 MEMORIAL DR CITY/STATE/ZIP . . . : CIRYSTAL.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 ----------------- --------------- -------------------- C HECK 84 . 02 52471 --------------- TOTAL RECEIPT 84. 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING .F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTiNO Building Department JOB ADDRESS: l 3 , - RMIT # �o ;S. OWNER'S NAME: / ��,�� PHO -Z' GENERAL CONTRACTOR: FAXfiK I am not using any subcontractors: Signature IVDate Please check applicable subcontractors /dcom:)lete 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 . ,;. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # 213 4 0 0 V; 4- --'L-- 4�-0 1'e/ OWNER'S NAME: PHONE # / GENERAL CONTRACTOR: FAX# I am not using any subcontractors: ff � /0 ? Si;;nature batie Please check applicable subcontractors and complete the following information: 60 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 r ou �0 7 Owner/Contractor Signature Date CITY OF CUPERTINO _ 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl-,z: Lot: APN 34:?55007 . 00 DATE ISSUED. . . . . . . : 08.117/2007 RECEIPT #. . . . . . . . . : BS000002409 REFERENCE ID # . . . : 07080161 SITE ADDRESS . . . . . : 23,100 VIA VENTURA UNIT 22 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HFITRY LESSING ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : ALLEY ELECTRIC CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34. 86 0. 00 34 . 86 0. 00 BREMFIXT NO. FIXTURES 15. 00 18. 00 0. 00 18. 00 0. 00 BREMRECEPT NO. OUTLETS 10. 00 12.00 0. 00 12 . 00 0. 00 BSEISMICRE VALUATION 1, 500. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 103 .73 0. 00 103 .73 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 103 .73 5773 --------------- TOTAL RECEIPT 103 .73