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07090159�C :m :UE 1F� ia= u• u •O. jot <�E Q L 0 Z a W a U w U CITE' OF CUPERTINO BUILDING DIVISION PERMIT 77777777777771 77777774. �� ' �� Z��y��I®P. �' _._:. PERMIT NO. 07090159 BU" (GAjTER' STELLING RD l �J �J `j ACE PLUMBING PERMIT ISSUE DATE OWNER'S NAME: ROBERT KUNZLER 565 N CENTRAL AVE 09/24/2007 SANITARY NO. CONTROL NO. 'NE: (408)22E-2243 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3ofthe Business and Profcssions��dmylicenscis INSTL & REPLACE MAIN SEWER LINE. in full force and efC� License C1 Le• S DaterArfrmf Contra tar ARCHITECTS DECLA TION I understand my plans shall he used as public records i Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the i following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement 9 >q. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter $12000 (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 Number Occupancy Type not more than rive hundred dollars (5500)L 32628081. [11, 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 sae (Sec. 7044, Business Required Inspections and Professions Code: The Conuactor'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. U. 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 sate.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractees Li - to an owner of who builds or improves thereon, and . IL cense Law does not apply property who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License (n _ n " 4 ": B & P C for this exempt under Sec. reason ❑ [ am ex 4 y i,, 4'Jt Owner Dale x I Edi iia d ^ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fallowing declarations: wy d ❑ I 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. ❑ 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. My Worker's Compensation Insurance carrier and Policy number arc: Carrier �Yl/Kll ' Policy No.l1% L A OF EXEMPTION FROM WORKERS' ERTI LATE COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY A I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 3097, Civ. C.) Name zLender's Lender's Address 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 Ubuilding construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We) agree to save, indemnify and keep harmless the City of Cupertino against Ok V) liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. Date Z Z ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: _ SOURC ATIONS. Re -roofs Sign rc of Applicant/Contractor Date T of F.00f Type HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant 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 roofs shall be inspected prior to any roofing material being installed. ❑ Yes ❑ No If roof; s installed without first obtaining an inspection,agree to remove a .1 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 materials for inspection. District? ❑ Yes ❑ No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- niaHcalth&SafctyCodc,Sections 25505,25533 and 25534.1understand thatirthe building d of currently have a tenant, that it is my responsibility to notify the occupant of the Date ens which must be met prior to issuance of a Certificatecup�y. Signature of Applicant f9a`"� All roof coverings to be Class "B" or better Owner or authorircd agent Date CITY OF C'UPERTINO REPIPE/ . R, /MAIN SERVICE PERMIT APPLICATION FORM 0700 �APN #3c; ( Bl Jg. Permit Fees BUILDING Date:p(tv &�55,6 /6!2 Building Address: PLUMBING ! PPERMITFEE Pliunbing Permit Issuance PLUMBING BPREPIPE Owner's Name- L abe C�cch e— PLUMBING BPFIXTURE Phone #: 1 0 Contractor: Phone: C.u��r X08 dos- � BPWSVCS _dei) - License #: Contact: Phone: / BPSEWER Se givers Cupertino Business License #: BPSEWAGE Se,vage Disposal PLUMBING ,i Building Permit Info: BUSLIC Business License BUILDING Bldg ❑ Elect ❑ Plumb Job Description: �k,41etce Residential Cominercial. ❑ Cost of Project: PIL Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bl Jg. Permit Fees BUILDING BPGAS Gzs Piping System Fee PLUMBING ! PPERMITFEE Pliunbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING / BPSEWER Se givers PLUMBING BPSEWAGE Se,vage Disposal PLUMBING BUSLIC Business License BUILDING