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07050208 CITY OF CUPERTINO BUILDING DIVISION PERMIT �TaR INE(IRMTI()N BUILDING ADDRESS: PERMIT NO. 10454 STERLING BLVD PLUMB III TIME INC 07050208 PERMIT ISSUE DATE OWNER'S NAME: LINDA BORRMANN 360 MEMORIAL DR 05/21/2007 SANITARY NO. CONTROL NO. NE: (866) 29:3-3031 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH I p p LICENSED CONTRACTOR'S DECLARATION Job Description VF I hereby affirm that I am licensed under provisions of Chapter 9(commencing UUa withScction7000)oCDivis' n3ofllytBusinessandProfessions(ipdc,andmyliccnscis REPLACE HOT WATER HEATERr 30 GAL GAS y in full Core and ((j( ? License Class LK•S yI� /�•_ 3 F,W Date Contractor A HITECTS DECLARATI N i a< 1 understand my plans shall be used as public records �yU U.y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the pO 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 -Z prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;>q.Ft.Floor Area $500 aF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 ofNumber Occupancy Type not more than five hundred dollars(5500). 3752304 � ❑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 docs 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.). ❑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- 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 Contractors License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor C ,for the performance of the work for which this permit is issued. My Wo r Drape/yo�lrtgu 'ce crier �Po^I' number are: C Carrie C�'�'�C �7 TIFICATE OF EMPTION FROM WO ERS' COMPENSATION INSURANCE (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 Z forthwith comply with such provisions or this permit shall be deemed revoked. z OCONSTRUCTION LENDING AGENCY (~r rct)-r 1 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.) ALender's Name ]z Lender's Address U 0 1 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 relating to rJ U building construction,and hereby authorizt 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 ,Fr V) liabilities,judgments,costs and expenses which may in any way accrue against said City n U z in consequence of the granting of this permit. Date ►'� AP LICA UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: SO R G CATIONS. 4 If OL —� Re-roofs toor, plicant/ContractorDare Type of RDof HAZARDOUS MATERIALSOSURE Wi the applicant or future building occupaSssnor handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs;,,hall be inspected prior to any roofing material being installed. ❑Yes ° Will the applicant or future building occupant use equipment or devices which If a roof i.,,installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants •dEfmcd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes ❑N° 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building d not c ntly have a tenant,that' y responsibility to notify the occupant of the rcq • w'Is stbS t amce°ra fteateOfocea � Signature of Applicant Date 7��1f� L All roof coverings to be Class"B"or better caner or au rized agent Datc CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN . . . . . . . . . 37523042 . 00 DATE ISSUED. . . . . . . : 05,'21/2007 RECEIPT #. . . . . . . . . : BS000001410 REFERENCE ID # 07050208 SITE ADDRESS . . . . . : 10,654 STERLING BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . LINDA BORRMANN ADDRESS . . . . . . . . . . : 10,654 STERLING BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PLUMBINTIME CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PLUMB IN TIME INC ADDRESS . . . . . . . . . . : 360 MEMORIAL DR CITY/STATE/ZIP . . . : CIRYSTAL 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 #50780 --------------- 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 4-WEkTINO Building Department JOB ADDRESS: ;>Uy`j'!� ��'' G,/� �G �Q PERMIT# l OWNER'S NAME: j PHONE # GENERAL CONTRACTOR: LFAX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following ' ormation: 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 O/wner/Con—tractor Signature Date