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06100166
CITY OF CUPERTINO BUILDING DIVISION PERMIT � TTOR1E}RMATIf� t BUILDING ADDRESS: PLUMt IN TIME INC PERMIT No.0 610 016 6 19780 AUBURN DR PERMIT ISSUE DATE OWNER'S NAME: ALOK GUPTA 360 MEMORIAL DR STE 140 10 23/2006 .ONE: SANITARY NO. CONTROL NO. (866) 293-3031 ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a o 0 a O p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9 ommcncing j Z with Section 7000)of Divisi 3 of the Business#nd,Prof ionso my license is >>aw in full force and effect. lU�l/E'n U REP CE WATER HEATER j ? License Class Lie.# E in Date Contractor J AR HITECTS DECLAMATION LQ U 1 understand my plans shall be used as public records .4 O in Licensed Professional h OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the L 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $500 Ed which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior ut 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 i H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i $ 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 r Occupancy Type not more than five hundred dollars($500). ❑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 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 themon,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 Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insurc 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. r ;Co-m n�auon Ins race caricr and Policy nu be r L 7� � � Qy No ��riRTIFICATE OF EXEMPTION FROM WORKERS' Z�—COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 Workcrs'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 O forthwith comply with such provisions or this permit shall be deemed revoked. z ' ' CONSTRUCTION LENDING AGENCY (~.w►�-� 1 hereby affirm that there is a construction lending agency for the performance of (Y. .� the work for which this permit is issued(Sec.3097,Civ.C.) L4 A Lender's Name Lender's Address U C) I certify that I have read this application and state that the above information is [t. 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 U above-mentioned property for inspection purposes. {:4 (We)agree to save,indemnify and keep harmless the City of Cupertino against CA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of thegrantin of this permit. Date Q�_Z ►-w PPL M UNDERST AND WILL COMP WITH ALL NON-POINT Issued by: /r REGUL I �d Re-roofs Sign re of Applicant/Contractor Date HAZARDOUS MA LS DISCLOSURE Type Of Roof 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 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 4cftncd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes No 1 have read the hazardous materials requirements under Cha 6.95 of the Califor- ia Health&Safety Code,Sectio 5505.25533 and 25534.1 u wand that if the building docs n currently have a ten it is my rcspansibilit o notify the occupant of the men whichrqustmet rtoissu rtificatco capan SignatureofApplicant Date �� All roof coverings to be Class"B" or better 04L or authorized age Datc Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO BuildinDe artment JOB ADDRESS: 1q-7�-O 1241 ,D i c_.__ PERMIT # r OWNER'S NAME: PHONE # C - — GENERAL CONTRACTOR: — AX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 Owner/Contractor Signature Date CITY OF CUPERTINO em 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN 31635015 . 00 DATE ISSUED. . . . . . . : 10/23/2006 RECEIPT # . . . . . . . . . : 36531 REFERENCE ID # . . . : 06100166 SITE ADDRESS . . . . . : 19780 AUBURN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ALOK GUPTA ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : PLUMB IN TIME CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : PLUMB IN TIME INC ADDRESS . . . . . . . . . . : 360 MEMORIAL DR STE 140 CITY/STATE/ZIP . . . : CRYSTAL 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 NUMBER - - --- - - - ---- - ---- -- -- -------- - ----------------- CHECK 84 . 02 1158 CHECK 84 . 02 1255 TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ________ ------------- -- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 3S�I��6��4g S� 663 ' c7/� 7��:ti'fYC`'a'/ c��J. � ��a' Y P.il;,F"° �"' C 3 ,� r WATER HEATER IT A P"t"'LICATION FOR. Ay -- — I i Date: I i to►3)o b OwDef'S a.me— hE3ne '7 i E cantr ez©r------- �.9ee �- , �p� I , x fc- pengat3 business license N: 3 xB Bi`o i� 1 _ Elect ' Ph � r i �O esmptlon- � n � I o Pr�lerci=3 Mech f Cost e� x©sect.p- Platform Bonded i F i N�Wc tie__ Repl acemeni Qty-i if Applibable dee ID r ec esc fl�7ce5. PIPW Eh TER a �vr d^ �Fee Groua UILDTNG lun CF T BEN J €2e �j 3 —SLIC BpuS? s SS u,ZCelllSe �� _ DfNG I I �C (-00 C)I 56 66:3 . 11- a o