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06100165 77,77 7: 777. 71 77777777777.. CITY OF CUPERTINO BUILDING DIVISIoiV � � O"" ` �� * PERMIT BUILDING ADDRESS: PLUMB IN TIME INC PERMIT"°.0 610 016 5 11776 PINE BROOK CT OWNER'S NAME: PERMIT ISSUE DATE STIEGLITZ MARK 360 MEMORIAL DR STE 140 10/23/2006 _)NE: SANITARY NO. CONTROL NO. (866) 293-3031 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1 O p LICENSED CONTRACTOR'S DECLARATION Job Description tm I hereby affirm that I am licensed under provisions of Chapter (commencing i y., with Section 7000)of Divi' n 3 of the Business an Profession.C nd my license is REPLACE WATER HEATER in full force and effect r j ? License ass Lic.# �_. F, Date - Contractor U&h- a ARCHffECI S DECLARATION UJ U I understand my plans shall be used as public records ,a O H Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county 5 0 0 e m ff which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior hi its issuance,also requires the applicant for such permit to role a signed statement _ i that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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(5500). ❑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 q P property who builds or improves thereon,and who does such work himself or through his own employers,provided that such improvements are not intended or offered for We.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 comractor(s)licensed pursuant to the Contractor's 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: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- 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. Wo mpe {upsa�'on Insuran c mcr an Policyitu F";-. cr arcY ` '/ r (_(%t�t,�, ;yd J alicy No.: CERTIFICATE OF EXEMPTION FROM—� COMPENSATION INSURANCE (This section need not be completed if the permit is for anc 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.Dale 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 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.) Iia A Len r' Name z L.cndees Address tU O 1 certify that I have read this application and state that the above information is Li. correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. Ow (We)agree to save,indemnify and keep harmless the City of Cupertino against Cn liabilities,judgmcns,cosy and expenses which may in any way accrue against said City U z �'n onsequence of thr granting of 's permit.LI NT UNDERSTAN ND WILL COMPLY WITH ALL NON-POINT Issued by: Date Re-roofs `�--�- Signet f Applicam/Contractor Date HAZARDOUS MATERI DISCLOSURE Type of Roof ill the applicant or future building ant store or handle hayardous material as defined by the Cupertino Munici al Codc, aptcr 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [3 Yes No Will the applicant or future buil ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminantsas incd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials6- nia under Chapter 6.95 of the Califor- Health&Safety Code,Sections 25505, 34.I understand that if the building d of ntly have a tenant, ity'sbility to notify the occupant of th re ui ents hich must be me rior lb iCertificate of Occupant l Signature of Applicant Date All roof coverings to be Class"B"or better ;6wn&o thorized agent Date Community Development 10300 Torre Avenue 4, 0,M ` Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY Of -,UPEkTINO Buildin �Dje ar'rJOB ADDRESS: ' PERMIT # O 6- OWNER'S NAME: C.e K, PHONE # GENERAL CONTRACTOR: ;-div - # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followm* 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 3S'+4663-7 S9_ &M- R CITY 0-F CUP 4 O 060100) (VrD WATE IR H 1EATER A- PEWMIT APPLICATION FORM 7 of— Date: 1Id i Bu" ` 1 It— Address: WIA 0",v ,"SNarne: Phone IT- uontw+ U\ Lor: Dl I rk T-% License n. s Contac' t- p, Cuupertino Business License Tr: Buildiho Permit Info- Blda �D Elect u Fn b Mech Job D(�Scriptio-n- Corrimercial cost oifproject: S-uapp6d On—Phatform Bond New L'ocation El Replacement V & A-PP66able Fee ID JI I 10 P,BPWHEATER Fee Descripti dee Grout) Water Heater/Vent BUILWING PIL!m- bing Fltnmit fssldp.nce BENERGYPLUN4BING _nervy BUSLIC BUILDING is BUSIness License BUILDfNG �Pkx M. )D Me t Lai C,-)-S - Got,D 14,