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12020082 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:SPEEDY ROOTER PERMIT NO: I2020082 BUILDING ADDRESS: 779552 F'U14IPK1N DR PLUhiBINCi 137 BELLEVUE AVE DATE ISSUED:02/21/2012 OWNER'S NAME: LAMA PATRICIA M PHONE NO:(408)234-8t34 SAN JOSE,CA 95110 OWNER'S PHONE: 4085534718 ❑ L,ICF,NSED f_'ONTR4CTOR/S DECLARATION BUILDING PERMIT INFO: BLDG ' ELECT' PLUMB G License Class Lia# J MECH RESIDENTIAL COMMERCIAL i Contractor Date JOB DESCRIPTION:SINGLE FAMILY DWELLING SEWER REPAIR ADD I hereby afti m that I am ceased under the provisions f Chapte 9 PROPERTY (commencing with Section 7000)of Division 3 of the Business& rofessions LINE CLEAN OUT Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Valuation:$4300 Section 3 700 of the Labor Code.for tire performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:3b20300>.00 Occupancy Type: 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 building construction,acrd hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT S LWkO R indemnify and keep harmless the EO City of Cupertino against liabilities,judgments, WITHIN 18U DAPS OF PERMIT I55 costs,and expenses l may accrue against said City in consequence of the lgd D AYS FROM I BAST CALLED N. granting of this crit Additionally, he applicant understands and will comply with all non pant s, rce gulaticn per upertino Municipal Co e,Section 9.18. j�,% 21 Issued by -� Signature- (V�( Date / ❑ /�vafrirtu OYVNER-BUIL:DE CLARATION RE-ROI here that I am exempt from the Contractor's License Law for one of All roofs shall be in, prior to an a eirg installed.If a roof is the following two reasons: installed shallwithb fast obtaining an sped I agr to remove all new materials for r Illy employees with wages as their sole compensation 1,as owner of'the property,o , inspection. Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant. Business&Professions Code) ,. I,as owner of the property,am exclusively contracting with licensed contractors to ALL RO F C04'L GS TO BE CLASS"A"OR BETTER coirstruct the project.(Sec.7044,Business&Professions Code). I hereby affirm[ruder penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's le Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter .95 of m Sections 25505,25533,and 255344 m . twill maintain California Health&Safety Code, performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code c 'on 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for t}re performance of the work for which this Addition• y,sh uld I use equipment or devices which emit hazardous air permit is issued. contarrlii ansts defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall rnaintkin co Alwith the Cupertino Municipal Code,Chapter 9.12 and the ia a w not employ any person in any, manner so as to become subject to the Worker's Health/&- afety ode,Sections 25505,25533,and 2553. Compensation laws of California. If,after making this certificate of exemption,I OJw ' ora rized agent: 2 / /Z become subject to the Worker's Compens;rtion provisions of the Labor Code,[must Date: forthwith comply with such provisions or this pen-nit shall be deemed revoked. / CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby affir t at there is a construction lending agency for the performance of vwrk's I certify that I have read this application and state that the above information is for which th' errnit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnity and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARC'HITECT'S DECLAItAT[ON granting of this permit.Additionally,the aliplicant understands and will comply with all nor,-point source regulations per the Cupertino Municipal Code,Section I underst<urd my plans shall be used as public records. Signature Date____ Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z 2( - PERMIT# PHONE# OWNER'S NAME: � Z ' 2 GENERAL CONTRACTOR: PF. a Z( � Z BUSINESS LICENSE# ADDRESS: d 1 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. TIL THE NO BUILDING FINAL OR FINAL OCCUP CY INSPECTIHAVS) OBTAINED AWILL BE H7;V7 TFNEO GENERAL CONTRACTOR AND AL U N CTO BUSINESS LICENSE. A�I am not using any subcontractors: Signature Please check applicable subcontra rs and complete the followi information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering lumbing Roofing Septic Tank Sheet Metal Sheet Ro e D e Owner/Contract ignature CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 6 ITEMS OF 6 COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 36203005-00 DATE ISSUED. . . . . . . 02/21/2012 RECEIPT #• • • • .. . . . BSOOOO16OS9 REFERENCE ID # . . . 12020082 SITE ADDRESS . . . . . 7952 PUMPKIN DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LAMA PATRICIA M ADDRESS . . . . . . . . . . : 7952 PUMPKIN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4932 RECEIVED FROM . . . . : RICHARD S ALVAREZ CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY . . . . . . . . . . . SPEEDY ROOTER PLUMBING . ADDRESS 137 BELLEVUE AVE . . . . . . . . . . . CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 234-8134 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ----- ---- -------- - ------------- ------1 .00 -----41 .00 ----- 0 . 00 41 -00 0 .00 1ADMIN HOURS 4, 300 -00 1.00 0 .00 1 .00 0 .00 1BCBSC VALUATION 050 0 .00 0 .50 0 . 00 . 0 00 44 00 IBSEISMICR VALUATION 4, 300 .00 0 .00 1 .00 44 .00 . . 1PPERMITFE FLAT RATE 1 .00 22 .00 0 .00 22 .00 0 .00 1PRSEWER UNITS 1 .00 44 .00 0 .00 44 .00 ------0 . 00 1TRAVDOC FLAT RATE ---------- ---------- ---------- ---- 152 .50 0 .00 152 .50 0 .00 TOTAL PERMIT AMOUNT --REFERENCE------- NUMBER METHOD OF PAYMENT ----------------- ------------- - -------- CREDIT CARD 152 .50 VISA ---- ---------- TOTAL RECEIPT : 152 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- --------- ------------------ -------- ---------------------------- 202 UNDERFLOOR PLUMBING 106 SEWER & WATER 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7952 pumpkin dr. DATE: 02/21/2012 REVIEWED BY: bobs. I APN: BP#: VALUATION: $4,300 PERMIT TYPE: Plumbing Permit _,_,PLAN CHECK TYPE: Alteration /Addition / Repair ION 1 RPSS PRIMARY' PENTAMAT USE: SFD or Duplex PERMIT TYPE: WORK sfd sewer repair add property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $22 EEEET TOTALS: $22.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $44.00 Public Fire,Sanitary Sewer District,School A10TE: This estimate does not include fees due to other Departments{i.e.Planning, ublic Works, District,etc.). These ees are based on the relinsna in ormation available,and are onlyan estimate. Contact the Dept or addn'I into. FEE QTY/FEE t;f;'4 .€a:, ?'r t —�':`_ € ` �' € i�? MISC ITEMS FEE ITE PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Administrative Fee: 1 AL?MIN $41.00 --7= Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: IF= TRAVDOC $44.00 } t;: IBSEISA�ICR $0.50 Select an Administrative Item _Fce: IBCBSC $1.00 St1BTOTALS. $152.50 $0.00 TOTAL FEE: $152.50 Revised: 1/19/2012 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255(4oa)777-322a• FAx(40=)777-3333• buildin cu ertino.or misc CUPERTINO PLUMBING OMECHANICAL ELECTRICAL F�NGSMLANEOUS F:CO7NTACT ADDRESS J �( APN��„ I T Z � EMAIL NAME I/t4 - 1 � n STATE,ZIP FAX ADDRESS NAME G/ � � 7C 6A FAX s Ess •Z�� " Z �J NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT ❑OWNER ❑ OWNER-B=ER ❑ OWNER AGENT LICENSE NUMBER j / (T� � E�j/ BUS.LIC# CONTRACTOR NAME }y� E-MAIL �('_ 0 I _ / E MAII FAX COMPANY NAME 11 I CITY,STATE, d_I 1 . PHONE f1{/� (, 72 STREET ADDRESS ]I I Z� Ayv( ii 64 ( V LICENSE NUMBER BUS.LIC# ARCHITECT/ENGINEIIRIVAME /� r' E-MAIL-MA AX COMPANY NAME' CITY,STATE,ZIP PHONE STREET ADDRESS IS THE BLDG AN C3 YES USE OF SFD or DUPLEX ❑ MULTI-FAIrIILY PR07ECTIN WII DI-aND ❑ NO FLOOD NE ❑O II�ER HOME? ❑NO BUILDING. E3COMMERCIAL URBAN INTERFACE AREA ❑ } / DESCRIPTION OF WORK G 1�`ei l ` - It (� y 1 ( --( RECEIVED BY: r TOTAL VALUATION: a t By my signature below,I certify to ch of e f g: I the property owner or authorized agent to act an the mp owner's behalf I have Lea local application and the information I have d is rrect, ve the D=10"1eof up ork�d t eq verify it is ee a fi d prop for' ectiapplicable putposes. ordinances and state laws relating to; co traction." au a repre Signature of Applicant/Agent: ' SU7ENIEIAL ETFl]RM4 N RE D O/FFIC EONLY a O E-COUNTER r� F ❑ EXPRESS Y U T ❑ STANDARD U < ❑ LARGE ❑ MAJOR MSPMiscApp 2011.doc revised 06/21111