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11040014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10250 LOCKWOOD DR CONTRACTOR:TATS INC DBA MR PERMIT NO: 11040014 ROOTER PLUMBING OWNER'S NAME: ALBERT KUO 44777 S GRIMMER BLVD STE C DATE ISSUED:04/04/2011 NER'S PHONE: 4088078092 FREMONT,CA 94538 PHONE NO:(408)271-2822 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB License Class C" 5(1 Lic.# 761;21_2 MECH RESIDENTIAL COMMERCIAL Contractor' ,`>�� L�G7�(��_ Date JOB DESCRIPTION: SFDWL CLEAN OUT I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. tr t 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. Sq.Ft Floor Area: P i Va uation:$3000 I have and will maintain Worker's Compensation Insurance,as provided for by *' Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34214038.00 '' Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the y 3 ( f granting of this permit. Additionally,the applicant understands and will comply Issued by�/y Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. _.,__ . RE-ROOFS: Signaturekve".e/) Date __ /� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. Li OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mu*ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 75505. 5313,and 25534. , _..; Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 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 Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10250 lockwood dr. DATE: 04/04/2011 REVIEWED BY: bobs. APN: BP#: rVALUATION: 1$3,000 Y°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK install property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $21 TOTALS: $21.00 T7Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 Lj NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee.Resolution 09-051 F.,ff. '1.-/(?) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 rs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 ]ADMIN J •15 SUBTOTALS: $106.50 TOTAL'FEEd Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Lo C 0 0 I (L'- PERMIT# 1`'t 0 OWNER'S NAME: PHONE# Z GENERAL CONTRACTOR: ets BUSINESS LICENSE# ADDRESS: y< < �� 8L_ , .t.-. CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC NTRA ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. !�7 Z71 o I am not using any subcontractors: ture Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting Linoleuri /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering or Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 073trry Mir for Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Lis (408)777-3228 • FAX(408)777-3333•buildingLa?cupertino.org MISC CUPERTINO /) PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS f% APN 4 /Y,\Orhowp, PI OWNERNANIEAk Be, STREETADDRESS CITY ,TATE. !(�s. oc / FAX Lc f' CONTACT NAME J C r ` 1 t ta. tJ P / /50- r � STREET S I\1�Vi, 1 C �( l' CIT STATE. ZIP �. /� - FAX /t./ {< A �7 � c- l� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 1-16-nNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA E j��i �� LICENSE LICEN E BUS.LIC s ((� 7 1 ' COMPANY N EMAIL FAX S ET ' ✓GIM J c: rP HO/-f O ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC g., COMPANY NAME E-NIAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'JSE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ CommercialURBAN INTERFACE AREA ElYes C1No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK / L j r % - i f TOTAL VALUATION: RECENED BY By my signature below,I certify to each of the foll7ing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is,orre_t. ave rid the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin stru I nze representatives of Cupertino to enter the above-identified pro erty for inspection purposes. Signature of Applicant/Agent: Date: 'V SUPPLEMt7AL-MFORMATIONREQUIRED re _ Mpm r - MEPMiscApp_101 Ldoc revised 03/16/11