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11010001 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1502 POPPY WAY CONTRACTOR:TATS INC DBA MR PERMIT NO: 11010001 ROOTER PLUMBING OWNER'S NAME: HUNTS JAMES L AND COLLEEN A 44777 S GRIMMER BLVD STE C DATE ISSUED:01/03/2011 ( M'S PHONE: 4082524007 FREMONT,CA 94538 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB License Class e 36 Lic.# 96 7n�� MECH r— RESIDENTIAL F COMMERCIAL Contractor� /)'_ Dated—fd-�� I hereby affirm thla�t-I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LINE,ADD PROPERTY LINE CLEANOUT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: _A 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: al 4000 I have and will maintain Worker's Compensation Insurance, Einormation d for by 3 Section 3700 of the Labor Code,for the performance of the whic this permit is issued. APN Number:36610114.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the abois correct.I agree to comply with all city and county ordinances and state laws relating PERMIT.�" F WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN $ lA OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-po' source regul ons per the Cupertino Municipal Code,Section Issued b ' �� Date: — 9.18. Signature Dat /�v3i! RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Scontaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compli nce with he Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safe ctions 25505,25533,and 25534. 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 Worker's Owner or nt: Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith 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 work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 1502 poppy way DATE: 01/03/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: $6,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PENTAMATION 1 RPSS PRIMARY SFD or Duplex I OC.`II_ USE: p f'LC)t1I�.�f fcE PERMIT TYPE: WORK replace sewer line add property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 Vfc h_ h,:f k Plumb.Plan Check 0.0 hrs $0.00 Vfcch' Plumb.Permit Fee: IPPERMIT L Other Plumb Insp. 0.0 hrs $42.00 Orh f 1�f<°c. Imp,1 Li r{? In"p. NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (&e Resolution 09-05I Ef. T"l!10j FEE QTY/FEE MISC ITEMS Man Cllec:k .>lfpp/. 1'C..'F'cle PME Plan Check: $0.00 Permit Fee: Sld/)/)/. /11sp Fee PME Unit Fee: $21.00 PME Permit Fee: $42.00 ("01zstFalciiorz 1,CL "Icouslical f cvleiv f-'ec. Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:' $106.60 $0.00 TOTAL FEE: 1 $106.60 Revised: 12/07/2010 CITY OF CITY OF CUPERTINO / REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# Date: -- !3 ". 1(3 0/ 70 3 Building Address- /60 ddress:/5 Oa pig 1,-VAy Owner's Name: Phone#: Contractor; /A/� / Phone #: Sod �/� Fax#: Contact: Phone#: / 0 7190—7 3 rgxmr(( 6Fax/e-mail: Contractor License#: ;�r �� Jr Cupertino Business License#: Job Description: 452 a .e lL,Vcc) Residential [[� Commercial ❑ Valuation: � / 06 Project Size: Counter Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity , Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 11CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1 CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10