13100177CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10405 STERN AVE
CONTRACTOR: TATS INC DBA MR PERMIT NO: 13100177
ROOTER PLUMBING
OWNER'S NAME: MARIANO CASTILLO
1260 YARD CT DATE ISSUED: 10/28/2013
SAN JOSE, CA 95133 PHONE NO: (408)271-2822
OWNER'S PHONE: 4088024205
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
(a (O ��
_J Lia #
INSTALL 30' TRENCHLESS 4" SEWER LINE & REPLACE
L NOUTS
License Class (�
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Contractor I� 0 �L° Date i o - � v ✓
BOTH FOUNDATI T
I hereby affirm that I am licensed under the provisions of Chapter 9
bA,,NITP
(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:
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
Sq. Ft Floor Area: Valuation: $8000
performance of the work for which this permit is issued.
L ► / 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: 37510058.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
information is
PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above
I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 F PERMIT ISSUANCE OR
correct.
to building construction, and hereby authorize representatives of this city to enter
180 FRO ALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
�v Ze/-7
costs, and expenses which may accrue against said City in consequence of the
sued b Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. _ '
Date 0 l
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
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 & Professions Code)
HAZARDOUS MATERIALS DISCLOSURE
1, as owner of the property, am exclusively contracting with licensed contractors to
the (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
1
construct project
California Health & Safety Code, Sections 25505, 25533, and 25534. will
the Cupertino Municipal Code, Chapter 9.12 and the
I hereby affirm under penalty of perjury one of the following three
maintain compliance with
Health & Safety Code, Section 25532(a) should I store or handle hazardous
declarations:
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
by the Bay Area Air Quality Management District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
the Health & Safety Code, Sections 25505, 5533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
for this
Q
"" Date: O ;Z
Section 3700 of the Labor Code, for the performance of the work which
Owner or authorized agent:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
el
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
Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of
C.)
become subject to the Worker's
or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ
forthwith comply with such provisions
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
county ordinances and state laws relating
correct. I agree to comply with all city and
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
may accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs, and expenses which
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
CUPERTINO
GENERAL PERMIT APPLICATION �9
MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \� misc
(408) 777-3228 • FAX (408) 777-3333 • building a0cupertino.org M
,PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADD" c tr
APN # � �
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OWNERNAME OAsTk
PHONE
E-MAIL
STREET ADDRESS r ,
C Y, STATE, ZIP AFAX
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CONTACT NAME
f'�
PHONE
-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT .0 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME '
LICENSE NUMBER O I l _
LICTE TYP
BUS. LIC #
G �j `f
COMPANY NAME r �l�T�
E-MAIL
FAX
STREET ADDRESS` �r
C qY, STATE, ZIP
[
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PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WIIALAND ❑ YES
PROJECT IN
❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE
❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK '
L
TOTAL VALUATION:�. /RECE
01
By my signature below, I certify to each of the following: I am the property owner or authorized o'on th
rop o is behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate gree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-
identified property for inspection purposes.
Date: ��'1`�✓(
Signature of ApplicandAgent.
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10405 STERN AVE
DATE: 10/28/2013
REVIEWED BY: MELISSA
UNITS
APN: 37510 058
BP#:
"VALUATION:
1$8,000
*PERMIT TYPE: Plumbing Permit
1
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
Permit Fec
PENTAMATION 1 RPSS
PERMIT TYPE:
USE:
WORK
INSTALL 30' TRENCHLESS 4" SEWER LINE & REPLACE BOTH FOUNDATION & PROPERTY LINE
SCOPE
CLEANOUTS
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 hrs $0.00
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
1 /w, Vic c. h,y'
:,i""
1
#
$24
Permit Fec
Supp/. 111sp 1 ce
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
('o11Srr11c1i0r7 TIX.
Administrative Fee: (ADMIN
$44.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRAVDOC
$24.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, fire, Sant[ury Sewer . Llfvv&
IL I. ormation available and are onl an estimate. Contact the De t or addn'1 in o.
Dtstrtet, etc . These ees are based
on t e re tmtna
FEE ITEMS (Fee Resolution 11-053 E{f 7.%1113)
to
FEE
Plumb. Plan Check 0.0 hrs $0.00
MISC ITEMS
Plan Chcrc./,: Fc c:
Plumb. Permit Fee: IPPERMIT
0"Ji r alep h. Insp.
Other Plumb Insp. 0.0 hrs L$47.00
1 /w, Vic c. h,y'
:,i""
11"(h In yj VC0
P?rrnt?, trup. Feed
� laze
Permit Fec
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, fire, Sant[ury Sewer . Llfvv&
IL I. ormation available and are onl an estimate. Contact the De t or addn'1 in o.
Dtstrtet, etc . These ees are based
on t e re tmtna
FEE ITEMS (Fee Resolution 11-053 E{f 7.%1113)
to
FEE
QTY/1
MISC ITEMS
Plan Chcrc./,: Fc c:
Srppl. PC1�'Ce
PME Plan Check:
$0.00
Permit Fec
Supp/. 111sp 1 ce
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
('o11Srr11c1i0r7 TIX.
Administrative Fee: (ADMIN
$44.00
Work Without Permit? 0 Yes (F) No
$0.00
�Idva71ccd Plur1111rtg Fees:
A
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$163.801
$0.00 TOTAL FEE:'
$163.80
Revised: 10/01/2013