151101781-
= CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10345 WUNDERLICH DR
CONTRACTOR: TATS INC DBA MR
PERMIT NO: 15110178
ROOTER PLUMBING
OWNER'S NAME: MICHAEL CARSON f
2827 AIELLO DR
DATE ISSUED: 11/24/2015
OWNER'S PHONE: 4082523221
SAN JOSE, CA 95111
PHONE NO: (408) 227-1630
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
/nREPLACE
r� l �� �
(E) SEWER LINE FROM FOUNDATION TO
License.Cl' Lic.41 V
PROPERTY
Contracto� � '� Dan1 Z q ) ,j
r �� �� ' .I �� l
LINE & INSTALL 2 CLEANOUTS
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.
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I hereby affirm under penalty of perjury one of the following rivo declarations:
for Worker's
I
I have and.will maintain a certificate of consent to self-insure
�.i
Compensation, as provided for by Section 3700 of the Labor Code, for the
cif, rmance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $8000
d < ve and;will maintain. Worker's Compensation Insurance, as provided for by
APN Number: 37516024.00
Occupancy Type:
eetion 3700 of the Labor Code, for the performance of the work for which this
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
WITIIIN 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
t/
a by: Da
granting of this permit. Additionally, the applicant understands and will comp y
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
being installed. if a roof is
9.18.
11 LI I
Signature Date
All roofs shall be inspected prior to any roofing material
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
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the'property, or my employees with wages as their sole compensation,
will do the w6rk, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, 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: '' I I
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should 1 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 Municipal Code, Chapter 9.12 and
I have andiwill maintain Worker's Compensation Insurance, as provided for by
Section 3700 the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 255 and 25534.
,of
Owner or authorized agent: Date:
04&
permit is issued. , . 1. , .
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 t ' 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
indemnify and keep'harmless the City of Cupertino against liabilities, judgments,
costs, 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
GENERAL PERMIT APPLICATIONMEP
COMMUNI IY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTIN O (408) 777-3228 • FAX (408) 777-3333 • build inO(a)cuoertino.org
�PLUA,�ING MECHANICAL I (ELECTRICAL hii1SCELLANFEOi1S
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LICENSE TYPE
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USE OF ❑ SFD.. DUPLL. ❑ 1✓mui-F.4j G=Y I . PROJECT IN wILDLAND ❑ YES
PROTcCT LN ❑ YES
IS T=- - BLDG AN ❑ ' _S
BiTLT NG:❑C01,DE-:RCLAI. URBAXT12NTERFaCEAP.EA ❑ NO
FLOOD ZONE El}v0
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DESCPJPTION OF WORK � 1 � V� 1 C/ `'e
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service
TOTAL Vt_I.UATI ON: • tmv
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By my signature below, I ce tti y to each of the follovring: Iain
the property owner or authorizejtg-ent to act o roperty owner's be ha r I hav this
application and the Lnfornation I have provided is correct. I
have read the Description of'Work and ver' accurate. I 2gree to comply Zvi h applicable local
c:cl-ances and state laNi s relat� building construction. I authorize representatives of Cupert'
Lo enter the above-iidentified property for inspec`' urposeS.
Si�ature of �,pplicant/Agent.
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Date: G
S P_ _2EINIT tORMIATIONRELp.EDU
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M'EPlfisC.4pp_2011.doe remised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Afech. P/ran Check
ADDRESS: 10345 wunderlich dr
DATE: 11/24/2015
REVIEWED BY: melissa
Plumb. Permit Fee: IPPERMIT
APN: 375 16 024
BP#:
*VALUATION:
1$8,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1 RPSS
PERMIT TYPE:
WORK
REPLACE E SEWER LINE FROM FOUNDATION TO PROPERTY LINE & INSTALL 2 CLEANOUTS
SCOPE
Afech. P/ran Check
Plumb. Plan Check 10.0 1 hrs $0.00
Dec. i'lan Check
�teclr..l'er,a�ia.I F;e:
Plumb. Permit Fee: IPPERMIT
1._'lec, 1'erltdf Fee:
Other Plumb Insp. 0.0 hrs $48.00
C3:'rc r 1"Iec.
9%r.'f?. Ins}?, 11?t-:
1'171P1tZi..l}t:�). i :'£'.;
l le'C:. liiijl.
NOTE: This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Eff. Z/LQ
FEE
QTY/FEE
MISC ITEMS
Plan ("heck I" iee:
Supy)L PC .Fee
PME Plan Check:
$0.00
Perinif I.ee.
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
c[?ns!? Uc:fion l irx:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Plannin,�I -Yees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:. IBSEISMICR
$1.04
Select an Administrative Item
Bldjz'Stds Commission Fee: IBCBSC
$1.00
r SUBTOTALS
$168.04
$0.00 TOTAL FEE
$168.04
Revised: 10/01/2015