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10050086 CITY OF CUPERTINO BUILDING PERMIT PERMIT NO: 10050086 BUILDING ADDRESS: 21820 OAKVIEW LN CONTRACTOR:ABLE SEPTIC DATE ISSUED:05/10/2010 P O BOX 24819 PHONE NO:(408)377-9990 DWNER'S NAME' CHRIS TSAN SAN JOSE,CA 95154 1ER'1.S PHONE: 4084315172 ELECT PLUMB BUILD NG PERMIT INFO: BLDG LICENSED CONTRACTOR'S DECLARATION COMMERCIAL License Class Lic.# �77 1/ 1 � MECH� RESIDENTIAL j{ G Date -. � / b Contractor f��'L — JOB D ASCRIPTION:SEPTIC TANK ABATEMENT WITH SANITARY SEW ER I hereby affirm that I am licensed under the provisions of Chapter HOOKIP (commencing with Sectio n s m full force and effectthe Business&Professions Code and that my 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 Valuation:$5100 performance of the work for which this permit is issued. e,as provided for by Sq.Ft Floor Area: I have and will maintain Worker's compensationperformance of the work for which this Section 3700 of the Labor Code,for the p Occupancy Type' permit is issued. APN Plumber:32619110.00 APPLICANT CERTIFICATION I certify that I have read this application anation is d state toadin nce°ands ate laws relating esentatives of this cp E I,I, EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and herebyauthorize inspection purposes. (We)agree to saveity to r upon the above mentioned property P 80 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertinoagainst it i in tclonsequence of the judgments, costs,and expenses which may accrue against cant understands and will comply granting of this permit. Additionally,the app Date: with all non-point source regulations per the Cupertino Municipal Code,Section Issu:d by: 9.18. S.j0, ;a -- ��.•� Date Signature RE_ROOFS' OWNER-BUILDER DECLARATION All oofs shall be inspected prior to any roofing material being installed.If a roof is lJ instilled 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 n insl ection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, g Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Si iature of App BE CLASS"A"OR BETTER Business&Professions Code) ALL ROOF COVERINGS TO 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: Code,Sections 25505,25533,and 25534. I will maintain rtificate of Consent to self-insure for Worker's I I�forn a Health&Safety materials requirements hadter 9 12 and the Health& I have and will maintain a Ce C Compensation,as provided for by Section 37it of the Labor Code,for the cc mplian d with the Cupertinoshould Istore orehand a hazardous material. provided for by S dety Code,Section 25532(a) performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air c►ntaminants as defined by the Bay Area Air Quality Management District I will 1 have and will maintain Worker's Compensation Insurance,as p Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cup permit is issued. I[ealth&Safety Code,Sections 25505,25533,and 25534. [certify that in the performance of the work for which this permit is issued,I shall agent* 57- /0- / V not employ any person in any manner so as to become subject athe Worker's 0 r autho ' g DDate,---- 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. KATION [hereby affirm that there esued(Sec 30io Civ lending agency for the performance of work's APPLICANT CERTIF for which th p 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 Lender's Name purposes.(We)agree to save Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property forof Cu inspectioncertmo against liabilities,judgments, -unify and keep harmless the City P m consequence of the ARCHITECT'S DECLARATION and expenses which may accrue e against City understands and will comply laps shall be used as public records. granting of this permit.Additionally,the appI understand my with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Date— / Signature CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE CI,_TY Of PERMIT APPLICATION FORM CUPETINO Date: 10-147 APN Building Address: Phone#: Owner's Name: S-/7 +' S Phone .9-142 Contractor: Fax#: b lt P� L Phone#: q11 7Y Z7 Contact: C'114-L Fax#: Contractor License#: e , yL Cu ertino Business License* 4 �� r fzeG�C r Job Description: 5: , C J Ccmmercial ❑ Residential Valuation: d Project Size: Express Standard, Major Large uildin : Please compLJ lete relevant portion of the Green Building Checklist & attach it to the Green B g application or if applicable, include in plan set& the sheet index. Green Buildin Points: Fee Description Fee Permit Type Quantity Fee ID Grou 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1CPRP 1 BPREPIPE Commercial re-pipe per fixture P 1PGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT 1BCBSC Cal Bldg Standards Commission TYPES Fee P 1BSEISMICOM Seismic Commer,ial Revised 01/07/09 CITY OF CU P ERTINO REPIPE/SEWER/MAIN SERVICE CITY O# FEE SCHEDULE CUPEIZTINO Quantity Fee ID Fee Description Fee Permit Type Grou 1BCBSC Cal Bldg Standards Commission B ALL Fee TYPES J =BSEISMICRSeismic Residential P 1 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer IPRREPIPE Residential re-pipe pe: fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pile P 1BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5-r- Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas ::nsp. P 1TRAVDOC Travel & Documentz.tion Fee B 1BUSLIC Business License B CITY OF CUPERTINO BU'LDING PERMIT BUILDING ADDRESS: 10228 PALO VISTA RD CONTRL►CTOR:TBD-TO BE DETERMINED PERMIT NO: 10050184 DATE ISSUED:05/25/2010 OWNER'S NAME: CHARLES&TERRI YAGER PHONE NO: (, BR'S PHONE: 4082526626 ' PLUMB r LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r License Class /� Lie.# MECH I- RESIDENTIAL f- COMMERCIAL r ^/.._. �� (n k ��1 Date d 10 Contractor Z JOB D&SCRIPTION:KITCHEN(160SQ),NON-STRUCTURAL REMODELING AND � I hereby affirm that I am licensed under the provisions of Chapter 9 INSTAL-7 CAN LIGHT IN LIVING ROOM (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 performance of the work for which this permit is issued. y S Ft]loor Area: Valuation:$37000 1 have and will maintain Worker's Compensation Insurance,as provided for b q. Section 3700 of the Labor Code,for the perfonnance of the work for which this Occupancy Type: permit is issued. APN Number:35702060.00 APPLICANT CERTIFICATION 1 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 p city P'�RMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of thus ci to enter WITHIN 180 DAYS OF PERMIT' ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 130 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this pen-nit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issue I b Date: 9.18. Signature /1 Date D 2 2'� RE-ROOFS: ❑ OWNER BUILDER DECLARATION All ro afs shall be inspected prior to any roofing material being installed.If a roof is instal ed 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 the following two reasons: inspe;tion. I,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signz ture of Applicant: Business&Professions Code) 1,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 ha-le read the hazardous 5 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Cali Forma Health&Safety Code,Sections 25505,2553,and 25534 .pter 9 I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the com?fiance 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 Add itionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this coni aminants as defined by the Bay Area Air Quality Management District I will permit is issued. mai atain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall Hea lth&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 Ow tier or authorized agent: In o Date: `9— 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 APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec. , iv C.) 3097C correct.I agree to comply with all city and county ordinances and state laws relating Le ider's Name to building construction,and hereby authorize representatives of this city to enteL Le ider's Address up--the above mentioned property for inspection purposes.(We)agree to save i dfy and keep harmless the City of Cupertino against liabilities,judgments, c::. ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. L%'` Li:ensed Professional , Signature Date f