The URL can be used to link to this page

10040113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10641 CARVER DR CONTRACTOR:ROOTERS ON DEMAND PERMIT NO: 10040113 OWNER'S NAME: LUCIA MADRID 32940 LAKE MEAD DR DATE ISSUED:04/19/2010 NER'S PHONE: FREMONT,CA 94555 PHONE NO:(510)475-8271 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB License ClassG^316 Lic.# "' v MECH r— RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:INSTALL SEWER LINE I hereby affirm that I am licensed under the provisions of Chapter 9 114 (commencing with Section 7000)of Division 3 of the Business&Professions ° Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: F 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 Floca: Valuation:$5600 1 have and will maintain Worker's Compensation Insurance,as provided for by k1 Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type: permit is issued. APN Numb 3 48.00 Panc Y Yp _APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city 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 Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue ainst said City in consequence of the granting of this permi ' A;re rtheCupertino derstands and will comply with all non-point souk MunicipalCode,Section Issued by: Date: 9.18. S� Date RE-ROOFS: LI OWNER-B LDE 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 here a arm that I am exempt rom the Contractor's License Law for one of inspection. the f to ng two reasons: 1,as er of the properly,or my employees with wages as their sole compensation, Signature of Applicant: Date: will f9oh work,and the structure is not intended or ot1'ered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to 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 Section 3700 of the Labor Code,for the performance of the work for which this contaminants ldefined b the Bay Area Air Quality Management District I will maintain compianc 't t�e Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safe C de, ctions 25505,25533,and 2553 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 iz a �t: 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. C STRUCTION LENDIN AZEISCY I h eby ffirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for w ' h this permit is issued(Sec.3097,Civ C.) I certify that I have read this application state that the above information is Len er's Name correct.I agree to comply with all city a d ounty ordinances and state laws relating to building construction4onally, aut ori a representatives of this city to enter Lender's Address upon the above mentionfor nsp ction purposes.(We)agree to save unify and keep harf C pertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses whie aga' st said City in consequen e of the granting of this pe t. , a plicant understands and illcomly I understand my plans shall be used as public records. with all non-point our a the Cupertino Municipal C de,Se ion 9.18. ,, / Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37534048 . 00 DATE ISSUED. . . . . . . : 04/19/2010 RECEIPT # . . . . . . . . . BS000010217 REFERENCE ID # 10040113 SITE ADDRESS 10641 CARVER DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LUCIA MADRID ADDRESS . . . . . . . . . . : 10641 CARVER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM RANDY MARQUEZ CONTRACTOR ARA AZIZIAN LIC # 30848 COMPANY ROOTERS ON DEMAND ADDRESS 32940 LAKE MEAD DR CITY/STATE/ZIP . . . : FREMONT, CA 94555 TELEPHONE (510) 475-8271 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ------ 1BCBSC VALUATION 5, 600 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 600 . 00 0 . 60 0 .00 0 . 60 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0. 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PRSEWER UNITS 1 . 00 21. 00 0 .00 21 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 -----42 . 00 ------0. 00 ---------- ---------- TOTAL PERMIT 220 .60 0 . 00 220 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 220 . 60 MC --------------- TOTAL RECEIPT 220 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO a-7 REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # 6 q(^, I Date: Building Address/o l C Owner's Name- Phone#: �� 75 /-J C I Z---il 0 S� )- - Contractor: Phone#: Cl / C Fax#: Ac/Contact: Phone Fax#: Contractor License#: C? Z G 1-1-61 Cupertino Business License#: Job Description: OF Residential Commercial ❑ Valuation: Project Size: Express Standard 0 Large M 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 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group / 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P I 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C � PERMIT# D OWNER'S NAME: Cf PHONE# GENERAL CONTRACTOR: Pc 7113USINESS LICENSE# ADDRESS: Z L / (JLg CITY/ZIPCODE: *Our municipal code requires all businesses worin the ' to have a City of Cupertino business license. NO BUILDING FINAL OR FINALOCCUP CY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S $ NTRACTORS HAVE OBTAINED A CITY O CUPER IN BUSINESS LICENSE. L / - ? I am not using any subcontrac o "� (� Signature ate Please check applicable subcontrac o s and c lete the following information: SUBCONTRACTOR BUSINESS NAME USINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date