13050056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10320 S TANTAU AVE CONTRACTOR:TATS INC DBA MR PERMIT NO:13050056
ROOTER PLUMBING
OWNER'S NAME: CARL BUCK TRUST 1260 YARD CT DATE ISSUED:05/07/2013
OWNER'S PHONE: 4083342220 SAN JOSE,CA 95133 PHONE NO:(408)271-2822
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCI4,1,0
License Class Lie.# (J�D ,�P2S REPLACE(E) R E INSTALL(N)PROPERTY
LINE
Contractor rn/ ot Date 5- CLEANOUT
I hereby affirm that I am licensed under the provisions o Ch ter 9 mft%�
(commencing with Section 7000)of Division 3 of the Business&Professions N TA
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. Sq.Ft Floor Area: Valuation:$12000
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:37508036.00 Occupancy Type:
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 WITHIN 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 LA INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which :clue against said ity in consequence of theLl
granting of this permit. diti nally,the appli t derstands and will comply sa ued
with all non-point sour reg ations per the 9fiperdno Municipal Code,Section
9.18.
RE-ROOFS:
SignatureA/AwDate -:' 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
inspection.
❑ O ER-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
I,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)
I,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. 1 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: Health&Safety Code,Section 25532(a)should I store or handle hazardous
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
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay ea Air Q Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cu rt a Mu cip Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 505 2553/,an 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued.
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to 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 APPLICATION
1P. MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O
(408)777-3228•FAX(408)777-3333•building(ftupertino.orp ! MSC.'
cup"1E:RT',IIN
ING' : ❑/MECHANICAL ❑ELECTRICAL ❑MISCE�L�LANEOUS
PROJECT ADDRES Is / J V� APN# n
OWIVERNAME " j// `VGA PHONE
STREET ADDRESS Jr 3 'Y' 6t-✓��I�.dJ'✓� TATE,ZIP �D �}/ FAX
CONTACT NAME',I i PHONE E-MAIL X127g
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER - OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT _
C O LICENSE NUMBER& 9 C�Zs LIC S SYpE BUS.LIC#
COMPANY NAME /__ E MAH, v (� FAX
STREET ADDRESS STATE, IP PHONE
ARCHITECTIENGINEER;NWE LICENSE NUMBER BUS.LIC#
COMPANY AIAM I l l s E-MAILFAX
STREET ADDRESS• : CITY,STATE,ZIP PHONE .
USE OF 1.❑SIb o[DUPLEX ❑+MULTI-FAMILY PROJECT IN wiLDLAND ❑ YES PROTECT IN ❑YES 15 THE BLDG AN ❑.YES
BUII`.DING i ❑COMMIItCLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
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DFSCRIPTIONp1NOI , I
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By imy signature'Ie�ow II certify tojeach of llowing: the property owner or authorized agent to act on the property owner's behalf. I have read this
apglicahotT and the iitQormahon I have pro ded! s come I h e read the Description of Work and verify it is accurate. lar t com with ail.applicable lci '
ordinances and date laws;Felating,to butC truct n. uthorize representatives of Cupertino to enter the above-identifie ro for inspection purposes.
Signature of Ap)libant/Agent I.' 'i r. !: Date:
oll ,II SUPP NTAL INFORMATION REQUIRED
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10320 S TANTAU AVE DATE: 05/07/2013 REVIEWED BY: MELISSA
APN: 375 08 036 BP#: *VALUATION: 1$12,000
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPS
WORK REPLACE E SEWER LINE & INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $23
Sewer, Building 1PRSEWER 1 # $23
TOTALS:
$46.00 11"
= RM ,. � f
l fech.Ilan Check Plumb.Plan Check 0.0 hrs $0.00 131ec..P1an Check
:Lfer.A 1'erwit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit(ee:
Other A ech.Insp. Other Plumb Insp. 1 0.0 hrs $45.00 Offier Elec.Insp.
ELLA
_9(ech.Insp. Fee: Plunib. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees 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 .
E 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
supp1. .Insp Fee
PME Unit Fee:- $46.00
PME Permit Fee: J7 $45.00
Constr-uction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00 A
Strong Motion,Fee: IBSEISMICR $1.20 Select an Administrative Item
Bldg,Stds Commission Fee: IBCBSC $1.00
$180.20 $0.00 '; $180.20
Revised: 04/29/2013