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14020038 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7911 OCTOBER WAY CONTRACTOR:TATS INC DBA MR PERMIT NO: 14020038 ROOTER PLUMBING OWNER'S NAME: DAO-CHEN ZHENG 1260 YARD CT DATE ISSUED:02/06/2014 OWNER'S PHONE: 4084606186 SAN JOSE,CA 95133 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] �r^� REPLACE(E)SEWER LINE FROM FOUNDATION TO(E) License Class Lic.# Vl PROPERTY LINE CLEANOUT.INSTALL(N)FOUNDATION CLEANOUT Contractor '\ • ` Date 44 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. 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:$8500 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:36212024 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 WITBIN 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 M LAS CALLED IN SPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,an4eme, may acc e a ainst said City in consequence of the Issued by: Date: �granting Additio e a plicant understands and will complywith all nreg do s pe a Cupertino Municipal ode, ection 9 18. RE-ROOFS: SignaturDate 7 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. ❑ 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 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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municip I Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should tore or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipm or devices w hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay A a it QManageme District I performance of the work for which this permit is issued. will maintain compliance with the Cup ti o , er 9.12 nd I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' ,255 ,a 2 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate: 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 CONSTRUCTION LENDING AGENCY 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 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 918. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255(408) 777-3228•FAX(408)777-3333•buildino(a)cuoertino.orgVd. %J MIC PLUMBING ❑MBCHAZ\TICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS CT( \ S0 APN# OWT�ERNAME 'Dp� 2 � - VIJ�' EMAIL STREET ADDRESS l rl n r III 1l Cre, �j_`` „\ C V4- I FAX CONTACT NAME n,^ Gn^ .( 1^ {!1 /L,(� E-MAIL STREET ADDRESS �r/ V. \ t ^ C�yATE ZIP f FAX DOWNER ❑ oAIM-BTADEEL ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO BUS.LIC# COMPANY NAME T� 7 1 /T`TS E-MAIL u(Q / FAX STREET ADDRESS / ` CITY,STA PHONE Cd'© AF-CB=/ENGINEER NAME l- LICENSE NUNMER BUS.LIC;9 c� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF El SFD or DUPLEX ❑ MULTI-FAMjLy PROJECT IN WII DLAM E] YES TPROJECT IN YES IS THE BLDG AN El YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONEI ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK Gi v��. .�C�L�� f, 1�� /� ` Q Gleams Axgo-a Ys� ai wr TOTAL VALUATION: vF x�. w-._ 'r -e .,.......� 'Pw5✓i'=-het. _z': By my signature below,I certify to each of following: I am the property owner or authorized _ ct on e property owner's behalf. I have read this application and the information I have pr ed is correct. I have read the D can verify it is accurate. I agree compl writh all applicable local ordinances and state laws relat g to b In repre 4 ve upertino to enter the abgtc�glentifi �pFepe f ection purposes. Signature of Applicant/ g Date: /, SUPPLEMENTAL INFORMATION REQUIREDV GFcE�JsonP WimKAM ,_ T _ a� BE cGua. R_x QR-r',- MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION IF2TAPN: DDRESS: 7911 OCTOBER WAY DATE: 02/05/2014 REVIEWED BY: MELISSA 362 12 024 1. BP#: *VALUATION: $8,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair. PRIMARY . SFD or Du lex PENTAMATION USE: p PERMIT TYPE: 1 RPS WORK REPLACE E SEWER LINE FROM FOUNDATION TOE PROPERTY LINE CLEANOUT. INSTALL SCOPE (N) FOUNDATION CLEANOUT APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: $24.00 1 <:r. P;<tr U!"", Plumb.Plan Check 0.0 hrs $0.00 /fe{-. P/0, 7 Ch,c1c 14'ecr'r. Pc>rwil Fee: Plumb.Permit Fee: IPPERMIT F:ILc. Pt'rmil i e, --tC?t7;er:11ccs�i. Ir; z 3. Other Plumb Insp. 0.0 hrs $47.00 oilier E'i<�c.1Nsp, is/E cr. trz t. i as: Plumb h,,p. Fee: 1 ler.rias', NOTE: This estimate does not include fees due to other Departments(i.e.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 Dept./or addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS a, Srr1,'�`L PC F' "c- PME Plan Check: $0.00 jv'v) Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 f�l'CPttL'£'G'it/"iL3Y)J1tYt£r�`e'eS': Travel Documentation Fee: 1TRAVDOC $47.00 A Strong Motion Fee: 1BSEISMICR $0.85 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.00 $163.85 $0.00 TOTAL FEE: $163.85 1- 1 .; Revised: 01/15/2014