11100093 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10842 E ESTATES DR CONTRACTOR:TATS INC DBA MR PERMIT NO: 11100093
ROOTER PLUMBING
OWNER'S NAME: SINGH YOGENDRA AND ANURADHA 44777 S GRIMMER BLVD STE C DATE ISSUED: 10/13/2011
ER'S PHONE: 4084802258 FREMONT,CA 94538 PHONE NO:(408)271-2822
❑ LICENSED CONTRACTOR'S DE^C�LARATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB�
License Class �
Lic.#
� MECH RESIDENTIAL COMMERCIAL r
Contractor �AG 1M c o t d N Date Iti I I I
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LINE AND PROPERTLY LINE
(commencing with Section 7000)of Division 3 of the Business&Professions CLEANOUT
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$5000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36922006.00 Oc pa
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
to building construction,and hereby authorize reVeesenta ive(We)agree to saver PERMIT EXPIRES IF VOORK IS NOT STARTED
upon the above mentioned property for inspect'
indemnify and keep harmless the ' of Cup iho against liabilities,judgments, WITHIN 180 DAYS PERMIT ISSUANCE OR
costs,and expenses which may c e again s id City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Add on y,the I' ant understands and will comply
with all non-point source gula ons er rtino Municipal Code,Section
9.18. -- jj Issued by: Date:
Signature Date
L OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
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 have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cu tino Mu ipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 2 32(a)sh I store or handle hazardous material.
Additionally,should use equi t or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as de red by t B y Area Air Quality Management District I will
permit is issued. maintain co is ce with th C pertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health& ety ode,Sec' , 2550.5,25533,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,I wn or anth riz agent Date: Y ��
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.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
-nnify and keep harmless the City of Cupertino against liabilities,judgments,
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.
Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36922006 . 00
DATE ISSUED. . . . . . . : 10/13/2011
RECEIPT #. . . . . . . . . BS000015035
REFERENCE ID # . . . : 11100093
SITE ADDRESS 10842 E ESTATES DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SINGH YOGENDRA AND ANURADHA
ADDRESS 10842 E ESTATES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM ADAM COLON
CONTRACTOR . . . . . . . : TATS INC LIC # 23496
COMPANY . . . . . . . . . . : TATS INC DBA MR ROOTER PLUMBIN
ADDRESS 44777 S GRIMMER BLVD STE C
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE (408) 271-2822
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---
-ADMIN HOURS 1. 00 41. 00 0 . 00 41 . 00 0. 00
1BCBSC VALUATION 5, 000 .00 1. 00 0 .00 1.00 0 .00
1BSEISMICR VALUATION 5, 000 .00 0 . 50 0 . 00 0 .50 0. 00
1PPERMITFE FLAT RATE 1.00 44 . 00 0 . 00 44 .00 0 . 00
1PRSEWER UNITS 1.00 22 . 00 0. 00 22 . 00 0. 00
1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 152 .50 0 . 00 152 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 152 .50 VISA
---------------
TOTAL RECEIPT 152 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
// C)ov ? �
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
LM (408)777-3228- FAX(408)777-3333- building(acupertino.org MISC
CUPERTINO
VIPLUNMING"""��' ` ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS
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❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /s � �,^ LICENSE NUMBER LI SE E. BUS.LIC#
COMPANY NAME E ((�
STREETADDRESS _ (1 STA ZIP J HONE�}
ARCF[ITECTIENGINEER NAME ` LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
JSE OF BfFD or DUPLEX ❑ MULTI-FAMILY I PROIECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
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TOTAL VALUATION: RECEIVED BY.
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By my signature be#,I certify to each of the follo : IarntheOP er or authorized agent to act on the prop owner's bekf. I have read this
application and the i ormation I have provide the cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws f Cupertino to enter the above-identified property or inspection pu(poses.
by 111
Signature of Applicant/Agent' Date'
PLEMENTAL INFORMATION REQUIRED OFFICE E ONLY
❑ OVER-THE-COUNTER
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AEPMucApp_2011.doc revised 06121111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
'.U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (0V7, ' PERMIT#
OWNER'S NAME: (} PHONE#
GENERAL CONTRACTOR BUSINESS LICENSE#
ADDRESS: h LA11 S rt, M l ,�. CITY/ZIPCODE: � -15' 3
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY PECTIO , ILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL AC TAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractor
Signature Dat
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS 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