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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 A EG APN#OWNER NAME ; i �, / O STREET ADDRESS C CITY, STATE I rre_ FAX CONTACT NAME PHONE 3�S E-MAII STREETADDRESSLj(A ZIP %-jS FAX rrr� c G�Od J C� ❑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 CKLE C S - TOTAL VALUATION: RECEIVED BY. IL 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 a ❑ EXPRESS Y U w ❑ STANDARD T U ❑ LARGE a ❑ MAJOR 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