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11040138 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18624 LOREE AVE CONTRACTOR:TATS INC DBA MR PERMIT NO: 11040138 ROOTER PLUMBING OWNER'S NAME: JAIGAK SONG 44777 S GRIMMER BLVD STE C DATE ISSUED:04/19/2011 ER'S PHONE: 6502838069 FREMONT,CA 94538 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# n V� & 2 f MECH r RESIDENTIAL r COMMERCIAL Contractor Date !�Y � l JOB DESCRIPTION:REPLACE BUILDING SEWER ADD PROPERTY LINE I hereby affirm that I am licensed under the provisions of Chapter 9 CLEAN OUT (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$6000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:375 07 0 Occupancy Type: 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 representatives of this city to enter PERMIT EXPIRESIF ARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF P U r OR costs,and expenses which may accrue against said Ci in consequence of the 180 DAYS FROM LAST CALL DQ : granting of this permit. Additionally,the applican n erstands and will comply with all non-pour urce regulations per the Cu rt' o Municipal Code,Section / 9.18. / Issued 15y:-- Signature b'-v--- E 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. 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, 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 I 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. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. 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 as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino 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&Safety Code,Sections 25505,25533,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 Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 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 mrk'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 -unify 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 37525072. 00 DATE ISSUED. . . . . . . : 04/19/2011 RECEIPT #. . . . . . . . . : BS000013227 REFERENCE ID # . . . : 11040138 SITE ADDRESS . . . . . : 18624 LOREE AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JAIGAK SONG ADDRESS 18624 LOREE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAIGAK SONG 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 0 .50 39.00 0. 00 39.00 0.00 1BCBSC VALUATION 6, 000 .00 1. 00 0. 00 1.00 0.00 1BSEISMICR VALUATION 6, 000.00 0.60 0.00 0.60 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 145.60 0 . 00 145 .60 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 145.60 MC --------------- TOTAL RECEIPT 145.60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18624 loree ave DATE: 04119/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$6,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Rep-:� air PRIMARY SFD or Du lex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK replace building sewer add property line clean out SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 F Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 Elf.' 7,/1,'10) FEE QTY/FEE MISC ITEMS •x PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 �r Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.60 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 1ADMIN SUBTOTALS: < $106.60 $39.00 TOTAL FEE: $145.60 Revised: 03/01/2011 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: ?1F Lol-ee e- Com,. e,b0c PERMIT# OWNER'S NAME: <q'. D✓l PHONE# CW Z 61a GENERAL CONTRACTOR: BUSINESS LICENSE# jr�7 7 n ADDRESS: CITY/ZIPCODE: 1? *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors• Signature D to Please check applicable subcontractors and complete the following information: I/ 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 110q (-113f GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION _ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC (408)777-3228• FAX(408)777-3333•buildingCDcupertino.org CUPERTINO PLUMBING ❑NIECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN k ADDRESS OWNERNAME CL` c4_ J�� PHONE�rO. �• Scb� E-MAIL (L�r C G d wci, STREET I• 1 t►1t T' CITY,STATE,ZIP V R r�-i yl o FAX 1 S°� CONTACT NAME PHONE E-MAIL STREET ADDRESS CITl,STATE,ZIP FAX ❑OWNER ❑I OWNER-BUILDER .❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA V e�j y�C'' LICENSE NUMB LICENSE TYPE BUS.LIC# / > COMPANY NAME FAX J -'(p C FAX CO CY STREET ADDRESS ` / / LVID CITY.4ATE,ZIP � PHON5W ARCHITECT/ENGINEER NAME LICENSE NUMBER "l BUS.LI__CA COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK r7t/ Y TOTAL VALUATION: O d RECELEI�BY r :By my signature below,I certify to each of the Following: I am the property owne orized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the De ption Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t I _ng constru on. I authorize re se s of Cupertino to enter the abov id feed pro rty for inspection purposes. Signature of Applicant/Agent: Date: zz SUPPLEMENTAL INFORMAZ40N REQUIRED Wig `� — u MEPMiscApp_2011.doc revised 03/16/11