14040097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6288 SHADYGROVE CT CONTRACTOR:QUICK PLUMBING INC PERMIT NO: 14040097
OWNER'S NAME:
DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
RE-ROUTE KITCHEN AND LAUNDRY DRAIN LINES TO(E)
License Class —13 Lic.# �SGZS�2 CO SEWER LINE&REPLACE(E)SEWER LINE
Contracto Date
I hereby affirm that I am licensed u er the provisions of aapter 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
"erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4500
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:37541030 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 DAmaninspection,
CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of t pe it. Additionally,the applicant understands and will complyDate:
with all r Municipal Code,Section
9 18.
OOFS:
Signature Date /v' :installed
ofs shall befing material being installed.If a roof is
without n,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
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. I 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 the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance
Date:
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 6288 SHADY GROVE CT DATE: 04/16/2014 REVIEWED BY: MELISSA
APN: 375 41 030 BP#: *VALUATION: $4,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE:
WORK RE-ROUTE KITCHEN AND LAUNDRY DRAIN LINES TOE SEWER LINE & REPLACE E SEWER
SCOPE LINE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $24
Sewer, Sanitary 1 PRSEWER 1 # $24
TOTALS: $48.00
AM
-h":r t"layt Plumb.Plan Check 0.0 hrs $0.00i<r�.
Plumb.Permit Fee: 1PPERMIT
Other Plumb Insp. 0.0 hrs $47.00 ot,'a<rf i<�c_INsh
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prefintiha information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
/an Check
PME Plan Check: $0.00
Permit
Supp/, Insp Feer
PME Unit Fee: $48.00
PME Permit Fee: $47.00
On 77dV.'
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
cl�'fa�at�'r.t plarntia Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee:_ IBCBSC $1.00
- TAI.S $187.50 $0.00 ,1`1
TOTAL FEE: $187.50
Revised: 04/01/2014