B-2016-2703 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: - CONTRACTOR: PERMIT NO:B-2016-2703
10744 MORENGO DR CUPERTINO,CA 95014-3515(375 35 058) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA
91346
OWNER'S NAME: MAUSLING RAYMOND F AND SANDRA L DATE ISSUED:09/12/2016
OWNER'S PHONE:408-209-5412 PHONE NO:(888)929-4376
LICENSED CONTRACTOR'S DECLARATION BUII,DING PERMIT INFO:
License Class PLUMBING Lic.#973014
Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 X BLDG _ELECT X PLUMB
MECH X RESIDENTLAL—COMMERCL&L
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. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE BUILDING SEWER;CLEAN OUT
i. 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
ormance of the work for which this permit is issued.
Jp.
veand willmaintain Worker'sCpensation Insuranceas provided for by
3700 ofthe Labor Code,for the performance of the work for which this
t is issued. Sq.Ft Floor Area: Valuation:$6000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 35 058
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrueagainst s ' City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the app' nt unde ds and will comply with all non-point
source regulation er the _perti o MuniGioal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatu Date 9/12/2016 Issued by:AbbyAyende
Date:09/12/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. 1,as owner of the property,or my employees with wages as,their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:9/12/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally;should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air_guality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the CupertinoWpMcipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall -
be deemedrevoked. Owner or authorized age
APPLICANT CERTIFICATION 16ate:9/12/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the:City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECL RATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 9/12/2016 Professional
GENERAL PERMIT APPUCATION
CONNUNITY DEVELOPIdiENT DEPARTMENT BUILDING DIVISION M E P"
10300 TORRE AVEN-UE. CUPERTINO, CA 95014-3255
CUPERT6NCJ
(408)777-3228 • FAX(408)777-3333• buildingQcuDertino.org misc
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PROJECT ADDRESS G n A I C� N_ -35
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STREET ADDRESS I CITY;STATE,ZIP PHO\E
USE OF ❑SFD orDliPLFX ® MULTI-FAMILY, PROJECT Z\WT-DLAND ❑ 1 tS � PROJECT IN ❑YES IS THE BLDG.4N ❑ vEs
BLaDLNG: ElCOAT,ERCIAL LPB,4 INTERFACEAREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: �VL � RFCFIVED 1
By my signature below+,I certify to each of the following: am the property owner or authorized agent to act on th ppe I have read this
application and the nfonnation I have rovi o x Iia d the Descr.'ption of��'ork and verii%itis accurate. I _ee to ompl}cw ith all applicable local
ordinances and state law's relating tsr}d>rl�c *5zef CupertL--)o to enter t'ue above-i ntified roperty for inspection purposes.
Signature of Applicant'Aeent: Date: -7
SUPPLEMENTAL I'-FORbIATION REQUIRED
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