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090700963ccZ U <LLJ CL �z s _c 0 Dat - L W F ZOO n�- �pC yZ� i CITY OF CUPERTINO �T777777.77777 BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 7375 ROLLINGDELL DR TBD - T3 BE DETEMINED 09070096 OWNER'S NAME: ATMTACT F PERMIT ISSUE DATE 2 9 t0NE: SXNITAM9 CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70110) of Division 3 of the Business and Professions Code, and my license is REPLACE SEWER LINE WITH TRENCHLESS SEWER in full force andeffec( 3� x g�g�7 License Class C. Date— jedits -f Pa �Contractor Tr'0C CTSDECLON I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement License Law 9 3q. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's (Chapter (commencing with Section 7000) of Division 3 of the B usiness and Professions Code) or $6500 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 35933012 .27_25—HSE ❑ 1, as owner of the property^ or my employees with wages as their sole compensation, Required Inspections P will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of q property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-' ❑ 1, as owner of the property, am exclusively contracting with licensed contractors toRY cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. B & P C for this -,I, ❑ 1 am exempt under Sea reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workees Compen- sation, as provided for by Section 3700 of du Labor Code, for the performance of the wo for which this permit is issued. have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number are: carrier. Mu+ya 1 Policy No.: !1-)C Z 11010 b5 i0301t CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ) ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the wort for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lcnder'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 misting to ' building construction, and hereby authorize 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 j liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit- " APPLICANT UNDS AND� COMPLY WITH ALL NON -POINT Issued by: Date SOU�VL.ATION f 7/9/° 9 Re -roofs of R sof Signature of Applicant/Contrictor DateType HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 2No All roofs,, hall be inspected prior to any roofing material being installed. [3 Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection. District? / ❑ Yes E No I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health a Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my nsibility to notify the occupant of the mquiremsnLs w ' st be met prior to' ance of a Certificate of Qc d r lgnature A Applicant Date All roof coverings to be Class ''J�" or better Owncrorauthmrizcdagcnt Dam CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35933012.27 -25 -HSE DATE ISSUED.......: 07/09/2009 RECEIPT #.........: BSC00008166 REFERENCE ID # ...: 09C70096 SITE ADDRESS .....: 7375 ROLLINGDELL DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ......: OWNER ............. PIANACLE ADDRESS ..........: 7375 ROLLINGDELL DR CITY/STATE/ZIP ...: CUPERTINO, CA 95054 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ....: GRAVES INC CONTRACTOR .......: TBE - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBE - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 6,50Q.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICO VALUATION 6,500.00 1.47 0.00 1.47 0.00 1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00 1PCSEWER UNITS 1.00 21.00 0.00 21.00 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 221.47 ---------- 0.00 221.47 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 221.47 --------------- 221.47 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER REFERENCE NUMBER -------------------- 58086 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO ' n REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPIACATION FORM 4q7x�� APN # Date: Fee Descript ion Fee Building Address: 3 5 V,6WN del ` CuP��fiI No 95q�/ ) Owner's Name: Phone #: �o�� y9� -rte � L Contractor: Phone #: J 2'r L 14 3 ` M iNc C-1 Fax #: 7,5- SContact: Contact: MAP -4.1 P -e be i'z Phone #: q_� S' - L1 I I I 1CPSS Fax #: Contractor License #: M816 Cupertino Business License #: Job Description: Se-weC I�N� L�)'�� '1kteNt�leSS 56w Residential ❑ Commercial CK Valuation: b �-OO Project Size: Express Standard Large Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Descript ion Fee Permit Type Group / 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 Irn Of CUPEkTINO CITY OF C UPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building sewer/sanitary ser P 1RPSS 1PRREPIPE Residential re-pipE; per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS I PPRSEWG Private Sewage Disposal System P I PCESS Cesspool P I BPWATER Install/alter Water Pipe P I BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets P I PPERMITFEE Plumbing Permit Fee Issuance P IPLMBLNCK Plumbing Plan Check P IPLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B CITY OF . MkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADD PERMIT PERMIT # Q OWNER'S NAME: PHONE # GENERAL CONTRACTOR: c,,.,-,, FAX # I am not using any subcontractors: Signature Please check applicable subcontractors and com-:)lete the following information: Date —7l Owner/Con ctor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile —7l Owner/Con ctor Signature Date