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09080101CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21356 AMULET DR OWNER'S NAME: LAI -IF NATHANI ;R'S PHONE: 4083423089 ❑ LICENSED CONTRACTOR'S DECLARATION License Classtll/__-_ Lic. 4 q)10S'e)L4 Contractor 26akc th'v Date S-10-09 1 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. 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnity 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 this permit. Additionally, the applicant understands and will comply with all non -point s egulations per t e Cupertino Municipal Code, Section 9.18. Signature Date ] OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). CONTRACTOR: ROOTERS ON DEMAND PERMIT NO: 09080101 .2940 LAKE MEAD DR DATE ISSUED: 08/11/2009 I,REMONT, CA 94555 PHONE NO: (510) 475-8271 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH F RESIDENTIAL r— COMMERCIAL JOB DESCRIPTION: SEWER LINE REPLACEMENT & TRENCHLESS METHOD Sq. Ft Floor Area: Valuation: $1800 APN Number: 32443020.00 Occupancy Type: I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 have and will maintain W'orker's Compensation Insurance, as provided for by Section 3700 of the Laber Code, for the performance of the work for which this permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I rri so forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 ups the above mentioned property for inspection purposes. (We) agree to save v and keep'harmless the City of Cupertino against liabilities, judgments, C, x1d expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understandE and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ __ Date PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. kit roofs shall b4spe!i ed prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection, I agree to remove all new materials for nspection. signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534, 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Com, Sections 25505, 25533, and 25534. Owner ized age C( Date• CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM 090ZD101 APN # ?�I� q 2-0 v Date: Building Address: a 3 s-� AftA LA Itis- p r- �kAP_e�-�, o .. �� �. �- so P Owner's Name: L A -%h �' ► Phone #: ('Y4) 3 Y2 • 3a Contracto' ©O4-esS p<,,- rni-\� Phone #: -S�� - t17 0--- ySSS— Fax#: Contact: �� Q Q Phone #: LH o�) 6qo -- 390i 1CPSS Fax #: Contractor License #: g Z 6 b 0 y Cupertino Business License #: Job Description: '�r���cc i►'► cl�� -i'ftee-Oc SS mc4 h Od Residential Commercial ❑ Valuation: � 0 0 Project Size: Express Standard ❑ Large [J 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 Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary :ewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gz s Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Comm:,rcial P Revised 01/07/09 CITY Of CUPEkTINO CITY OF C UPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Descriptio -i Fee Group Permit Type 113CBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building sewer/sanitary sewer P 1R -PSS 1PRREPIPE Residential re -pipe, per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage D_sposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas P -ping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit )i ee Issuance P 1 PLMBLNCK Plumbing Plan Cl eck P 1 PLMBINSP Other Plumbing/gis Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B