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12090249 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21685 GRANADA AVE CONTRACTOR:ALLSTAR PLUMBING PERMITNO: 12090249 OWNER'S NAME: TIAN IIUA 326 PHELAN AVE DATE ISSUED:09278012 ORSNER'S PBONI.: 4089751001 SAN.IOSE,CA 95122 PI ZONE NO:(408)230.5569 ❑ LIICEENSEDCO\'IRACFOR''S DECLARATION BUILDING BUILDING PERMIT INFO: BLDG C ELECT r C. PLUMB License Class�� gg //�L Lie.4 ( � 81' 1'r- ��//�� //-- ,{J�'/�� I MECH r RESIDENTIAL r COMMERCIAL rl Contractor 4/z 51/ // &4,,, ytc 9 _2 7 -/Z. I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION OF PROPERTY LINE CLEAN OUT (commencing with Section 7000)of Division 3 fir the Business$Professions Code and ihat,my license is in full force and effect. 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 A performance of the work for which this permit is issued. Sq.Ft Floor Aren: Valualimi 52859 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of the work for which this permit is issued. Ali\Number:35717032.00 � upaucv Type: APPLICAN`r CERTIFICATION Xx I certify that I have read this application and stale that the above information is correct.l agree to comply with all city and county ordinances mid state laws relating PERMIT EXPIRES IF WO 1=RS NOT STARTED to building construction,and hereby authorize representatives of this city to enter E3.S, w a upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS O k -ERMIT ISSUANCE OR indemnify and keep harmless the Cit'of Cupertino against liabilities,judgments, r costs,and expenses which may accrue against said City in consequence of the 180 DAYS FRO IaA CALLED INSPECTION. grmuing of this permi Additionally,the applicant understands and will comply 7 with all non-poi o ce regulations per the Cupertino Municipal Code,Seclinn Issued b)•: G Date: 9•p�'l 9.18. Signaturea r-.- Date 9—27-17 v✓ • RE. ROOFS: ❑ ONVNER-BUILDISR DE RIION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm thus 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicane Date: will do the work,mid the structure is not intended or offered for sale(Sce.7044, Business B Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLAS"A"OR RE ITER construct the project(Sec.7044,Business R Professions Code). hereby affirm under penalty of perjury one of the following three IIA%ARDOUS MATERLUS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Ileallh&Safely Code.Sections 25505,'_5533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth S performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of die work for which this cottm inants as defined by the Bay Area Air Quality Management District I will permit is issued. mai mntain cora lit nce with the Cupertino Municipal Code.Chapter 9.1_and the 11,01h ` e Code,Sections_5505,25533,and_5534. 1 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 O mer authorize eat Compensation laws ofCalifomia. If,after making this certificate ofesemplion,I Date: y "z7�� become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall he deemed revoked. CONS'1'RI1CfION LENDING AGENCY _ I hereby affirm that there is a construction lending agency for the performance of%wrk's APPLICANT'CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Leader's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, AKCIIII'FCI"S DEC1.,IRAI'ION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Licensed Professional Signature Date GENERAL PERMIT APPLICATION M E 1 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 _ I A CUPERTINO (408)777-3228 • FAX(408)777-3333 • building Guoertino.ora v\ L. L '{ TNG ❑r.�cBA.��CAL �rp �yP � [� ❑ELECTRICAL ❑MISE�C LLA,�'EOUS PROJECT ADDRESS ZI Q I APN' `7` 1// — 0 3 OWNER NAME e2. PHONE ^_ EMAIL STREETADDRESS CITY. STATE.ZIP .rC• FAX CONTACT NAME (`� M PHONE / E-MAIL ST=ADDRESS s/�✓�-c, CITY.STATE IIP FAX ❑OwHER U_0wNER-BUDDER ❑ OMWER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT Cl ARCKrTECr ❑ENGDrEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LICe PCa •, •7306i/ C- b COMPANY NAME ryI L I E-MAIL FAX /�//\• STREETADDRESS CITY,STATE IIP PHONE `�O? 32L ARCHIT..0 JENGA•EER NAME LICENSE NUMBER I BUS.LC.Y COMPANY NAME' E-MAIL. I FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF O SFD w DUPLE% [IMULTI-FAMILYI PROJECT IN W D.DLAN'n O❑ YES I PRaMCT W [3 YES I IS THE BLDG AN ❑ YES BUILONG: W C0?^1ERC . URBANINTERFACEAREA NO FLOOD ZONE ❑NO EICHLER.110 c7 ❑ NO DESCRIPTION OF WORX \/ TOTAL VALUATION: G J [ �� I RECEIVED BY: By my signaaue below,I certify w tach of Ihe1` owing?"T am the pmpery ownu or authorized agent W act on the property owner's behalf. 1 have read this application and the ia`ormation I have pro, is co t. I hzve d he Description of Work and verify it is actuate. 1 agree w comply with all applicable local ordinances and state laws relating to buil g cons etion. I au representatives of Cu enino to enter the abbove-idennttiified properyfor inspection p doses. Signature of ApplicanUAgem: Date: S EMENTAL INTO&MATION REQUTRED OFFICE USE ONLY sr ❑ OVER-THE-COUNTER r - ❑ EXPRESS 1 'J ❑ STANDARD U L ❑ LARGE ❑ MAJOR MEPMLttApp_1011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 21685 Granada Ave DATE: 09/27/2012 REVIEWED BY: Sean APN; BP#: 'VALUATION: $2,859 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYPENTANLITION USE: SFD or Duplex PERMITTYPE: At 1RPS WORK Installation of property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $23 TOTALS: I I 1 1 $23.00 Mech. Plan Check Plumb. Platt Check 0.0 1 hrs $0.00 Elm.Plan Check 'Lit-ch.Permit Fee: Plumb. Permit Fee: IPPERMIT I Elec.Permit Pee: Other,ifech. Ihcp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.hup. El .41ech. hup. Fee: Plumb. hasp.Fee: Elcv.Insp.Fee.' NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public 11'arks, Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliminan information available and are onh,an estinuae Contact the Dept for addn7 in a. FEE ITEMS (Fee Resolution 11-053 E(! M 111 FEE QTY/FEE MISC ITEMS Plan crrach Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. /nsp Fee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Conswuction Tar: Administrative Fee: 1ADMIN $42.00 Work Without Permit? Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA PDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item I31clg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $156.50 $0.00 TOTAL FEE: $156.50 Revised: 07/01/2012