12100108 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10066 S STELLING RD CO\I'RAC`VOR:QUICK PLUMBING INC PERMIT NO: 12100108
OWNER'S NAME: AGARWAL SANJAY V AND AGRAWAL SAPNA 1044 MARTIN AVE DATE ISSUED: 10/152012
OWNER'S PHONE: 4086471036 SANTA CLARA,CA 95050 PUONENO:(408)732-1220
❑ LICENSED CON^rRAC`'OO'R�'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUDIR r
License Class( 3G Lie.4 �C/��,� CXJ r I- 17
//'' _ q RIECII RESIDENTIAL COMMERCIAL
Cmumctor � &V7 ) Date 1C�'��,� �-7
I hereby affirm that under the provisions of Chapter JOB DESCRIPTION:ABATE SEPTIC TANK AND CONNECT TO SEWER LINE
(commencing with Section 7000)of Division 3 of the Business A Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the Ddlowing nvo 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. Sq.Ft Ploor Area: valuation:$9400
1 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. ANN Number:35907002.00 Occupancy Type:
APPLICANT CF.RTI FICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 1 s r
with all non-points urce regulalinns p¢r the Cupertino Municipal Code,Section Issued b}': C1Gr� Date
9.18.
Signature
V
RE-ROOF
❑ / OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofii6ent. rim reg sealled.if o roof is
installed without first obtaining an inspccuon,l gr rem ve all new materials for
1 hereby affirm that I 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 Applicant: 101trX Date:
will do the work,and the structure is not intended or offered for sale(Scc.7044,
Business R Professions Code)
I,as owner of the property,am exclusively contracting with licensed contmctors to ALI.RO�P OV RIS."I'D RE CLASS"A"OR RE I`fER
construct the project(Sce.7044,Business& Professions Code). ff
�t��
1 hereby affirm under penalty of perj are one of the following three I AZ';1RIIOUS,%LA'rERIAI S DISCLOSURE
declarations: 1 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 Health S Safetv Code,Sections 25505,25533,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 3
performance of the work for which this permit is issued. Safety Code.Section 25532(a)should I store or handle hazardous material.
1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices.which emit hvardous air
Section 3700 of Labor Code,for the performance of the work for which this contaminants its defined by the Bay Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Ilealth S afely Code,Sections_55Q5,25533,and_5534.
1 certify that in the perforanance 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 Oeoe)� ttfl orized efiTr� /�,.� /
Compensation laws of California. If,after making this certificate of exemption,I //'o Date. 0
become subject to the Worker's Compensation provisions of the Labor Code,I must 6V
forthwith comply with such provisions or this permit shall be deemed revoked. / CONS'I'RIICI'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLIC N"I'CERT'IFICAT'ION 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 Lender'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 l iabil ities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCII ITECI"S DECLARATION
granting of this permit.Additionally,the applicam 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 Profession)
Signature Date
GENERAL PERMIT APPLICATION M E f
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ,
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 w A I A
CUPERTINO (408)7773228 • FAX(408)777-3333• buildina0cuoerino.ora '\9/' v\
❑PLUAfBING []MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS C r 1 APN — O _ O Z
0 ER NAA¢ NE Q I E-MAIL -
,
CO OR AME 7 I / PG' P E.MAtL
SAD RESSI ,,S��TA�� AX
❑ OWT.A ❑ OW'NEIt-BUILDER ElO%WZR AGENT ❑ CONTRACTOR L�f'M =R AGENT ❑ Ajtcii CT ❑a'GiirEvR ❑ DEVE.DPER ❑ T?LNT
TRACT RN 1 LC SENLICENSE TYPE I BUS.
I � BOJ 77 �
COMPAN`(NA I _MAIL��L1 / FAX
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ARCHITECV GIN=NAI.SE I LICENSE
'NUMEER SUS.LICx
COMPANY NAME I E-MAS. FAX
STREET ADDRESS CJ7Y,STATE,ZIP PHONE
USE OF S-D m DUPLEX El MULTI.FANID.Y I PROIER N w1Dt.RND 0 Y s I PROTECT IN ❑YES ( IS THE BIDfi AN ❑ M
BL 1i4G: CON4.ffRCIAL URRANINITRFACEAREA NO FLOOD LANE ❑NO ER}ILA HOM ❑ No
DESCRIPTION OF WO /RX �^ '-1 •�
4 IkJ
TOTAL VALUATION: LZ 2 ( RECEIVED BY: vJV
By my signature below,I Emit m each of the following: 1 am the propery owner or authorized agent to act on the property owner's behalf 1 have road this
application and the imormation I have pyovil is conecL I have: Description of Work and verity it is accurate. I agr..e--:o comply with all applicable local
ordinances;and state laws relating to' ii c�olnsvuctioa. I nze:epmsen Cupe¢ino to enter the above-identi5edr'propee/for inspection putjroses.
Signature cf ApplicanJAgenr. '1 Dare: =,T�
L NTAL INIFOR2,vL4TION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUA'TER
I — ❑ EXrRESS
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❑
STANDARD
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❑ LARGE
❑ NWOR
AEPMucdpp20l1.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10066 S. Stelling DATE: 10/15/2012 REVIE\VED BY: jsg
APN: BP#: 'VALUATION: $9,400
*PERMIT TN'PE: Plumbing Permit PLAN CII ECK TYPE: Alteration /Addition / Repair
At
PRIMARYPENTAMATION
USE: SFD or Duplex PERMIT1RPS
WORK Abate septic tank and connect to sewer line
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $23
TOTA LS: $23.00
Nech. Wan Check Plumb. Plan Check 0.0 hrs $0.00 Elec.Plan Check
Mech,Permit Fee: Plumb. Permit Fee: IPPERMIT I Elec.Permit Fee:
Other Meeh. lnsp. Other Plumb Insp. 0.0 hrs $45.00 Other Flec.Insp.
.ldwch.Insp.Few: Pluoth. hup. Fee: Flee.Insp.Fee:
NOTE: This estintate does not include jeer clue to other Departments(i.e. Planting. Public IVorks, Fire,Sanitary Sewer District,School
District,etc.). There ees are based on the reliminary information available and are only an estimate. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 F/C 7111121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sapp/. PC Fee
PME Plan Check: $0.00
Perinii Fee:
Supp1. Insp Fee
PME Unit Fee: $23.00
PME Permit Fee: $45.00
Consnvction Tax:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? Yes (F) No $0.00
Advanced Planning Fe ':
Travel Documentation Fee: ITR.tVDOC $45.00
Suona Motion Fee: 1BSEISMICR $0.94 Select an Administrative Item
I31c1£ Sids Commission Fec: IBCBSC $1.00
SUBTOTALS: 1 $156.94 $0.00 TOTAL FEE: $156.94
Revised: 10/01/2012