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13010118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21844 BENETTI CT- CONTRACTOR: DRAIN DOCTOR PERMIT NO: 13010118 OWNER'S NAME: TENNEY GLENN TRST 480 ALDO AVE DATE ISSUED: 01/222013 OWNER'S PHONE: SANTA CLARA, CA 95054 PHONE NO: (408)370-3082 y`s> LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ' License Class 3Lm # � Ui' '�� () REPLACE E SEWER DRAIN FORM TOILET FIXTURE TO LA & -- _ — Contractor Date PROPERTY CLEANOUT & OPEN TRENCH FROM COMBO TO - - - a am linder I hereby affirA '.h censed uthe provisions of Chapter 9 BUILDING CLEANOUT (5) (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: � a 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 Sq. Ft Floor Area: Valuation: $5500 performance of the work for which this permit is issued. _ I have and will maintain Worker's Compensation Insurance, m provided for by - - Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32649029.00 Occupancy Type: - permit is issued. .. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY L CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the j Tj Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18: ., q[�/} RE -ROOFS: Signature 1' === Date s 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 inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will dothe work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, w owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE, construct the project (Sec.7044, Business .& Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: - Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued - -- - Owner or authorized agent: Dat 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, t CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender'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 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 ARCHTTECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION g M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Q 41 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O ` M I /� (408) 7773228 • FAX (408) 777-3333 • buildinc(cDcuoertino.orD \� C &LUMBING I— mm4ANH'AT. I IFT nA T..T PROIECIADDRESS L( 9 - 029 OWNERNAME PHONE E -MAB. STREETADDRESS CITY, STATE, ZIP Y` FAX - CONTACT NAME w PHONEra� Op _711 EE-MAIL1rU. STREET ADDRESS 32 CITY. STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT e * CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE LIPENSETYPL42 BUS. LIC I COMPANY NAME a 1 wv V E-MAIL FAX STREET ADDRESS CITY, STATE. \ '0' 9 9,Ie 3S ARCHTCECT/ENGINEER NAME SE NUMBER BUS. LIC 8 COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP - PHONE USE OF ❑smD DUPLEX ❑ MULn.FAM11Y PROTECTBJwiLDLAND ❑ YES PROrECTIN ❑ YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK ticL-- v>1 C4. t ♦ �y ` eoVA tl ce 4I -LD 4-o - TOTAL VALUATION: 1U RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constru 'on. I authorize representatives of Cupertino to enter the above-identifiedproperty for inspection pu(1 oses. Signature of Applicant/Agent: Date: 2-- SUPPLEINFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER F Y ❑ EXPRESS U V ❑ STANDARD ❑ LARGE ❑ MAJOR MEPMisa4pp_2011.doc revised 06/21/11 ���� CITY OF CUPERTINO Iml FEE ESTIMATOR — BUILDING DIVISION NUIE., This estimate does not includejees due to other Departments (Le, Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). 7heve fear are hived an the nreliminam informatinn availahle and are nnly an esdmale_ rantarl the Dant inn addn'1 inf. FEE ITEMS (Fee Resolution 11-053 E . 711/12) ADDRESS: 21844 BEN ETTI CT 01/22/2013 REVIEWED BY: MELISSA Plumb. Plan Check APN: 326 49029 ---i0DATE: BP#: *VALUATION: $5,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Elec. Pennit Fee: PENTAMATION PERMIT TYPE: 1RPS i WORK REPLACE E SEWER DRAIN FORM TOILET FIXTURE TO PROPERTY CLEANOUT & OPEN SCOPE I TRENCH FROM COMBO TO BUILDING CLEANOUT (5') NUIE., This estimate does not includejees due to other Departments (Le, Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). 7heve fear are hived an the nreliminam informatinn availahle and are nnly an esdmale_ rantarl the Dant inn addn'1 inf. FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE Xlech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Man Check Me& Penni[ Fee: Plumb. Permit Fee: PME Plan Check: Elec. Pennit Fee: 0 her Mcch. Insp. - Other Plumb Insp. 0.0 hrs $45.00 Other Elec. Insp. Mach. Insp, Fee: Plumb. Insp. Fee: PME Unit Fee: Elec. Insp. Fee: _ NUIE., This estimate does not includejees due to other Departments (Le, Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). 7heve fear are hived an the nreliminam informatinn availahle and are nnly an esdmale_ rantarl the Dant inn addn'1 inf. FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# Plumbing $23.0 B � Sewer, Sanitary Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee 0 Reg.. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Consiruction Tax: Administrative Fee: $42.00 Q 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure Travel Documentation Fee: 1 $45.00 Strong Motion Fee: I $0.55 Select an Administrative Item Bldg Stds Commission Fee: $1.00 $133.55 $23.00 w ' TOTAaLE $156.55 Revised: 10/01/2012 -.