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13030174CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10238 RICHWOOD DR CONTRACTOR: GOGO ROOTER PERMIT NO: 13030174 OWNER'S NAME: FAUCETT JOHN W AND DELORES A 2530 BERRYESSA RD STE 509 DATE ISSUED: 03/29/2013 OWNER'S PHONE: 4082573394 SAN JOSE, CA 95132 PHONE NO: (408) 282 -7026 JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE] LICENSED CONTRACTOR'S DECLARATION License Class Lie. # l ? ✓ r°_,� REPLACE 30' OF (E) SEWER LINE &INSTALL (N) CLEANOUT AT THE FOUNDATION & REPLACE (E) Contractor r-C 0% Date +�� CLEANOUT ,a r I hereby affirm that I am licensed under the provisions of Chapter 9 AT THE PRCIPER Y . E (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 Sq. Ft Floor Area: Valuation: $6500 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 APN Number: 36908026.00 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 D 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. A OM ST 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 7 Z9 Is b Date: J granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal C de/ec n 9.18. -13 /7 Q �3 RE- ROOFS : Signature Date �G.� 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 1, 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 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. I 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 Cuperti nicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:? 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 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 ARCHITECT'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 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building a5CUDertino.org PLUMBING ❑ MECHANICAI Mo`� H MEP ° MISC [-]ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS `"'v �. �Q 3 6 0? O Z OWNERNAME 567A/1 PHONE E -MAIL STREET ADDRESS /�;�o aw-cc C , STATE, ZIP - 5G I FAX CONTACT NAME � y PH � �O� Q( /� j - -MAIL STREETADDRESS C IV '2 / / //_ ► \ , / CITY. STATE, ZIP [ FAX El OWNER E] OWNER- BUILDER ❑i OWNERAGENT El CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ) /) ✓%/I „, ./lily LICENSE NUMB qC)-3 (�/ LICENSE TYPV_ 3 % BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS � `� 67 L CITY, STATE, ZIP �� PHONE , J 7n'� V ARCHITECT/ENGLNTEER NAME LICENSE NUMBER BUS. L1C # COMPANY NAME ' E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK d & .2 yl% G1 t ez 5:i� 0 N Q R'iZ 04J TOTAL VALUATION: 5� !J, EIVE By my signature below, I ce 'fy to each of the following: I am the property owner or authdfSed agent to act on the p L owner's behalf. I have read this application and the information I have provided is rrect. I have read the Description of Work and verify it is accurate. I agr to comply with all applicable local ordinances and state laws relating to buildin ction. I authorize representatives of Cupertino to enter the aabbjove drenti ed propertyy for inspection pu €poses. Signature of Applicant/Agent: Date: rJ �`Z �l SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER- THE - COUNTER ❑ EXPRESS U V ❑ STANDARD ❑ LARGE y ❑ MAJOR MEP?klucApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FF.F. ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE 10238 RICHWOOD DR DATE: 03/29/2013 REVIEWED BY: MELISSA JimADDRESS: APN: 369 08 026 BP #: *VALUATION: 1$6,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: 1 RPS WORK REPLACE 30' OF E SEWER LINE & INSTALL N CLEANOUT AT THE FOUNDATION & REPLACE SCOPE I (E) CLEANOUT AT THE PROPERTY LINE APPLIANCE / EQUIP TYPE FEE ID QTY /FEE QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $23 Perinit Fee: Suppl. harp Fee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: $23 00_ Strong Motion Fee: 1BSEISMICR kfech. Plari (,heck I I I Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan ( "heck iLfech. Pera it Fee: I Plumb. Permit Fee: IPPERMIT Elec. Pernfit Fee: Other Alech. Insp� I I I I Other Plumb Insp. 10.0 I hrs I $45.00 I Other Elec. Insp. 1lech. Imp. Fee: I Plumb. Insp. Fee: I Eke. Insp. Tee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School n:.f,.: t ,t 1 71— F — -- A--f nn /ho infarmalinn availahlo and aro nnly an octimato_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E . 7/1/12 FEE QTY /FEE MISC ITEMS Plan Check F'ee: Suppl. PC ree PME Plan Check: $0.00 Perinit Fee: Suppl. harp Fee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $156.651 $0.00 $156.65 Revised: 01/01/2013