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11040082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10372 STERLING BLVD CONTRACTOR:GOGO ROOTER PERMIT NO: 11040082 OWNER'S NAME: RATNES SIVA 2530 BERRYESSA RD STE 509 DATE ISSUED:04/12/2011 OWNER'S PHONE: 4088737412 SAN JOSE,CA 95132 PHONE NO:(408)282-7026 .J LICENSED CONTRACTOR'S DECLARATIONr- BUILDING PERMIT INFO: BLDG ELECT P UMB License Class Z— g/)I Lic.# 0_7467e 63 F / MECH RESIDENTIAL COW CIAL Contractor cs7� /CGS'" Date �� 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: PROPERTY LINE CLEAN OUT (commencing with Section 7000)of Division 3 of the Business&Professions ► Code and that my license is in full force and effect. All I hereby affirm under penalty of perjury one of the following two declarations: t' 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 Floor Area: Valuation:$1000 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.1 h��7 :.3752rF60 :I�O 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 1 PERMIT 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 FROM ALLED INSPE TION. indemnify 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. c RE-ROOFS: Signature�!ner_ Date 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 I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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 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 2 805,25533,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, `s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. .ting 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10372 Sterling Blvd DATE: 04/12/2011 REVIEWED BY: Bobs APN: BP#: '"VALUATION: 1$1,000 Y PERMIT TYPE: Plumbing PermitiH-PLAN CHECK TYPE: Alteration /Addition/Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 Plumb.Plan Check0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 Ll L NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-051 IW T1,10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 F71 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $106.50 $0.00 TOTAL FEE: 1 $106.50 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /d 37-Z V d PERMIT# 6 OWNER'S NAME: c fes,,, PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 6 Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving -Plastering Plumbing &{cV ,�,.-- Zg O Roofing Septic Tank Sheet Metal Sheet Rock Tile O/<Z— Owner/Contractor Signature Date GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(Mcupertino.org misc CUPERTINO 1 //61466&� "LING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS FN# _1[: 2 OWNER NAME /�f PHO E MAII STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /O l e /?"� LICENSE NUMBER 013107,T7E TYPE ` BUS.LIC M 2 Q O !J (J' 'TV V O COMPANY NAME E-MAIL FAX STREET ADDRESS �SU�, CITY,STATE,zrn jc � RH`Oos ARCHITECTIENGINEER NAME / _�,r O 0 f LICENSE NUMBER 2^O 3 f/ BUS.LII d COMPANY NAME E-MAIL 7% 'f� FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'JSEOF SFDorDuplex ❑ Multi-Family PROJECTINWIiDLAND PRGJEC,IN STRUCTURE: ❑ Commercial SAN INTERFACE AREA ❑ Yes 21NO FLOOD ZONE ❑ YesNo DESCRIPTION OF WORK /V RECI:ItfEI�BLt — r 3 TOTAL VALUATION: u `` * v By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an 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 build' constructlo authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ` Date: S PPLEMENTAL INFORMATION REQUIRED Y� r MEPMiscApp 2011.doc revised 03/16/11