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11060026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19985 PRICE AVE CONTRACTOR:TATS INC DBA MR PERMIT NO: 11060026 ROOTER PLUMBING OWNER'S NAME: SHANTONU SEN 44777 S GRIMMER BLVD STE C DATE ISSUED:06/03/2011 'ER'S PHONE: 4083861018 FREMONT,CA 94538 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Lic.# ��2 5 MECH J_ RESIDENTIAL COMMERCIAL Contractor=t-f1'�S IwEL.e='u LAr�'K_ Date 6 <' I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL NEW MAIN SEWER LINE,ADD NEW PROPERTY (commencing with Section 7000)of Division 3 of the Business&Professions LINE Code and that my license is in full force and effect. CLEAN OUT 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 , a x Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for b Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Are .:� Valuation:$4000 permit is issued. �Y ' APPLICANT CERTIFICATION APN pm er `(7Fj Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date_4 I Issued by: ; Date:-;_-, L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Llty Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must er ororized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save ina^mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address r and expenses which may accrue against said City in consequence of the &...ang of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36905041. 00 DATE ISSUED. . . . . . . : 06/03/2011 RECEIPT #. . . . . . . . . : BS000013645 REFERENCE ID # . . . : 11060026 SITE ADDRESS . . . . . : 19985 PRICE AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . SHANTONU SEN ADDRESS . . . . . . . . . . : 19985 PRICE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RUBEN GONZALEZ CONTRACTOR . . . . . . . : TATS INC LIC # 23496 COMPANY . . . . . . . . . . : TATS INC DBA MR ROOTER PLUMBIN ADDRESS . . . . . . . . . . : 44777 S GRIMMER BLVD STE C CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE . . . . . . . . : (408) 271-2822 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0. 00 1BCBSC VALUATION 4, 000 .00 1. 00 0. 00 1. 00 0. 00 1BSEISMICR VALUATION 4, 000 .00 0 .50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0. 00 42 . 00 0. 00 1PRSEWER UNITS 1 . 00 21. 00 0. 00 21. 00 0. 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 145.50 0. 00 145.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 145 .50 VISA --------------- TOTAL RECEIPT 145.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19985 price ave. DATE: 06/03/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$4,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK install new main sewer line add new property line clean out SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT LiOther Plumb Insp. 0.0 hrs $42.00 Li NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (I�ee Resolution 09-05I Etf.' 7/1,%I(1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg?Stds Commission Fee: IBCBSC $1.00 $39.00 LMIN SUBTOTALS: $106.50 $39.00 TOTAL FEE: 1 $145.50 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRPERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 'z BUSINES LICENSE# ADDRESS: W CITY/ZIPCODE: 1E IS *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA RS HAV OBTAI ED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ign ure Yate' 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date 2—(7o GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUFERTINO (408)777-3228 •FAX(408)777-3333•building(-@cupertino.org MISC LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS \(�� S � ^J APN# OWNER NAME ` ` STFHO E-MAIL REET'ADDRESS J J CITY, STATE,ZIP FAX CONTACT NAME1 PHONE E_MAII �;�VI O R�,c�-33S CITSC.STATE ZIP � A J 2�& FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT '2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 7❑ENGINEER ❑ DEVELOPER ❑SANT CONTRACTOR NAME i_ LI SE NUTv® ✓ LICENSE TYPE BUS.LIC COMPANY NAME -�—� t/ MAII. FAX [ (� STREET ADDR{,SS_ CITY,STATE P (�(f fj� _0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'TSE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROTECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes Cl NO FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK C 1 � MA' L i t v-fs - TOTALVALUATION: V By my signature below,I certify to each of the following: 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 p9-/ d is corre I have read the Description of Work and verify it is accurate. I agree to omply with all applicable local ordinances and state laws relating to b ' onstrue I authorize representatives of Cupertino to enter the above-ide tified p pe for inspection purposes. Signature of ApplicanUAgent: Date: /i L ZIF-1 1� S EMENTAL RNIVORMATION REQUIlZED _.� - � _ — s .. NfEPM1scApp_2011.dac revised 03/16/11