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11050015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10420 MANN DR CONTRACTOR.- PERMIT NO: 11050015 OWNER'S NAME: SHOAEE HAMID ET AL , �Gt d DATE ISSUED:05/04/2011 OAVNER'S PHONE: 4082538913 PHONE NO: G LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class F2 Lic.# O, ,Z �1:13 MECH RESIDENTIAL COMMERCIAL Contractor s Qaurr�e4 4 Date 4 1 W I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ABATE SEPTIC TANK,ADD NEW SEWER LINE (commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES** 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$6700 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. � APN Number:32645012.00 Occupancy Type: C_� APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: 1--:55-7- - Date: 5,1 Signature Date S / OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owrtgrpr authorizedJZent. become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 0 14 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Wrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, cost- and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g ;of this permit.Additionally,the applicant understands and will comply W. ..i non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32645012 . 00 DATE ISSUED. . . . . . . : 05/04/2011 RECEIPT #. . . . . . . . . : BS000013383 REFERENCE ID # . . . : 11050015 SITE ADDRESS . . . . . : 10420 MANN DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SHOAEE HAMID ET AL ADDRESS 10420 MANN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1141 RECEIVED FROM . . . . : EDDIE BARRON CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : SHOAEE HAMID ET AL ADDRESS . . . . . . . . . . : 10420 MANN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1141 TELEPHONE . . . . . . . . . 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 6, 700 . 00 1. 00 0. 00 1 .00 0.00 1BSEISMICR VALUATION 6, 700 .00 0. 67 0 . 00 0 .67 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 .67 0. 00 145 .67 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255ILE 1 MISIC (408)777-3228• FAX(408)777-3333 (@ •buiidingcupertino.org CUPERTINO ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �q ]�! APN# OWNER NAMEA y A/ �� PHONE E-MAIL AI b '11 STREET ADDRESS CITY,STATE,ZIP3 , FAX CONT A NAME 7�l' PH I `n _ E-MAII 0� ,ri G i1 STREET ADDRESS CITY,S ATE,ZIP '4 a FAX c< q ,s`} OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBERLICENSE TYPE BUS.LIC# ISCOMPANY NAME• E-MA /1 FAX STREET ADDRESS CTJ Y STATE,ZI PHO IA 5 t 5�- C S / -L ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: C] Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE C3 Yes ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: 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 sic n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. r ` Signature of ApplicantIAgent: C� Date: SU LEMENTAL INFORMATION REQUIRED f = .RGE A a 3 MEPMisr-App_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION II[ADDRESS: 10420 mann dr. DATE: 05/03/2011 REVIEWED BY: bobs. PN: I BP#: "VALUATION: 1$6,700 y°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: p PERMIT TYPE: wORK abate septic tank add new sewer line. 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 $42.00Li NOTE: These fees are based on the preliminairTy in ormation available and are onL an estimate. Contact the De t or addn I info, FEE ITEMS (Fee Resolution 09-051 I f. 7,'1.-10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 Work Without Permit? Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.67 0.5 hrs Admin./Clerical Fee Bld�zy Stds Commission Fee: IBCBSC $1.00 $39.00 ]ADMIN SUBTOTALS: $106.67 $39.00 TOTAL FEE: $145.67 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 :UPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: / L' 6406C— ,�✓ PERMIT# OWNER'S NAME: PHONE# 7-3f) GENERAL CONTRACTOR: — BUSINESS LICENSE# ADDRESS: G? 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: Signature Date Please check applicable subcontractors and complete the following information: 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 % Date Owner%Contra or Signature