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10030133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7608 ERIN WAY CONTRACTOR:TATS INC DBA MR PERMIT NO: 10030133 ROOTER PLUMBING ER'S NAME: DAMS BARBARA J 44777 S GRIMMER BLVD STE C DATE ISSUED:03/22/2010 OWNER'S PHONE: 4082527608 FREMONT,CA 94538 PHONE NO:(408)271-2822 11 LICENSED CONTRACTOR'S DECLARATION �.�� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 7 Contractor Date �r � MECH r RESIDENTIAL r COMMERCIAL r I hereby affirm that I am licensed u der the provisions of Chapter 9 JOB DESCRIPTION:INSTALL PROPERTY LINE CLEAN OUT 4 INCH CAST IRON (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. s I hereby affirm under penalty of perjury one of the following two declarations: j 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. t ' Sq.Ft Floor Area: x �� P I have and will maintain Worker's Compensation Insurance,as provided for by �� Valuation:$3200 Section 3700 of the Labor Code,for the performance of the work for which this V, ' 5cs permit is issued. APN Num4r9- 0: Occupancy Type: APPLICANT CERTIFICATION , _ • .� I certify that I have read this application and state that the above information is 4ii . 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may'd crue 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 Dat �Z Z Date 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. 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertiil"ugicipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a).sli614d I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use+equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants its defined b the Ba Area Air Y Y 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 1&Safe Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's ¢wn�rorv, o Compensation laws of California. If,after making this certificate ofexemption,I become subject to the Worker's Compensation provisions of the Labor Code,I mus _ 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 work'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 huilding construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned prop or,nspection purposes.(We)agree to save nnify and keep harmle he pity of Cupertino against liabilities,judgments, costs,and expenses whi (accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this i,Y. Additionally,the applicant understands and will comply with all norypoi ource regulations per the Cupertino Municipal Code,Sectors I understand my plans shall be used as public records. 9.18. ; .� J �... Licensed Professional Signat Date �'�� CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35921020 . 00 DATE ISSUED. . . . . . . : 03/22/2010 RECEIPT #. . . . . . . . . : BS000010001 REFERENCE ID # . . . : 10030133 SITE ADDRESS 7608 ERIN WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DAVIS BARBARA J ADDRESS 7608 ERIN WY CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4343 RECEIVED FROM . . . . : JOSE MANGOS 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 ----- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 200 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 200 . 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 : 106 . 50 0 . 00 106 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------- --------------- -------------------- CREDIT CARD 106 . 50 MC --------------- TOTAL RECEIPT 106 .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 REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM Date: Building Address: .76&1V �X/A i� ��,,,�T1� �� 5�7 Owner's Name: �J / V Phone#: Contractor: 9 A1K FPhone AT6Jax # #H09 5O Contact: Phone#: Fax#: Contractor License#: %7(p,`26 Cupertino Business License#: Job Description: I/VS7-1CL--A.1/ 0a yi/Vr// C,-V6-7- Residential 4i Commercial ❑ Valuation: L) Project Size: Express Standard Large Major Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 -,, CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEI,TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P j 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P / 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B 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: (/ f� j PERMIT OWNER'S NAME: PHONE# O V69=621-2 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 OCCUPA TION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND A NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontra ors: ignature 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 Owner/Contractor Signature Date