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10020027 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 7515 TIPTOE LN CONTRACTOR:NATIONAL ROOTER PERMIT NO: 10020027 OWNER'S NAME: KALVELAGE B F :911 MONROE ST DATE ISSUED:02/03/2010 ER'S PHONE: 4082532586 MANTA CALARA,CA 95051 PHONE NO:(408)241-0887 ❑ LICENSED CONTRACTOR'S DECLARATIONBUr— ILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL� MMERCIAL Contractor Date ti I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CITY SEWER CLEAN Ou :< z (commencing with Section 7000)of Division 3 of the Business&Professions 5 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 d M1 5 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 fr Valuation:$1550 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 permit is issued. APN Nut6ber:3591 9. + Occupancy Type: % „ 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter 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, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply _ /�j� with all non-point source regulations per the Cupertino Municipal Code,Section [sued by: '?"' -''�-"-'" Dater!y —y 9.18. Signature Date RE-ROOFS: G OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(See.7044, 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's 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 Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 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 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 p Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Ow erre [efed a ►t: Compensation laws of California. If,after making this certificate of exemption,I � 4 & Date: "2 become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save in,' iify and keep harmless the City of Cupertino against liabilities,judgments, C' ad expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gra,iurg of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature RcDate U CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN . . . . . . . . : 35 )28009. 00 DATE ISSUED. . . . . . . : 02 /03/2010 RECEIPT #. . . . . . . . . : BS )00009686 REFERENCE ID # . . . : 10 )20027 SITE ADDRESS . . . . . : 75L5 TIPTOE LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CU?ERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KA:JVELAGE B F ADDRESS . . . . . . . . . . : 75L5 TIPTOE LN CITY/STATE/ZIP . . . : CU?ERTINO CA, CA 95014-5836 RECEIVED FROM . . . . : BE:ZNARD F KALVELAGE CONTRACTOR . . . . . . . : R014ALD J. PEREIRA LIC # 25124 COMPANY . . . . . . . . . . : NATIONAL ROOTER ADDRESS . . . . . . . . . . : 29L1 MONROE ST CITY/STATE/ZIP . . . : SA14TA CALARA, CA 95051 TELEPHONE . . . . . . . . : (4 )8) 241-0887 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 550 .00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 1, 550 . 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 ----------------- --------------- -------------------- CHECK 106 . 50 #2703 --------------- 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 C.1UPERTINO .. REPIPE/SEWEI-VMAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date Building Address: Owner's Nam Phone#: Contractor: Phone#: N11 77®l(/ Q - 6 Fax#: Contact: Phone#: 7 Fax#: Contractor License#: 7e� ( --36,Cu Cupertino Business License#: Job Description:` L �. � ��--� � Q0 Residential Commercial ❑ Valuatio ��� etc- Project SiW- Expres Standard Large [] Major LJ 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 Newer 1 BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 14 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF C:UPERTINO y . REPIPE/SEWEBJMAIN SERVICE CITY f CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Descriptio a Fee Permit Type Group P 1BCBSC Cal Bldg Standaks Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residenti it P 1PRSEWER Residential building P 1RPSS sewer/sanitary sevrer 1PRREPIPE Residential re-pip(,per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER 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 1PLMBLNCK Plumbing Plan Ch.-ck P 1 PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development 10300 Torre Avenue s= ; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Building Department JOB ADDRESS: PERMIT# fs l ,/ OWNER'S NAME: — PHONE # c'=�3 GENERAL CONTRACTOR: �o FAX # L � I am not using any subcontractors;. Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date