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10010130 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10422 JUDY AVE CONTRACTOR:SPEEDY ROOTER PERMIT NO: 10010130 PLUMBING NER'S NAME: BRAD MEYER 825 CIVIC CENTER APT 1 DATE ISSUED:01/25/2010 OWNER'S PHONE: 4082031227 SANTA CLARA,CA 95051 PHONE NO:(408)234-8134 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r Z, License Class -/ ALic.# �y MECH RESIDENTIAL COMMERCIAL Contractor -=--"?y�-% �'` Date I hereby af�Erfi that I am lice a under the provisio s of C apter 9 JOB DESCRIPTION:INSTALL BUILDING CLEANOUT (comme�ing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area f Valuation:$3300 I have and will maintain Worker's Compensation Insurance,as provided for by kra Section 3700 of the Labor Code,for the performance of the work for which this Y Occupancy Type: permit is issued. AP mj b 151 1��H � p Y YP APPLICANT CERTIFICATION " �b I certify that I have read this application and state that the above inform ati n ,, �..' y 4 correct.I agree to comply with all city and county ordinances and state laws refatng RMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city toy ent r 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 whin may accrue against said gty in consequence of the granting of this permit. , dditionally, a applic " u derstands and will comply with all non-point source regulations er t e o Municipal Cod/Secion Issued byl .' �`"'�'"" --� Date• �9.18.ature •�' ; � Date IV RE-ROOFS: ❑ ;' 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: 1,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(Sec.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 th 'Bay Area Air Quality Management District I will permit is issued. maintain compliance with t Cupertino Municipal Code,Chapter 9.12 and the P Health&Safety Code,$e :' s?5505,25533,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 Owy% `o t: Compensation laws of California. If,after making this certificate of exemption,I ! Date: v� 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 the above mentioned property for inspection purposes.(We)agree to save inify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against.said City in consequence of the granting of this permit,,Additionall;,tho appricant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations r Cupertino Municipal Code,Section 9.18. ,. �' ' Licensed Professional Signature {-t Date : CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37510001 . 00 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT #. . . . . . . . . : BS000009608 REFERENCE ID # . . . : 10010130 SITE ADDRESS . . . . . : 10422 JUDY AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER BRAD MEYER ADDRESS . . . . . . . . . . : 10422 JUDY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JUSTIN W CASH CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING ADDRESS . . . . . . . . . . : 825 CIVIC CENTER APT 1 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051 TELEPHONE . . . . . . . . : (408) 234-8134 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 31300 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 31300 .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 VISA --------------- 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 1 CA CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE E Y T C UPI NO PERMIT APPLICATION FORM APN # Date: 4 3-7 �S 16 QD Building Address: / Lel Z � � Owner's Name: A Phone#: Contractor: -� / Phone#: UEa 7 Fax #: Contact: =�� h Phone#: Fax #: Contractor License#: Cupertino Business License#: 2- Job Job Description: ,.•'✓I �, �{`jam 6/ !� ��`'�-r-� Residential ' Commercial ❑ Valuation: 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 Grou 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 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPS OF FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou j 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P 1 PRSEWER 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 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B ;y Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIT1(OF Fax(408)777-3333 U PEkT IN 0 Building Department JOB ADDRESS: �V PERMY4f-1-10 Z 04V 2- Z- )4, OWNER'S NAME: PHONE # `TL? Z u3 l;Lz JA- GENERAL GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ` Signature Date Please check applicable subcontract 'rs and complete the following information: Fa SUBCONTRACTOR BUSINESS 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 r Tile f ,OO er/Contractor S gnature Date