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09080102 (2) CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10203 MINER PL CONTRACTOR:SPEEDY ROOTER PERMIT NO:09080102 3LUMBING C FR'S NAME: SOKIMI 701 ALDO AVE STE 43 DATE ISSUED:08/11/2009 OWNER'S PHONE: 4082554892 iANTA CLARA,CA 95054 PHONE NO:(408)234-8134 ❑ ^ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class`.. • Lic.# �� ✓� r r MECH RESIDENTIAL COMMERCIAL Contractor . _WD�Date 1 -" 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SEWER REPLACE FROM HOUSE TO PROPERTY (commencing with Section 7000)of Division 3 of the Business&Professions LINE Code and that my license is in full force and effect. I herebv 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 F N performance of the work for which this permit is issued. Sq.Ft Floor Area i ( y,1INA1oo' 0 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 Number:31626066.00 Occupancy Type: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct.1 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 indemmfj and keep harmless the City of Cupertino against liabilities,judgments, i80 D YS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permi Additionally,the applicant understands and will comply / with all non-point so a regulations per the Cupertino Municipal Code,Section Issued by: -07 — Date: 9.18. 'a R ire at _ �v 9 RE-ROOFS: ❑ OW "ER-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 1 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) 1,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). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 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. 1 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 contaminants as defined by the Bay Area Air Quality Management District 1 will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. health Safety Code,Sections 25505,25533,and 25534. I 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 a e Vf1(] Compensation laws of California. If,after making this certificate of exemption,1 Date:_ — V become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. CO STRUCTION 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(See 3097,Civ C.) 1 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 h—lding construction,and hereby authorize representatives of this city to enter Lender's Address 11. me above mentioned property for inspection purposes.(We)agree to save ujr._ ..nify 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.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. — Signature___ Date_ CITY OF CUPERTINO 6 ITEMS OF 6 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 31E26066 . 00 DATE ISSUED. . . . . . . : 08/11/2009 RECEIPT # . . . . . . . . . BSC00008416 REFERENCE ID # . . . : 09CB0102 SITE ADDRESS 1003 MINER PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER SOKIMI ADDRESS . . . . . . . . . . : 110203 MINER PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2201 RECEIVED FROM . . . . : SPEEDY ROOTER & PLU CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING ADDRESS . . . . . . . . . . : 701 ALDO AVE STE 43 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408) 234-8134 FEE ID UNIT QUANTITY %MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- -- 1BCBSC VALUATION 6, 000 . 00 1 . 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 6, 000 .00 0 .60 0 . 00 0 . 60 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 220 . 60 0 . 00 220 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CHECK 220 . 60 #1448 --------------- TOTAL RECEIPT 220 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO 010Ptb2__ REPIPE/SEWE R/MAIN SERVICE CUPEt�TINO PERMIT APPLICATION FORM APN# Dg• — _I Bu�iy Addres —F�, � 0 qj ' Owner's Name: , Phone#: dg S()Y-kgnn. \ 0 Contractor. (Lot) Phone(o Fax# #• 7 t4$ Contact, Phone#: G 0 VC, Fax#: p9 q Contractor License#: -79 Cupertino Business License#: Job Description: �'WIFP, 'R�? GVU FRM fO�h&1�7 lb k,tiVQ., Residential Commercial ❑ Valuation: /„t OT Project Size: Express 0 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 3ewer 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 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 -� CITY OF CUPERTINO -V REPIPE/SEWERJMAIN SERVICE CUPE(,TINO FEE SCHEDULE Quantity Fee ID Fee Descriptio a Fee Permit Type Group 1BCBSC Cal Bldg Standares Commission B ALL PERMIT Fee TYPES f 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Watex Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas P.ping System P 1-4 Outlets 1BPGAS Gas Piping Systerl 5+ Outlets P 1PPERMITFEE Plumbing Permit ..-Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B