13060231 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7785 ORION PL CONTRACTOR:ABLE SEPTIC PERMIT NO:13060231
OWNER'S NAME: CHAN STANLEY W AND ELEANOR Y P O BOX 24819 DATE ISSUED:06/28/2013
OWNER'S PHONE: 4083911466 SAN JOSE,CA 95154 PHONE NO:(408)377-9990
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
License Class_ Lic.# !s n q 7, INSTALL 10" SEWER LINE
Contractor M L'��r!T'�1 L Date 4-2f-13
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing 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 *Aot
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: Valuation:$2975
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 APN Nur:362 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYJ FST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: (ty 2
with all non-point source regulations per the Cupertino Municipal Code,Section '
9.18.
.^ RE-ROOFS:
Signature�d )_LJ IS CT "��Date 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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 22/55534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �O< 1✓/S Vf;Y�ater
permit is issued.
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION
1 � MEP
�s " COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 2f
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 d
(408)777-3228•FAX(408)777-3333•building0cupertino.org `b� misc
CU�ERTINO
PLUMBING . ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#
OWNERNAME ;! • P I v� / l `�lY� E-MAIL
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STREET ADDRESS O D CITY, STATE,ZIP FAX
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CONTACT NAME
PHONE E-MAIL -
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STREET ADDRESS
CITY,STATE,ZIP FAX
❑OWNER ❑ QWNERBUILDER. ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME j t LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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ARCFi1TECT/ENGII IEER,NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS ' I CITY,STATE,ZIP PHONE
USE OF ❑SFD o[DUPLEX ':❑'MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN [].YES
BUILDINCr i ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO-
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By.riy signature Ibelow I cemfy toleach of the following: I am the property owner or authorized agent to act on the property wner's behalf. I have read flus
applrcariorl and the uiformation'L 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 retating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.?
Signature ofAppitbant/Agent e�e. I l�1 s Q�J2 Date:�h �S
I I } I I,i!I�I I '' I;SUPPLEMENTAL INFORMATION REQUIRED ,� ,
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2 11.doc revised 06/21/11
MEPMiscAPP
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$2,975
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: Lp PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $23
TOTALS: 5= $23.00
xE
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Xfech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
loch.Permit Fee:!7Plumb.Permit Fee: IPPERMIT Elec. Permit Fee:
Clhcr..Wech.Insp. Other Plumb Insp. 0.0 hrs n
Ocher Elec.Ins,,.
.1lech.Insp. Fee: Plumb.Insp.Fee.: Eley.Insp.fere:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
.FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan. Check Fee:
PME Plan Check: $0.00
Perl'nit Fee:
Suppl. Insp F'ee_
PME Unit Fee: $23.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
yah.r� $156.50 $0.00 `�;FSE $156.50
t,:'.9 fi.�Y.°i4A^.f. ..,
Revised: 04/29/2013