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13080018 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10700 CARVER DR CONTRACTOR:TATS INC DBA MR PERMIT NO:13080018 ROOTER PLUMBING OWNER'S NAME: ULRICH HUBER 1260 YARD CT DATE ISSUED:08/02/2013 OWNER'S PHONE: 6504649708 SAN JOSE,CA 95133 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIAL❑ License Class C�Q-� Lic.# -q (-Z-�' INSTALL(1)BUILDING&PROPERTY LINE CLEANOUTS 1 & Contractors )(�c.,� ��,,..�•c/ Date REPLACE(E)SEWER LINE BETWEEN I hereby affirm that I am licensed under the provisions of Chapter 9 CLEANOUTS**SUNNYVALE SANITARY** (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 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:$7500 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 Number:37532012.00 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 DAYS F 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 2 �� granting of this permit. Additionally,th icant understands and will comply by: with all non-point source regul i s p the upertino Municipal Co e,Se tion 9.18. RE-ROOFS: Signature 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,t a ay Area Air Q ality Management District I performance of the work for which this permit is issued. will maintain compliance with the al Code,Chapter 9.12 a I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 550 x553 nd 25 .`---- Section 3700 of the Labor Code,for the performance of the work for which this k/ Owner or authorized agen' Date: permit is issued. 11 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 CO TRUCTION 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 �V GENERAL PERMIT APPLICATION O� MEP 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERT (408)777-3228• FAX(408)777-3333•buildin cu ertino.or MIS PL ING ❑MECHANICAL [-]ELECTRICAL ❑MISCELLANEOUS PROJECTADDRE IGv �7V& APN(## OWNER NAME � �� ✓ PH �,� -V 6 �'�O� E-MAIL STREET ADDRESSCI Y, TATE,ZI FAX 0 7ovlr TSz'1 CONTACT NAME PHONE E-MAIL STREET ADDRESS D 1� ✓� CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AG CO .ACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LENS M�BER2�, LICTEY�PE_ BUS.LIC# COMPANY ISA r ` ` ' E-MAIL FAX STREET ADDRESS `�ce� p GL STATE, IPC ' P 16_ - I�� ARCHITECT/ENGINEER NAME -1 LICENSE NUMBER BUS.LIC# •..7v COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WHALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK 10 U'l —lc, I� � C lR.G2 f.VPi✓ I'd ` Q- TOTAL VALUATION:b CE Y By my signature below,I certify to each of follo ing: I am the property o er or authorized agent to act on the property owner's behalf. I have read this application and the information I have pro ded is c rrect. I have read the Desc ption of Work and verify it is accurate. Iagr to comply with all applicable local ordinances and state laws relating to buil g ction. I autho' repres tatives of Cupertino to enter the ab o� e2fired property for inspection purposes. Signature of Applicant/Agent: Date: SUPPL NTAL INFORMATION REQUIRED OFFICE USE ONLY W 95%VER-THE-COUNTER El SC EXPRESS x ❑ STANDARD El V LARGE MAJOR MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10700 CARVER DR DATE: 08/02/2013 REVIEWED BY: MELISSA APN: 375 32 012 BP#: *VALUATION: 1$7,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPS WORK INSTALL N BUILDING & PROPERTY LINE CLEANOUTS & REPLACE E SEWER LINE SCOPE d N!V y nt'c' APPLIANCE/EQUIP TYPE FEE II) QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: JIM $24.00 Mech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec-Plan Check FLlech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: Orher alec•h. Inch. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. Hech.Insp.I'E,c: Plumb. Insp.Fee: Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prellynWha information available and are only an estimate. Contact the Dept for addn7 info, FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 Consir action 1 a : Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes C) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 t OW $163.751 $0.00 $163.75 `� Revised: 07/01/2013