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13090111CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10932 SWEET OAK ST CONTRACTOR: DRAIN DOCTOR PERMIT NO: 13090111 OWNER'S NAME: TAO HUANG 480 ALDO AVE DATE ISSUED: 09/16/2013 OWNER'S PHONE: 4086463706 SANTA CLARA, CA 95054 PHONE NO: (408)370-3082 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class Lic. #(,>— r REPAIR SEWER LINE IN CONCRETE SLAB & REPAIR (E) FOUNDATION CLEANOUT Contractor Py&Z,— V -.A*'✓ Date Q 2) I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 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: $3000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32651052.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 FROM L Sim CALLED INSPEC ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Is Date: /L granting of this permit. Additionally, the applicant understands and will comply Y with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 6 - RE -ROOFS: 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,and 25534. Section 3700 of the Labor Code, for the performance of the work for which this �255333, Owner or authorized agent: Date: permit is issued. -!3-16-1-5 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 inconsequence 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 CUPERTIINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION a, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building ftupertino.org ` '7 misc PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS © APN # t� A ` / � OWNERNAME PHONE / 37 -TE -7 L STREET ADDRESS CITY, STATE, ZIP/7 ` N FAX CONTACT NAME - r PHONE (] Q E-MAIL �K' PO �.(�_ _ \ Ca � STREET ADDRESS v CTl'Y, STATE, ZIP FAX 0 / ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAM / LICENSE �IUMBE�R LICENSE TYPE C t_ BUS. LIC # COMPANY NAME � E-MAIL FAX 04 -9-7 a — STREET ADDRESS4V, A01 / a(�._. CITY, STATE, ZIklvP PHON ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD., DUPLEX BUILDING: ❑ COMMERCIAL ❑ MULTI -FAMILY PROJECT IN WI DLAND ❑ YES URBAN INTERFACE AREA ❑ NO OJECT n ❑YES OOD ZONE ❑ NO FF IS THE BLDG AN ❑YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK 5; 12,0 am;., TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or au prized agent to a prope owner's behalfk6av ead this application and the information I have provided is correct. I have read the Description of Work and verfly7 it is accurate. I agree to coin w' applicable local ordinances and state laws relating to building cction. I authorize representatives of Cupertino to enter the above -identified prrope orinspectionpurposes. Signature of Applicant/Agent: &__- Date: SUPPLEMENTAL INFORMATION REQUIRED MEPMiscApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO Fw- MW FF.F. F.CTIMATOR — RITTI.DING DIVISION =.; ADDRESS: 10932 SWEET OAK ST DATE: 09/16/2013 REVIEWED BY: MELISSA UNITS APN: 326 51 052 BP#: `VALUATION: 1$3,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex USE: p $24 PENTAMATION 1 RPSS PERMIT TYPE: WORK I REPAIR SEWER LINE IN CONCRETE SLAB & REPAIR E FOUNDATION CLEANOUT SCOPE APPLIANCE;/ EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Sewer, Buildig 1PRSEWER 1 # $24 Permit Fie: Supp/. Insp Fee PME Unit Feer $24.00 PME Permit F e: $47.00 C-onso-action :TIU. Administrative Fee: 1ADMIN $44.00 Work Without ermit? ® Yes (E) No $0.00 Advanced Planiting7 Fees: TOTALS: $47.00 Strong Motion IiFee: IBSEISMICR gr `,-, , a _ $24.00 Bldg Stds Commission Fee: 1BCBSC Mech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 E'lec. Pian (.,'heckL1t>cEh. Perrnil Fee: Plumb. Permit Fee: IPPERMIT F;lec, Permit Fee: Other ,llech. Insp. i I I I I Other Plumb Insp. 10.0 I hrs I $47.00 I Other Elec. Insp. I-Allech. Insp. Fee: I I Pluriih. Irish. Fere: I Elec. Insp. Fee: I NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 7i6 --r— nrn &nand —A. nraiisnisnnr infarm ifinn availahle and are anly an e.0imate. Contact the Dent for addnY info. FEE ITEMS 'Fee Resolution 11-053 E.7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek T'ec : Suppl. PC. I'ee PME Plan Ch4k: $0.00 Permit Fie: Supp/. Insp Fee PME Unit Feer $24.00 PME Permit F e: $47.00 C-onso-action :TIU. Administrative Fee: 1ADMIN $44.00 Work Without ermit? ® Yes (E) No $0.00 Advanced Planiting7 Fees: Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion IiFee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $163.50 __ EG. $0.00_ ' Tt4J $163.50 Revised: 08/01/2013