13110135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7524 HOLLANDERRY PL CONTRACTOR:TATS INC DBA MR PERMIT NO:13110135
ROOTER PLUMBING
OWNER'S NAME: YEH JAMES J TRUSTEE&ET AL 1260 YARD CT DATE ISSUED: 11/20/2013
OWNER'S PHONE: 4083904097 SAN JOSE,CA 95133 PHONE NO:(408)271-2822
13LICENSffED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALEI
License Class O Lic.# B 6-7-6 Z REPLACE SEWER LINE&PROPERTY LINE CLEAN OUT
Contractor A ieJ26-0 " Date /I /?0//3
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.
Ihereby affirm under penalty of perjury one of the following two declaratio 3ANIIAP
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:$6000
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:36229014.00 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 WIT 80 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 D OM LAST 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:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Signature /i L.ry„+J �o Date j 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:�j7,/�Q(y� Date-)1/2—O
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 aboveinformation 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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONIts
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
J
(408)777-322 (a�
8•FAX(408)777-3333•building CUP�RTINO cupertino.org \ misc
PLUMBING [:]MECHANICAL ❑ELECTRICAL �J ❑MIgSCELL`ANEOUS
PROJECT ADDRESS Z �1 'PN
OWNERNAME n /J PHO - Ol/ E'2&& 0LW .Cd
K O
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STREET RESS CIT , STATE,ZIP. /SL7 FAX
CONTACT NAME /�_3 PHONE E-MAIL
STREET ADDRESS(moi CITY,STATE,ZIP FAX
❑OWNER ❑ OWNg,4UfltDER ❑ OWNER AGENT IG CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N ///� ► LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS17,O d CITY,STAT Q P Q �r C�33
PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER b C' /c7 BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PTIMEC ❑YES IS THE BLDG AN ❑YES
BUII.DING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FNE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK )Qndn J7 a6 cgaa
/
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr a Yowner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurst . agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the tabove-identified
property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED > cE m
t r asl ..dd"T'I(i ' _
W s" �im OX),R.eT ORVTEI
�_ XPRES r,
�� TANI)ARD
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7524 hollanderry pi DATE: 11/20/2013 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$6,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1 RPSS
USE: PERMIT TYPE: �
WORK �re lace sewer line& property line clean out
SCOPE
y
Atec:h. flan Check Plumb.Plan Check 0.0 hrs $0.00 Elec...Plan Check.
iLfer,h.Permit Fee: : Plumb.Permit Fee: IPPERMIT F.tec. Permit Fee:
Other Afech.Insyy. Other Plumb Insp. 0.0 hrs $47.00 other Etec•.Insp.
tlech.Insp. Fee: Plumb. Insp.Tee: Dec.Insp.Fcze
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These-W are based on the prelfmina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E : 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Plumbing
Suppl.PC Fee: (F) Reg. ® OT 0,0 hrs $0.00 $24.00 IPRSEWER I Sewer, Sanitary
PME Plan Check: $0.00 1 # Plumbing
Permit Fee: $0.00 $14.00 IPRREPIPE Re-Pipe Interior
Suppl. Insp.Fee,( Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PW Permit Fee: $47.00
Con it uction Tax:
Administrative Fee: IADMIN $44.00 0
Work Without Permit? ®Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0
i
Strong Motion.Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
Revised: 10/01/2013