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14010100 'CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6674 CLIFFORD CT CONTRACTOR:TATS INC DBA MR PERMIT NO:14010100 ROOTER PLUMBING OWNER'S NAME: SAN JOSE,CA 95133 PHONE NO:(408)271-2822 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11 License Class 0 .3 �- Lic.# g(e 7 �¢ Z—S^ REMOVE AND REPLACE SEWER FOUNDATION MAIN -�—A+s =rJ e- FROM Contractor ,,.`R ISO T 12 . _ Date I L t( HOUSE TO PROPERTY LINE CLEAN OUT 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 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:$10000 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:36924051.00 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 WITB IN 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 D S FRO T 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply With all non-point source regulations per the Cupertino Municipal Code,Section 918. 1�� ^� 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 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. 1 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 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: ��/� 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 918. Signature Date GENERAL PERMIT APPLICATION o MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONLI � 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \,\ (408) 777-3228-FAX(408)777-3333•building CcDcuoerti no.org MISC CUIRSA `IN0 K" PLUMBING []MECHANICAL [:]ELECTRICAL1❑MISCELLANEOUS PROJECT ADDRESS APN# )n� OWINTERN - EMAIL STREET ADDRESS ( ( CITY,STATE,ZIP.. ati o/ FAX C' cs CO}IT NAME 1� t (7 �F N,�S P ?2 0 3 7 fO E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNEA ❑ OWNER-BUIIAEP ❑ Ol6'NERAGENT ❑ CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO 4NV LICEN NUMBER2 S LICTETYPE BU LI # Z S AJ L COMPANY N E-MAIL FAX /Z 20 3, T STREET ADDRESSCITY TATE,ZIP PHO 2 A 2.dr ? A•� o se. F s��2 I n U 3 7�' ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OFSFD or DUPLEX ❑ MULTI-FAMILY PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING. COMMERCIAL 'URBAN WTERFACE AREA NO FLOOD ZONE O EICFII.ER HOME? O DESCRIPTION OF WORK � ✓„S/�i'L Tey ��a �Z- � �r✓� �G � � �!/ - TOTAL VALUATION: RECEIYEDB �n� r By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's be . I have read this application and the information I have provided is correct. I have read the De iption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize re sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: Z— Z SUPPLEMENTAL INFO TION nQUIRED A_ of acElsE�i< � as � �� ud �� A&'ER TH1iGOI)�NNTER�� . 3h1 - Eal IFXPRESS Pw XIN TAT�'D'ARD _ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 6674 clifford ct DATE: 01/16/2014 REVIEWED BY: Mendez APN: BP#: ''VALUATION: 1$10,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK remove and re lace sewer foundation main from house to property line clean out SCOPE ea kfceh. Plan Check Plumb.Plan Check 0.0 hrs $0.00 F_lec.Plan(..heck 41eclr.Per,aait Pee: Plumb.Permit Feer IPPERMIT Elec. Permit Fee: F1,1",.h. Alech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Glee.Insp. Insp.I'ee: Plumb. hap.T ee: tslec.Insp.Fee: 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 onahe relimind in ormation available and are onlyan estimate, Contact the'De t or addn'1 info, FEE ITEMS(Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Plumbing Suppl.PC Fee: (D Reg. ® COT U:0 hrs. $0.00 $24.001 1PRSEWER Sewer,Sanitary PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feeig Reg. ® OT 0;0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction :Tax: Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0.Yes Q No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TRAVD0C $47.00 Building or Structure 0 Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 $140.00 $24.00 $164.00 ,: Revised: 01/15/2014