14010114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7909 BELKNAP DR CONTRACTOR:NATIONAL ROOTER PERMIT NO:14010114
OWNER'S NAME:
SANTA CALARA,CA 95051 PHONE NO:(408)241-0887
LICENSED CONTRACTOR'S'DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
/" f� INSTALL(N)TRENCHLESS SEWER LINE FROM HOUSE
License Class ' 6o Lic.# 7 ��V TO
J, fU PROPERTY LINE,INSTALL 2(N)CLEANOUTS
Contractor �" G d .P: Date
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 declarations: SA E=A
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 N1 1AR
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4800
L\�` 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:36208039.00 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 s INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,ju
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply I Y.
Z
with all non-point source regulations per the Cupertino Municipal Code,Se
918.
RE-ROOFS:
Signature �� Date 2 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 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
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
U
``
_ GENERAL PERMIT APPLICATION I� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \V
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228•FAX(408)777-3333•building(cDcupertino.org MISC
CUP RTINO
PLUMBING OMECHANICAL ❑ELECTRICAL ❑`MISCELLANEOUS
PROJECT ADDRESS •0 APN#
I FAX
CONTACT pB7 E MAM
STREET ADDRESS CITY,STATE,ZIP v FAX
❑ OWNER ❑ OWNER-BUILDER ❑ oA NERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT AME LICENSE NUMBER LICENSE TYP BUS.LIC17
#
COMPANY NAME EMAIL FAX
STREET ADDRESS PHONE _D8S.7
ARCHTTECT/ENGINEER NAME LICENSE NUMBER !/ BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMQ Y PROJECT INWB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL. URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: �� i
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope er's . I have read t Is
application and the information I have provided is.correct. I have read the Description of Work and verify it is accurate. o comply��th all applicable local
ordinances and state laws relating to buildi nstructi I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: evz�
S LEMENTAL INFORMATION REQUIRED
�
, Erg
AVER=THE-COIJtiTER-mss
WE ` , KESS , _
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7909 BELKNAP DR BATE: 01/21/20147REVIEWED BY: MELISSA
APN: 362 081039 BP#:. `VALUATION: 1$4,800
%PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1RPSS
USE: PERMIT TYPE:
WORK INSTALL N •TRENCHLESS SEWER LINE FROM'HOUSE TO PROPERTY LINE INSTALL 2 N
SCOPE CLEANOUTS
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
0
TOTALS: 3 na� �� $2400
MW ; _
:Ltech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
L1ech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee:
L,1
:19ech.'Insp. . Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp.
. Insp.Tee: P1 fnb. Insp.Fee: Elec.Insp Fee:
NOTE:This estimate does not include fees due to other Departments(i.c Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees.are based on the prefindna information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E ..713) FEE QTY/FEE MISC ITEMS
Plan Check F'ee:
4Sztxrpl. PC Fete
PME Plan Check: $0.00
hermit F'E'E':
Suppl' 'Imp Pee
PME Unit Fee: $24.00
PME Permit Fee: $47.00
Construction :Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fees: :
Travel Documentation Fee: ITPUTDOC $47.00
Strong Motion Fee: 1BSEISAfICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$163.50 $0.00 F E$ $163.50
Revised: 01/15/2014