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14020139 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11461=9-��frb`�' CONTRACTOR:TATS INC DBA MR PERMIT NO:14020139 A1J,, ROOTER PLUMBING OWNER'S NAME: HAMMER LAURA H AND AZZOPARDI MICHAE 1260 YARD CT DATE ISSUED:02/24/2014 OWNER'S PHONE: 4084690275 SAN JOSE,CA 95133 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL PROPERTY LINE CLEAN OUT License Classl//--_ Lic.#_sem('/,_77aC Contractor /0, .0.6 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. 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:$1129 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:36223035 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 ERMIT 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 AYS FR�LASALLED INSPEC ION. 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 Municipa Code,Section RE-ROOFS: 9 18. 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 hereb ffirm 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 1,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: 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 CONST UCTION 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 1 3� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC �u (408) 777-3228•FAX(408)777-3333•building (Qcupertino.org I PLUMBING []MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS. , I APN# /n 2�/�• OWNE \ PONE ((/ E-MAIL (J FAX STREET ADDRESS ' CI7 STATE,ZIP i I r ACf N P NE �r� E M� STRE ADD C ,STA IP � FAX(J C/ C_ ❑ OWI�E'R ❑ OV,'NER-BUII.DER ❑ O-ATiERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT [3ENGINEER 11 DEVELOPER ❑ TENANT C6RTRACTOR LIC SE NUMBER LIC ETYPE BUS.LI .1 I h. CO ANY N E-MAIL FAX STRE DRV STA PHONE <> t G — q`1 C- Z ARCETECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SID,or DUPLEX ❑ MULTI-FAMILY PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMtv1ERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK WEL -/ � TOT \ALUATTOh: RI?GELVEDB Y my signature below each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this applcatlon an the information I have provi ed is.correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil co re resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ORMATION REQUIRED o> cEusori�_ _ �N ' ©moo«Rsr cA . y Nuff?,. XP:RES S MEPA1iscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 1461 s stelling rd DATE: 02/24/2014 REVIEWED BY: Mendez APN: BP#: EVALUATION: $1,129 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: i WORK install ropertV line clean out SCOPE M,Jl. Pkll-1 C Plumb.Plan Check 0.0 hrs $0.00 Ahc.P r<an Ch'c'k h, 1': 1 lit Fee: Plumb.Permit Fee: IPPERMIT rill r. Pc:3 mF", Other Plumb Insp. 0.0 hrs $47.00 Otlre� t>1c'<.1tzs1�. lkch, hy,sP. 11,12m1h. layp. Tse: 1:aer.Insp hca: 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 on the relimina information available and are onlyan estimate. Contact the Det or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Plumbing Suppl. PC Fee: 0 Reg. ® OT 0.0 1 hrs $0.00 $24.00 1PRSEWER Sewer, Sanitary PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 ("oastrilclion TfIX., F-1 Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes No $0.00 G Advanced Planning Fee. $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure Strong Motion.Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 $139.50 $24.00 TOTAL FEE: $163.50 Revised: 01/15/2014