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14020146 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18671 RUNO CT CONTRACTOR:AMERICAN PERMIT NO: 14020146 RESIDENTIAL SERVICES OF CA OWNER'S NAME: MENON SURESH M AND SANTHIRE V TRU 965 RIDGE LAKE BLVD STE 201 DATE ISSUED:02/25/2014 OWNER'S PHONE: 4088288990 MEMPHIS,TN 38120 PHONE NO:(408)982-0405 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL PROPERTY LINE CLEAN OUT-SUNNYVALE License Class_ Lic.# ✓ JURISDICTION Contractor h C �V ��Q Date 0 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:37525028.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT�IIN 180 AY 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 FR T CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may ac against said City in consequence of the Issued b Date. granting of ermit. Addit all the applicant understands and will comply y' with all no -poi a re [at' s per the Cupertino Municipal Code,Section 9 18. `� 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 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,Se ion 55 33,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 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 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 SEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION i� +. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ,.. m MISIC G (408) 777-3228•FAX(408)777-3333•buildingna.cuoertino.org \�UP>rEt`;<`Ct�� •PLfUIaING ❑NMCHAIgCAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 /1�J � / ( I APN# 2 S�U Z E U� OV,NERNAME /,'n O PHONE�(J STREET ADDRESS b �'n J� CITY,STATE,ZIP. _^f�I�O I FAX CONTACT NAME V� U PHONE J� E MAII STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OwNm-BUIIAER ❑ OIANERAGEN'T�/ ❑ CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGII'TEER ❑ DEVELOPER TENANT CONTRACTOR NAME - `n! ►./� n/ 1� S 15 LICENSE NUMBER�(� C LICENSE TYPE BUS.LIC 4 N�jCOMPANY NAME Q �W� (l YVG� �wv' ` E-MAIL FAX 4 ef- STREET ADDRESS O. `/r CITY,STATE ZIP C ARCHITECT/ENGINEERNAME y C LICENSE NUMBER BUS.LI(C 4 COMPANYNAMEEMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUIIDING ❑COWdERCIAL URBAN INITRFACE AREA ❑ NO FLOOD Z,OIdM ❑NO EICHLER HOME? ❑No DESCRIPTION OF WORK 5eLkA � � tq(tl M 10tA � V16 U 5-� D TOTAL VALUATION: r O O D ZZECEIYEDB �� = y By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the operty ov s behalf. I have read this application and the information I e provided' rrect. I have read the Description of Work and verify it is accurate. ee to comply vrith all applicable local ordinances and state lana s relatin t ns ction. I authorize representatives of Cupertino to enter the abo /ii entifi p� rty for inspection purposes. Signature of Applicant/AEent: Date: V�, S P MENTAL INFORMATION REQUIRED - OFF3CE�ISE�A'L0- ,. 'Hl•<CO�"�IJZ�T„�ERAP- WWm� W _ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO *Z'FEE ESTIMATOR-BUILDING DIVISION ADDRESS• 761 RUNO CT DATE: 02/25/2014 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: p PERMIT TYPE: i WORK PROPERTY LINE CLEAN OUT SCOPE ;�. ...-'�, < Na- 3 Plumb.Plan Check 0.0 hrs $0.00 E/uc.Pi in(b:cfc 1,1<>.,;r.I c>;roil Fc>e: Plumb.Permit Fee: IPPERMIT C)tJrcr ,W,'h. fns,3. Other Plumb Insp. 0.0 hrs $47.00 (.3tl rnr tstee. tns�,. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $24.00 IPRSEWER Sewer, Sanitary PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,_01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (`oast•ucil1M 741:,: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldy,Stds Commission Fee: 1BCBSC $1.00 ®T " $140.00 $24.00 » TOTAL FEE: $164.00 Revised: 01/15/2014