14040026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10289 MENHART LN CONTRACTOR:JD PLUMBING PERMIT NO: 14040026
OWNER'S NAME: MARKO DRAGOJEVIC 270 UMBARGER RD STE 66 DATE ISSUED:04/03/2014
OWNER'S PHONE: 4086473216 SAN JOSE,CA 95111 PHONE NO:(408)646-3266
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F1 COMMERCIAL E]
REPLACE(E)SEWER LINE&INSTALL 2 CLEANOUTS
License Class �36 Lic.# C 2I (FOUNDATION&PROPERTY LINE-SUNNYVALE
— 3 1 SANITARY)
Contractor � � (�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
fC pensation,as provided for by Section 3700 of the Labor Code,for the
Sq.Ft Floor Area: Valuation:$5000
ormance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this APN Number:37515031 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 LLED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save Igo
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Date: 3
granting of this permit. Additionally,the applicant understands and will comp ue
with all non-point source regulations 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 th Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date:
permit is issued.
43 Zly
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
V
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 a,
(408)777-3228•FAX(408)777-3333•buildinp(a)cugertino.org MISC
CUp1=�T{[10
PLUMBING ❑MECHANICAL ❑ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS A/� ; L/0
APN#
OWNER NATvffi iAA Y_` �p� E MayII
l � V lC- PHO �_2 r fo
STREET ADDRES CITY, STA . t ^ - I FAX
CONTACT NAME PHONE E-MAIL _
STREET ADDRESS CITY,STATE,ZIP -- FAX
❑ OWNER-BURAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N n n (LICENSE NUMB �� LICENSE TYPE BUS.LIC#
VJ�
COMPANY NAlvjr� ,� t }{� E SAIL FAX
�h
STREET ADDRESS �. CITY,STATE ^ �( ( 1 PHO `„ A,>q(Go3
ARCHITECT/ENGINEERNAME LICENSE NUMBER. BUS.LIC# �
COMPANY NAMEE-MAIL F
STREET ADDRESS CITY,STA PHONE
USE OF ❑SFD or DUPLEX 7=n-FAMILY PROJECT IN WII DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? El No
DESCRIPTION OF WORK
$ �
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authonzed agent to a e prope owner'1 a f. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate o comply with all applicable local
ordinances and state laws relating to building construction. I a representatives of Cupertino to enter the above-id tifre roperty for inspection purposes.
Signature of Applicant/Agent: Date:
NTAL INFORMATION REQUIRED
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hfEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10289 MENHART LN DATE: 04/03/2014 REVIEWED BY: MELISSA
APN: 375 15 031 BP#: *VALUATION: 1$5,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex I PERMIT TYPE: A
WORK REPLACE E SEWER LINE & INSTALL 2 CLEANOUTS FOUNDATION & PROPERTY LINE -
SCOPE SUNNYVALE SANITARY)
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
TOTALS: $24.00
4 i �9s Esq°" t
Plumb.Plan Check 0.0 hrs $0.00 t tr-c. Pian Ch..,v",
b1c>t;lt. f'er,nit T'cre; Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. E7rs $47.00 <htre° Isr Irs"
ph nn�. brp. Fee".e, I,7ec.snst� 1-:
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 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7f 1113) FEE QTY/FEE MISC ITEMS
Plan C,-&,c is Fee:
PC
PME Plan Check: $0.00
Sapp!, lill /"; ""'Ce
PME Unit Fee: $24.00
PME Permit Fee: $47.00
C unsiriiction Tax: FT
Administrative Fee: IADMIN $44.00
Work Without Permit? ® Yes (E) No $0.00
"1dV'W 1(.Vcl Plai'ming Fes:
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
- of. $163.50 $0.00 TOTAL FEE: $163.50
Revised: 04/01/2014