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13120187 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10721 WUNDERLICH DR CONTRACTOR:SMART PLUMBERS INC PERMIT NO:13120187 OWNER'S NAME: MARK CONOVER 2112 SANTA CRUZ AVE DATE ISSUED: 12/23/2013 OWNER'S PHONE: 4089969433 SANTA CLARA,CA 95051 PHONE NO:(408)247-2400 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ PROPERTY LINE CLEAN OUT-SUNNYVALE SANITARY License Class_ Lic.# S?70A;?z 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 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:$5500 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:37529001 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 WITBIIN 1 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 DA LAST CALLED INSPE TIO indemnify and keep harmless the City of Cupertino agairist 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 nsource regulations per the Cupertincr Municipal Code,Section 91 8. RE-ROOFS: Signature DaGAll 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 agen Datt�� 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 918. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING91VI10300 TORRE AVENUE•CUPERTINO,CA 95014-3255(408) 777-3228•FAX(408)777-3333•build!n cu ertino.o \V MISC cuEATI�o �`� M PLUMBING O MECHANICAL ❑ELECTRICAL O MISCELLANEOUS PROJECT ADDRESS APN# -2 6e:-2 r OWNER NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP. I FAX CONTACT NAME PH E-MAIL STREET ADDRESSAX 1 f�� .g 1l o, TTY,STATE.ZIP 0 F ❑ OWNER ❑ OwTIER-BUIIAER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE ER LICENSE E BUS.LIC# CO ANY NAME E-MAIL _` FAX A' STREET ADDRESS CITY,STATE,ZIP PHOI� y asp a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# CONIPANYNAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ muLTi-FAMQ..Y PROJECT INWIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORKMe 1 TOTAL VALUATION: 00 RECEIVED B I� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the perty own e read this application and the information I have provided is correct. I have read the Description of Work and verify it is accur agree to comply with all applicable local ordinances and state laws relating to building construction, I authorize representatives of Cupertino to enter the above-i en K Ted property for inspection purposes. Signature of Applicant/Agent: ^ Date: ( 1 42 SUPPLEMENT II�TFORMATION REQUIRED t - �_ �+ pOVER THUCOUNTERr Mal � - EXPRESS - 'Ft � 'STAi1`D MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10721 Wunderlich dr DATE: 12/23/20137REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$5,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: P PERMIT TYPE: WORK [PTQPertvline clean .out .sunnVvale sanitarV . SCOPE i6 ra klec:h,Ilan Cdieck Plumb.Plan Check 0.0 hrs $0.00 Dec:.Ilan Check L1ech.I'erwit Fee; Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: t)ther Afecrh.Insp. Other Plumb Insp. 0.0 hrs $47.00 other Glee_Insp. Lj #Tech.Insp.Fee: Plunnb. Issp.Fee: Elec.Insp. hire: NOTE:This estimate does not includefees due to other Departments(Lee 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 De t or addn 7 info. FEE ITEMS(Fee Resolution 11-053 E . 711713) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $24.00 IPRSEWER Sewer, Sanitary PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.FeelD Reg: ,0 QT Q7o hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee:. $47.00 ConstructionTax: Administrative Fee: IADMIN $44.00 Work Without Permit?. 0 Yes (E) No $0.00 1 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TRAvDoC $47.00 Building or Structure ®, Strong Motion.Fee: 1BSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 11 : r:a — N =� $139.55 $24.00 �� E •� $163.55 - s � a a w Revised: 10/01/2013