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14050002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10647 S BLANEY AVE CONTRACTOR:ABC PLUMBING AND PERMIT NO: 14050002 DRAIN OWNER'S NAME: JANE ASHER P O BOX 21632 DATE ISSUED:05/01/2014 OWNER'S PHONE: 4082511883 SAN JOSE,CA 95151 PHONE NO:(408)234-8134 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REPLACE(E)SEWER LINE&INSTALL(N)FOUNDATION License Class ` j� Lic.# 47 REPLACE & r�► Date PROPERTY LINE CLEANOUTS 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 perform work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800 Ihle 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:36933008.00 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 save 180 D LED INSPECTION. 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: granting of this permit. A the applicant understands and will c with all non-points ce regulati 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,Sections 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age 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 0(7 M P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 MISC �O CUP>rF "1''thtO (408) 777-3228•FAX(408)777-3333•buildinc(5cupertino.org PLUMBING EINMCHANICAL ❑ELECTRICAL ❑ MSCELLL�ANEOUS PROJECT ADDRESS /O lj �5l I APN# OWI�TERNAME 7 ,/i�i' ""' f PHO? � � / � E MAIL i3'✓�L STREET ADDRESS U U C ! CITY, STATEZ29. I FAX CONTACT NAME 1 � PHOT 4W ✓�Gj?J, 8 E-MAIL e--- STREET ADDRESS ✓ CITY,STATE,ZIP [ l FAX ❑ OVIM '❑ OIAWM-BUILDER ❑ OWMRA= Jd-CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCr cT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMEC J '.•6r IICCF��1L1,J�B �S LICEI�SETIE` BUS.LI -40 COMPANY NA1VM !/~Y E-MAIL 5 ( 3 FAX STREET ADDRESS CITY.ST ar �e ARCHITECT/ENGINEERNAME / (/LICENSE NUMBER. [' BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CTTY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN VJII DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑�NfO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF wo /`. ` .O 101-1 TOTAL VALUATION: W RECEIVED a �€� By my signature below,I certify to each,of the fo ng: I am the prope own authorized agent to act on the property owner's behalf. I have read this application and the information I have pro . is.correct. Dee and verify it is accurate. I agree to compl with all applicable local ordinances and state laws relating to ding c c l r n upertino to enter the above-i P3ope 'f r i ection purposes. Signature of Applicant/Agent: Date: / S MENTAL INFORMATION D �� m e A«R r coy TIN r. J�REss - �n=V � �TA2QD1IiI� �' MEPMisc.4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10647 S BLANEY AVE DATE: 05/01/2014 REVIEWED BY: MELISSA APN: 369 33 008 BP#: "VALUATION: $3,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK REPLACE E SEWER LINE & INSTALL N FOUNDATION & PROPERTY LINE CLEANOUTS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $24 TOTALS: $24.00 rm bl<ch. flay!t-'hu'/s Plumb.Plan Check :Permit s $0.00 I lee. Plan Ch"", Mech. 11e;-init Fee: Plumb. e: IPPERMIT Ins,". Other Plumb Insp. s $47.00 C)d?u.>r 1 1-'w(. insp. Lj Plumb. hap. Fee: Eslec.In3p. Nec. 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 De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fce.' Suppl. PC Fees PME Plan Check: $0.00 PME Unit Fee: $24.00 PME Permit Fee: $47.00 C'onstrlacaon Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Blda_ Stds Commission Fee: IBCBSC $1.00 hrs $163.50 $0.00 TOTAL FEE: $163.50 _ * . Revised: 04/01/2014