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14050015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1423 ASTER LN CONTRACTOR:BAY AREA TRENCHLESS PERMIT NO: 14050015 OWNER'S NAME: ROHR CAROL 16690 OAK GLEN AVE DATE ISSUED:05/01/2014 OWNER'S PHONE: 4083142858 MORGAN HILL,CA 95037 PHONE NO:(408)981-5730 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] �* � REPLACE(E)SEWER LINE&INSTALL CLEANOUTS AS License Class ,14- (_ 3� Lic.# �� ?a/ 7o C. NEEDED Contractor 3 ! Date I hereby affirm gat 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: SANIIAR 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 formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000 ave 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:36617089 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 + IT 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 / LLED 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 te: StI' granting of this permit. Additionally,the applicant understands and will comply- with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. ` RE-ROOFS: Signature Date `— ��C� 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 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 CONSTRUCTION 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 918. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V JJJ (408)777-3228•FAX(408)777-3333•buildina(a.cuoertino.org V MISC CUPF-R`C'INO ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANTEOUS PROJECr ADDRESS`q/ ,� Q��- I AM# -3 C (_/ ' 1 -4- - O OWINTERNANM `J•C O I� PHONE7DU- QS lb E-MAIL STREET ADDRESS /q2- /� CITY, FAX / 4 CONTACT NAMEr PHONE O ��(��a EM e lfirenG�l rs STREET ADDRESS 0 STATE,ZIP FAX ❑ OWNER ❑ OIATIER•BUIIAER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME r-� LIJLE?� T UJBF L�EhTSEE�! BUS.LIC# 3 J,7 COMPANY NAME (^ (S/ E-MAIL v /j- b FAX ►'p,tic,L CSS STREET ADDRESS CITY,STATE ZIP PHONE ARCHTTECT/ENGINEERNAME LICENSE NUMEER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAM LY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK eo- 42-�� %� 74 TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to• c on rope er's behalf. I have 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 b n construction. I authorize representatives of Cupertino to enter the above-identified ro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INF TION REQUIRED Q __ OFFSCETJSDOI�LY ' 10 R�: 33?J2ESS, R` m TfD. 4A A1t'EPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 1423 ASTER LN DATE: 05/01/2014 REVIEWED BY: MELISSA APN: 366 17 089 BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK REPLACE E SEWER LINE & INSTALL CLEANOUTS AS NEEDED SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: $24.00 IN g Plumb.Plan Check 0.0 hrs $0.00 . ' I'--roar Fee: Plumb.Permit Fee: IPPERMIT , Other Plumb Insp. 0.0 hrs $47.00 C.Ir,'re>� t �rrs� lZc,Cto-�t�. '(� t'ittrtl?� lo•s�r. F<,a: i>i<,f_I»sx1E-.-. 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 f 7/1113) FEE QTY/FEE MISC ITEMS 1 Pum Check Fee: S rppl. P(. ].ee FA PME Plan Check: $0.00 11crini" :S11pp/, hIsP 1-'ec PME Unit Fee: $24.00 PME Permit Fee: $47.00 ("oll;M'11('11 O�7 7'J"%* F Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 �IC,h'G77t`NC/Plt?77i7ing,1,7 es: Travel Documentation Fee: ITRAVDOC $47.00 Strong;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 TOTAL FEE: 163.50 - Uk $163.50 $0.00 $ Revised: 04/01/2014