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14050073 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10750 BROOKWELL DR CONTRACTOR:DRAIN DOCTOR PERMIT NO: 14050073 OWNER'S NAME: LAI JAMES S AND LI FLORENCE Y TRUST 480 ALDO AVE DATE ISSUED:05/12/2014 OWNER'S PHONE: 4088930019 SANTA CLARA,CA 95054 PHONE NO:(408)370-3082 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] REPLACE(E)SEWER LINE&INSTALL(N)FOUNDATION I License Class C Lic.# & Contractor �&&IV DOGTa a. Date D 2 PROPERTY LINE CLEANOUTS(SUNNYVALE SANITARY) 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:$5800 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:36921038.00 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 WITIIIN 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 DAYS FROM LAS 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 _ granting of this permit. Add' ' I the applicant understands and will comply Y' with all non-point sou ula s er the Cupertino Municipal Code,Sec 9 18. RE-ROOFS: Signature Date Z All roofs shall be inspec 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 255 25 nd 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333•building cDcupertino.or9 ❑NEW CONSTRUCTION ❑ ADDTPION ❑ALTERATION/TI El REVISION/DEFERRED ORIGINAL PERMIT'## PROJECT ADDRESS ,ry) A O0 W APN# 3.6q— / q_ '2,1 -0-3e/ —V�y-3 e OWNER NAME �^ PH, qa _o D//.? E-MAIL( STREET ADDRESSCITY,STATE,ZIP FAX o +T-00it" K rs��_�� o cam►- � �� CONTACT NAME PHNE E-MAIL m.+r7 qu-4 ren P 2-r=11?-3 f. .,,AAV q aAK STREET ADDRESS CITY, TATE,ZIP F L{0 A -T}O -5c..t. CAt, ❑ OwNER-auff DER ❑OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGrNEER ❑ DEVELOPER ❑TENANT CONTRALTO NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# N 'bo C r8 �3b C (tc2 COMPANY NAME E-MAIL FAX tEa A3 STREET ADDRESS � �. CITY,STATE,ZIP PHO ! 12u ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK AJVW,t 44'ew 74 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES 2- USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNU YES SECOND STORY []YES BEINGADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS TBE BLDG AN ❑YFS BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below,I certify to each of the following: I am the property owner or act on the prowowner's behalf. I have read this application and the information I have provided is ve read the Description of Work and verify it is . I agree to comply with all applicable local ordinances and state laws relating to building 77�ADrize representatives of Cupertino toe a Ove-idd n-fled roperty for inspection purposes. Signature of Applicam/Agent: Date: lZ l SUPPLEMENTAL INFORMATION REQUIRED PIAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for VER-THE COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -n STANDARD 0 PUBLIC WORKS To—nn if any Hazardous Materials are being used as part of this project. LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑` MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL]HEALTH BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10750 BROOKWELL DR DATE: 05/12/2014 REVIEWED BY: MELISSA APN: 369 21 038 BP#: *VALUATION: 1$5,800 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD Or Duplex PERMIT TYPE: 1 RPS WORK REPLACE E SEWER LINE & INSTALL N FOUNDATION & PROPERTY LINE CLEANOUTS SCOPE (SUNNYVALE SANITARY) APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: $24.00 15 011 L1eeb. Nan Plumb.Plan Check 0.0 hrs $0.00 1,70c..11h,n Chactr Llecls. 1'e;rltit 1%e; Plumb.Permit Fee: 1PPERMIT C3nc�'t :Vcch, 7Ytsp. Other Plumb Insp. 0.0 hrs $47.00 C)tfret ["lec.I s/�. F'lurnb. hi.V). Fee: F,:C: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etG). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept./or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Chcck Fee: Slippf. PCS Fe PME Plan Check: $0.00 PME Unit Fee: $24.00 PME Permit Fee: $47.00 t`ost:st;vfcfIi0 r, K,,V Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (F) No $0.00 ,ldtioncir(l Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $163.58 $0.00 �v TOTAL FEE: $163.58 Revised: 04/01/2014