14080225 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10549 SAN FELIPE RD CONTRACTOR:MARTI'S PLUMBING PERMIT NO: 14080225
OWNER'S NAME: FLAMMER GEORGE H 171 BRANHAM LN STE 10418 DATE ISSUED:08/21/2014
SAN JOSE,CA 95136 PHONE NO:(408)375-3190
OWNER'S PHONE: 4085155963
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL
PROPERTY LINE CLEAN OUT
License Class C —3(10 Lie.# q,5p V 02-0 24
Contractor V L OV C 1"`OC l'1 UL- Datey- 2 1 _ r
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 Valuation:$100000
Dperformance of the work for which this permit is issued. Sq.Ft Floor Area:
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:34222086.00 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 ERlyIIT 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 S FROM L ALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments ' v
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 non-point source regulations per the Cupertino Municipal Code,Section
9 18. /� , RE-ROOFS:
Signature ` V� p IV/l/Vll�t^`� Date o 2 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
the Health&Safety Code,Sections 25505, 5533534.
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 Owner or authorized agent: Date: Vv
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
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. 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 PEERMIT RPPLICATION / MEP
COMMUNi iY DEVELOPMiEN T DEPART MEN i • BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255Lii V�
(408) 777-3228 r rPY.(403)77117-3333
m I S (c-,
eUP;=Ri I!�!4
LL? G I�h r���iC4L ❑ T�CTRiCaL riC-:I.AlacuS
k o 5�q Son fellpt I r vN 2 2
O'v.')�r 1\cy� ��.� � ��vl,�'•( �C l I "l�l� �`� S(�i�I
/Jr� C Tyl STATE c Z-",' 7 J , I PAX
e 1 �e �(/� L.'?.QT hAo
Co\--ACT
cam=—'TF�DP S I nk-IS, Z? FFA
O'vFn� ❑ OV, .rr•3L-_D ❑ OJ,T AC= i CO 4COiZ ❑COri�CTOR kChT ❑ A.?,=--CT E3 Na FEF El --o
OP? ❑ e_FSI
CG?� i� 02Ai� V«—ToI I C�S's)iJl,raE� c?O�t I C'^E 13uS.LICr 3Z���
CO) DR�1'\E�. Pl�rnb7� I i✓a� I FAX
S-==7ADi)parly,STA:s,ZCVper�,O() CA q j
1Uitp 6 Ivn ert O
2C:�,EC GLT� R\PN? I L)CE\SE).*tA BIZ. I BUS.Uc
CONY f?t'Y l i I Frl✓ik Z FAX
ST?.---T ADDRESS I CITY,STAT a,ZIP I PHO B
USE OP _�o;D JPLc ❑ NJLiI-FAt✓II Y pRO:.t=P�VIII DL_1,M Y rS PROJ-Z=N, ❑YPS IS
BLDG AN ❑�/liS
3L Tin G: E]COi✓ CLiLI.Li3PN ITT-R'rAC AP 4 ❑ 0 I PL60D ZOIC �AO uCPtr�e HOl�? 6E D
DESC?.IPTIO\OF 1TWORK
PL
OF SE��� �9-4-reu P
70 i — P"OPL,2- Lzt, -
/,it/ 7 Z-. t v-, C L p 9/vo:15 ,Z' L i
Fa J12(,:� vG%7,lz Ss P/Pe- C�
VN/)tYL ZY- Ox-lVE(,V
70Tf T VL 1LJATIO\—t V 0(�
B-
V my -e C-------iFFFFFFO'''"���w,Ito each o the following: I E.m u:-propt-ty o,-mnr or uzhoi,ud apTit to ECi On the fropeMY o'.;,ier s behalf. I have r--ad&r's
_pp,.cien nd the:inc-;a�;on I have pro-,:;d.-d is c -w. Th,-,le r-'a the Descrip'tdon of)Mork and it is a=2Fe. i :0 CoIIDiy R7th aliapp_;c�h
ie ioCai
ding cmsto:diaancaad e,aas;elan, sesea:arive
of Cupe iao:o enter ibe abo ide �. ? :� `or pec:ion p_, >-s.
..i`�-.'.()1 AT1Iii�..�IL�^'CPr:t: L(1�) alei�� -
SL�Pigh �rt ....................
Tom= -�����
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
9 ADDRESS: 10549 san felipe rd DATE: 08/21/2014 REVIEWED BY: Mendez
APN: BP *VALUATION: $10,000
'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE:
WORK ro ert line clean out
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1 PRSEWER 1 # $25
TOTALS: $25.00
Plumb.Plan Check 0.0 hrs $0.00
7',<7. T _r efit Fee: Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $48.00 Cit3e>i`I �� Itrs'.
Plumb. hasp. Fee
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'1 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/131 FEE QTY/FEE MISC ITEMS
P"c,;'? 01cck 1 zr :
PME Plan Check: $0.00
PME Unit Fee: $25.00
PME Permit Fee: $48.00
,Xsti irc ���; l.t:te
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: 1BSEISMICR $1.30 Select an Administrative Item
Bldg* Stds Commission Fee: 1BCBSC $1.00
® 5, ' $168.30 $0.00 TOTAL FEE: $168.30
�x
Revised: 07/10/2014