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14090009 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7603 KIRWIN LN CONTRACTOR:GOGO ROOTER PERMIT NO: 14090009 OWNER'S NAME: JOBS PATRICIA A 2530 BERRYESSA RD STE 509 DATE ISSUED:09/03/2014 OWNER'S PHONE: 4084990920 SAN JOSE,CA 95132 PHONE NO:(408)282-7026 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL REPLACE LAUNDRY&KITCHEN DRAIN LINE TO License Class Lic.# q31 o 3 IU FOUNDATION It � L f� q Contractor (;TO 0 tLOC��[f Date ONLY I hereby affirm that I am licensed under the provisions of thapter 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:$3800 ave and will maintain Worker's Compensation Insurance,as provided for by Stion 3700 of the Labor Code,for the performance of the work for which this APN Number:35921010 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 WITHIIN 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 18 S FR A 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 grantin this perm . dditio lly,the applicant understands and will comply Issue a e: with I non- oint so re e regul i ns per the pertino Municipal Code,Sec i n 91 L RE-ROOFS: Si atur Date 1 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 UILDER DECLARATION Signature of Applicant: Date: I hereby firm that I al exempt from the Contractor's License Law for one of the folio ing 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*AA or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by Quality Management District I performance of the work for which this permit is issued. will maintain compliance ticipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cod ,Sec ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agDate: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'sCompensation laws of California. If,after making this certificate of exemption,I CONS G AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there isonstruction le ding agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permits 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 9 18. Signature Date GENERAL PERMIT APPLICATION �e�MEP ,._ COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 0 70300 TORRE AVENUE• CUPERTINO, CA 95014-3235 (403) 777-322B- FAX(40B)7777-3333•building cuoe fino.oro M I s LL�✓3II�G ❑I.�Cti�ZCAL ❑ELECT-PJ Ca.L N-1.�SCELLANuiOUS PRO!---CT ADDRESS KI Ir LAI A T A 3S9 / Z r o ��`i b o I _-V-kr- r- COIv?ACI NLi�V �` : o� 9 6 Ve ct FAX //4C ❑ ova ❑ OV \ .- 3liIID ❑ o�'T tAG�? C0� -':RiOR ❑C01 rp-kCrORAGI ❑ F. =-,.CT ❑MM,-m 7, ❑ r) 0pHr, ❑ -K,a,-r CO1�T?kCTORI�AIJ:: /'� ,` � �r I LICr'T'Sfih �� I LICiTSEi:'?Eli �b 1BUS.LIC r cob OASYnv,S.- (/► ,[]/ I n� I F WAIL I IA i cel D l.�►(� V�.c�/'�^`�►X C) srAI-� >P 60 Cr I�L?l -- 7 ( J e.re a o ARChTiECt/r<�GIhT�RTT.�I I LiCcT'SENU2�'rR I Sp- BUS.LIC; CON3ANYI�??S1J£ TrIJfII I FAQ STR-=-T ADDRESS CrrY,STATE,ZIP I PiiOI t USE OF ❑SFD or DUP= ❑ MULTI-FAMILY I PROJECT LN WMDLAI.'D ❑ YES I PROJECT W, ❑YES I IS=—BLDG kX ❑ Y S BUILDNe. ❑COMMBP.CLkLUr BPN JT t�iFA AREA ❑ NO FLOOD Z02-ZE ❑].0tiCr3-R HOI�? ❑ NO DESCRIPTION OF WORK � CG��✓� �"1 01.1 I/� � ✓� • TOT V e T UA11ON: �-- w�F Lr�: Y• _ - e By my signature below,I ce ' to hof qhs follo;vn� the property o;;rer or authorized a--- ` act en Lte pro e,alf. I have read this application and he info-n pion I have rovided ^t h we r� - - SC-Urate. I a�Tee to cemaly vri h all applicable local Ordinances End State laws elatina t0 bu din co U hOrlZe reDresenta i, Cupertino to enter the above-i eritL_d propel 1� f0i LSpec'Cion purposes. Sika ireof:_pplicanvA� nt: Date: 3 T TAL OR�LkTION REQTJ -D . EM IE = '. 1EPAdisc,.pp 2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 7603 KIRWIN LN DATE: 09/03/2014 REVIEWED BY: MELISSA APN: 359 21 010 BP#: *VALUATION: 1$3,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPDP USE: p PERMIT TYPE: WORK REPLACE KITCHEN DRAIN LINE TO FOUNDATION ONLY SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Drainage 1PREPPIPE 1 # $48 TOTALS: $48.00 �ftc 1 _,�l C �cb Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT '< L OtherPlumb Insp. 00 hrs $48.00 {�:�,�, r,< 1>as�,. Lj't ?;zsp. i;�E-:_ F'hini,} liral. Fee. Ncf. G s � i!"C. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS Lee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS stinpl, PC PME Plan Check: $0.00 Permit P'ce: PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: 1TR4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg?Stds Commission.Fee: IBCBSC $1.00 V-JAW1, 02 MOW $190.50 $0.00 TOTAL FEE: $190.50 Revised: 08/20/2014