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14100047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20924 ELENDA DR CONTRACTOR: PERMIT NO: 14100047 OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �r License Class C�3 Lic. # yti7 Z REPLACE SEWER LINE W/NEW TRENCHLESS SYSTEM & INSTALL (N) PROPERTY LINE CLEANOUT. REPLACE (E) Cd.' WATER HEATER, SAME LOCATION Contractor i' Date I hereby affirm that I am licensed under a 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: SANITA RY 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 Sq. Ft Floor Area: Valuation: $5000 performance of the work for which this permit is issued. 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: 32630021 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 relatin+er WITHIN 180 DAY IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to e upon the above mentioned property for inspection purposes. (We) agree to sa180 DA M LAS LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgme costs, and expenses which may accrue against said City in consequence of the Date: l d granting of this permit. Additionally, the applicant understands and will com with all non-point source regulations per the Cupertino Municipal Code, Sect 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 2 5 , 2553 nd 25534. Section 3700 of the Labor Code, for the.performance of the work for which this A Owner or authorized agent: Date: /D b •l 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 GEE NIERAL PERMIT APPLICA T IONMEP 4 .v COMIMUNI iY DFV_LOPhtEN i DEPAR IMEN i • BUILDING DIV1S101h: 10300 I ORRE r.Vtt`U_ CUPERT lt\0, CA 95014-3255 0 (-'08) 777-3228 - R?.X (403) 777-3333 - building. l -Duos ino.oro `V�\\ mist; CALL Ay, ouS Y?.GADDF SS Z o l a n�� d,, ��T 3_ 3 0- o Z S ::K–r AIDDP sSs CITY, STATE, z13 v I Cv e.- l' CO?.. CTIia�r Q,- j p / �7 — e l7 i IJ_k� O r� / 1?o�rTS ,n , I n�s�� z� 1-12- 1 2- � ov❑oa -Bt_D oE\coaoz N ' ❑ D� ToP ❑ — s r F DCENSS/ l SJ J7j 4e I BUS.L}CI G �R1\� 1V1, CC"' ' lI V L-WikSL I f k^ 1—t DRESS . ljal 67Y q S 13 b I P� Q �l � b BUS }..} COiJDf}\TYl\'Ai I B-W.A_TL STRi7 ADDP?SS I CIlY, STA711, 21P I PiiO} ,usB OF ❑ _sm or DL?L -- 2 .JLTI va Y I P&orz= LST WILD? OQM ❑ YES I PP1ojBzT �i\* ❑ YES BULT D G El CONSFu c' CL4L t1RB.AN BD i_R?AC AR A [3 NO FLOOD Z03---- [31,10 I IS TM BLDG AN ❑ 1 FS _lC3 � HOM`? ❑ ?'o DFscPiPTlox or WORK Qi' Q 7"G ✓ a / /l S� !3 ! G T o i��l� � -e�.a v� • 1 OTAIV dT UA11o. V ©� `"r-r.l �'' - -= s - - ... _a ..,='c«-,�--�'•r=�_..�c=_ L tt �V 1'ijy si Jlalle bolo\•rDei :li7l ti') a—ri:1 �r i.�'i9 r011Oii'?.ri� I Gull he props.: ty o�ii er or au Jrlw•.d Gam.'. -1 0 act Orl �� �.1��i ly - �h�^.lf I hG�'A, rP.Cd &-s application and the ido.-mation I have provided is cored I have read the Description of -Work and verify it is accsate. " to comply with all applicable local o: dinances and state la -,vs rdatLlQ to buila caoa -u ho; r represcr; a ves of Cope iao to eater ,e a/bJo - _mom/)ed prope,:� or L ec en pu pews. Slr'1GLSeQrsl�ihC.arlV!/��.P.::l. �Gte. /�' �'/ SUPPLE. rTL?�YOT A/31_OIV RE•QU� D - " �3r=.'S.7Ll• RAY =—��..-�-�." i��i']Ilisc�a�_2011.doc r_vised 06121/11 CITY OF CUPERTINO WE FEE ESTIMATOR — BUILDING DIVISION 20924 ELENDA DR DATE: 10/08/2014 REVIEWED BY: MELISSA JimADDRESS: APN: 326 30 021 BP#: *VALUATION: $5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p Other Plumb Insp.0.0 hrs $48.00 PENTAMATION PERMIT TYPE: 1 RPS WORK SEWER LINE W/NEW TRENCHLESS SYSTEM & INSTALL N PROPERTY LINE SCOPE [REPLACE EANOUT. REPLACE (E) WATER HEATER, SAME LOCATION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $25 Water Heater 1 PRWHEATR 1 # $28 TOTALS: $53.00 NOTE: FEE QTY/FEE Plumb. Plan Check 0.0 hrs $0.00 E/cc. Map C:hvacp 1•"ee: Plumb. Permit Fee: IPPERMIT t < Other Plumb Insp.0.0 hrs $48.00 C>rlr,>, t �r_ :nzt,.E3 PME Plan Check: P inib. h,,sp. Fee: lace. hnp t ,v.- v' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ The.ce fees are ha.vod an tho nreliminary infnrmatinn availahlo and Oro nnk an actimnto_ ('nntart tho Dont fnr addn'1 info_ FEE ITEMS (Tee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS r PME Plan Check: $0.00 hisp Fee PME Unit Fee: $53.00 PME Permit Fee: $48.00 (Ion.,;o cti.;n �i.Y.' Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 g S $195.65$0.00 :: TOTAL FEE: $195.65 Revised: 07/10/2014