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14100171 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10741 N WOLFE RD CONTRACTOR:PROS PLUMBING& PERMIT NO: 14100171 ROOTER OWNER'S NAME: QUITO HOSPITALITY ASSCS LLC ETAL 117 BERNAL RD STE 70-205 DATE ISSUED: 10/28/2014 OWNER'S PHONE: 4087778787 SAN JOSE,CA 95119 PHONE NO:(877)544-7767 LICENSED CONT'RACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL HILTON-REPAIR SEWER&GREASE LINES IN(E) License Class — Lic.# �A/ KITCHEN Contractor ©5 1/L(/�IYJ(/1(.� Date �U 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9500 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:31645015 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 O IT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter LA LED INSPECTION. upon the above m tinned property for inspection purposes. (We)agree to save 18 indemnify and ke harmless the City of Cupertino against liabilities,judgments, costs,and expe e which in y accrue against said City in consequence of theed-by: Date: —� granting of thi pe mit. A rti ally,the applicant understands and will comply T with all non- in sourc a tions per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature DatAAAl 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 Date: Signature of Applicant: 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' OR BETTER 1,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) property,am exclusive) g HAZARDOUS MATERIALS DISCLOSURE I,as owner of they 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) ould 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 a ment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B y rea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the u rtino . ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 2 05,2 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater, /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 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 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 9 18. Signature Date _ 3 sNER."j . PERWIT APPLICATION \�� MEP COMMUNITY DEVELOPMENT DEPART1diENT•BUILDING DIVI5101•41 1D 10300 T ORRE AVENUE• CUPERTINO,CA°5014-3255 1� (408) 777-3228•Pfix(403) i7-333"s•buildina6-cuoeno.ora m 1 PLU?J�'1iG ❑1acaA1,iC.,L ❑ELECirticar ❑1.15 CE:,:-,AN- OUS As , lvr/4 ?6�c 4i4a=yap 1-17 iV CTtic�E>0?..?SS COIv_ACT]ETr• � I P� .. '7(PC�•;7! � I :]✓ams ST?.Y-;A"DDp. Sg GTS,5?Sin ZI? 1 O'v: ❑ OV?1—t•3i�� ❑ 371=z,tQ.i ❑ CO\ 4CsOrZ ❑COh 4CCOR�CI.? ❑ eaC CS ❑mma'a-m ❑ Dom%- 0?? ❑ -?KWI CG 4CTORI\A.kzs �l`J� I liC�S'n LT1 / T IC S_i n 13i_iS.LICZ� 41r 3 Col,fDE?�nl T 4Ns5 I p_t✓t r k" Pro r5 �� sTF.-r.sDD�, .�s/ -Y7y BUS.Lrcz coI�DAI.*r r 4�r= I I;I�.ta I FAX S-1?,--'T ADDF.SS I CITY,STAin,M I Mo\S 'USB OF ❑Sm or Dun= ❑ 1f'mn.Fm' Y I FR07-Za L*t WII_DLf\M ❑ YES I FF.OTr.C•I N' ❑Y:.S I IS T_^=BLDG AX ❑1:s SLLTDL C. ❑Col^C?CL4L IMANIh�-rACZ-ARZEA ❑ I 0 FLOODZ.Oh. ❑No �,CT11Z301 ? ❑ n0 De�ScFjpnc):N or WORK . _ , TOTFT\;eTUAitO: _amu __ � B. -my Sif_;at re beIm+',I ce iry to e. h L}7e I011 i�-1g: I n the property 0wmer or?uihariud agent to 2ci 07 r �w+"'y Oh, r s eh lf. I have read�n1S application and the info:.:+a ion I hp--,,p pr vided is o- I have re=d the Description of)%,cork and ver;it is nrnrata. i a_-ee to co-rply with all=oalicEble local ordinances and smote La+s relating to til 's_0 �: n I avtho;�e representa fives of C�pertin0 t0 enter she above-id/��r_a_ied prope,:�+for s?eoren pu poses. S i 01:_pplicar,t/.A pn.": Date: rr SU-PPLEV rs.P-lr0t2N!ATIO'-N-RE-•QTJ -D MEN AM _MEN ��:.. �_a Q w A�Ph!'sclpp_2011.dcc r_v:sed 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10741 N WOLFE RD DATE: 10/28/2014 REVIEWED BY: MELISSA APN: 316 45 015 BP#: "VALUATION: 1$9,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 CPS WORK HILTON - REPAIR SEWER & GREASE LINES IN E KITCHEN SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PCSEWER 1 # $25 Sewer, Building 1PCSEWER 1 # $25 TOTALS: $50.00 Y ale %t. Pkari 0Ywc k Plumb.Plan Check 0.0 hrs $0.00 Ja:Jecr.11r'far ChC$ f�>cl?. 1""rin d Fee: Plumb.Permit Fee: IPPERMIT oil,cr;11c,"h, 7rtsrrLi Other Plumb Insp. 0.0 hrs $48.00 {;,Ener•1 rr._ j sp. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . These fees are based on the prefinddna information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $50.00 PME Permit Fee: $48.00 ("Onstritztion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes (j) No $0.00 J<xz°E.r,zc<c, ' clritn,r 1'e'.e5. Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $2.66 Select an Administrative Item Bldp,Stds Commission.Fee: 1BCBSC $1.00 $194.66 $0.00 : TOTAL FEE: $194.66 Revised: 08/20/2014 �ryc Ss�b2 ��Q ' vJbcv. . soc-o/- -p� I v vj-�q z?I 6`V_I'm T21 I As pannalna� 30NVIldW00 3000 230 Q3M31n323 eda(3 bu1p1pb t4l\ AdOO c�h3� I -amt's Jamas g # W�� 7 ;� ,� ,�4� --g L.;- e1 �° ° �. ve uE�e,r.�.a '• +�u°a� � Q � v °� SNS`',`'°:• �Uti vao�1� Svo+a�'`,\:,�v��s�p as�,+u� 9� 1� -41d Gu, .'� o �� N 6v`G�+off•4`v�S uo SUS 1�n CH 4X �Q� �� �JFcj '0 '