The URL can be used to link to this page

14120111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18640 CYNTHIA AVE CONTRACTOR:ARROYO PLUMBING PERMIT NO: 14120111 AND DRAIN,INC OWNER'S NAME: JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] PROPERTY LINE CLEAN OUT-SUNNYVALE License Class C-.3 b Lic.it c(3 X13 S D JURISDICTION Contractor Date k2'` -V-t. I�) 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 th�i4ermit is issued. Sq.Ft Floor Area: Valuation:$3500 1 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:37522029 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 1 AY ERMIT 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 DAYSLAST CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1 a� costs,and expenses which may accrue against said Ci in consequence of the / Date- granting of this permit. dditionally,the plicant un erstagds and will comply Issued by: Date: with all non-point so a regulations per he Cupert Municipal Code,Section 9 18. i V t L ZZ I - 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 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) 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/.ea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the C ertino MumcijPTode,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectiong 505,2553 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:t Z Z2 t t 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 9 18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,1\` �/ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ` lb wMISC CUPERTINO (408)777-3228.•FAX(408)777-3333•buildingCcDcupertino.org , � In PLUMBING 1 MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS (� (1 0 C y, S � /►U �I APN# OWNER NAME lJ� l� y FAX (` CONTACT NAME PHONE r,� r ` �j� E-MAIL STREET ADDRESS CITY,STATE,ZIP Q FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME4L3f,. LICENSE NUMBER q LICENSECYPEy BUS.LIC# COMPAN NAMEu�4 I �y I J ` > tJ 1wlE-MAFAj ��1 ✓LV�` �, �� G✓ ,�Vvo J` l�lh��Ott ..c.s1-en \D� STREET ADDRESSll CITY,STATE,ZIP 0 6S-0 ��cb1 ,, ve syr U _S'jy\. to -Z't ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �r TOTAL VALUATION:3 By my signature below,I certify to each of the owing: I am the prTe Petror authorized agent to act on the property er's behalf. I have read this application and the information have pro s correct. I have r d the scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building on truction. I aut rize r esentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 1 Z' Z? `�'i SUPPLEMENTAL INFORMATION REQUIRED OFFICE osE Orn Y,;,...e .x e<D OYER THE-CQUNTER s ", mEXPRESSx tO_EIN � STANDARD` x' `t a T". Z u �` xr� a ,PAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 18640 cynthia ave DATE: 12/22/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$3,500 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPS WORK � ro erty line clean out- sunnyvale jurisdiction SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $25 TOTALS: $25.001,1111, I 1.-E:r. Plan Chef-"'t Plumb.Plan Check 0.0 hrs $0.00 A/ec- Plan C<e<' Plumb.Permit Fee: IPPERMIT . Icfh. F Ftp- Other Plumb Insp. 0.0 hrs i-lr�'a Ins'}: '5r::- 1'r'zsruh, tr��J. t•r�; /i�ee. dn��. t�e: NOTE: This estimate does not include fees due to other Departments(L e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These _f -fees are based on the relimina information available and are onlyan estimate Contact the De tor addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS ff PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $48.00 7' Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 P/urmirig Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 F-0 -1 # Revisions Bldg Stds Commission Fee: 1BCBSC $1.00 $0.00 IREVCOMTI Tenant Improvement n 1 $167.50 $0.00 ` TOTAL FEE:` $167.50 Revised: 10/01/2014