15080035CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7512 WATERFORD DR
CONTRACTOR: TATS INC DBA MR
PERMIT NO: 15080035
ROOTER PLUMBING
OWNER'S NAME: HOUSER CHARLES W AND ANN TRUSTEE
2827 AIELLO DR
DATE ISSUED: 08/05/2015
O R'S PHONE: 6507993252
SAN JOSE, CA 95111
PHONE NO: (408) 227-1630
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL (1) CLEANOUT AND REPLACE 35' OF BUILDING
License Class_ Lic. #
SEWER LINE (CUPERTINO SANITARY)
(LU'Y� Q� uw� iw� ' (�
'
Contractor hn(� Date Qj
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
SANITARY
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
Sq. Ft Floor Area:
Valuation: $8500
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: 36616016.00
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 OF PERMIT 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 LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
�0
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source re lations per the Cupertino Municipal Code, Section
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
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 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: U `
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
.11
CUPERTINO
GENERAL PERMIT APPLICATION /�Q��,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildincecu0ertlno.Org
LJ rI.UMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLAABOUS
PROJECT ADDRESS I APN n
1
OVJ1 ERNA1vIE PHOly EMAIL
�,� 9 .32
STREET ADDRESS
CITY, STATE, ZIP FAX
CONTACT NAME PH09. 0 r �C r ZJ E-MAIL
STREET ADDRESS
CITY, STATE, ZIP 5 C
L
FAX
�
Jer / OWNER ❑ OIANTER•BUIIDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARcarl-ECT ❑ ENcinm R ❑ DEVELOPER ❑ T _N.. f
CONTRACTOR NA.A4ELICENSE NUMBER LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
I FAX
STREET ADDRESS
7-211 0o
CITY, STATE, ZIP
? 0 A1lI
PHONE
o ,ZZ
ARCETECT/ENGINTER NAME LICENSE NUMBER
BUS. LIC n
COMPANY NAME
E-MAII.
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMII.y . PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
BUILDING: ❑COMMERCIAL I URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ No
IS THE BLDG AN ❑ 1 cS
EICHLERHOMEI ❑ NO
DESCRIPTION OF WORK
GL
TOTAL VALUATION:931, EI
;'�r c.r LstNt�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is orrect I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lad's relating t ilding c traction. I authorize representatives of Cupertino to enter the above -identified prope for inspection purposes.
Signature of Applicant/Agent:Date: & ' 5-e I
SUPPLEMEN AL INFORMATION REQUIRED
-
+�F.1rSCF�i,SE0NLY
?Y
:I2 THE COI \ LR
EMIRE
MEPA1tsc,4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO 1 6030DEs,
FEE ESTIMATOR - BUILDING DIVISION
611
ADDRESS: 7512 WATERFORD DR.
DATE: 08/05/2015
REVIEWED BY: PAUL
UNITS
APN: 366 16 016
BP#:
"VALUATION: $8,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY
SFD or Duplex
USE:
7
PENTAMATION
PERMIT TYPE: 1 RPS
WORK
Install N cleanout and replace 35' of building sewer line
SCOPE
Satppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
Elec. Permir ! .
Sewer, Building
1 PRSEWER
Other E1ec. Imp.
1
#
$25
Sewer, Sanitary
1 PRSEWER
Satppl. Insp Fee
1
#
$25
PME Unit Fee:
$50.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: LI DMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$50.00
Strong Motion Fee: 1BSEISMICR
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 preliminary information available and are only an estimate Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
Mech. Plan Check
Plumb. Plan Check 0.0 1 hrs $0.00
Flec. Plan Check
Plan Check Fee:
Plumb. Permit Fee: IPPERMIT
Elec. Permir ! .
Other Alech. hop
Other Plumb Insp. 0.0 hrs $48.00
Other E1ec. Imp.
iilech. hulz Fee:
'howl? '�zsp. Fl!
I.lec. Insp. 1,ec
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 preliminary information available and are only an estimate Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
aSuppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Satppl. Insp Fee
PME Unit Fee:
$50.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: LI DMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$1.11
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $193.11
$0.00 TOTAL FEE:
$193.11
Revised: 07/02/2015