15050131CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20966 ALVES DR
CONTRACTOR: GOGO ROOTER
PERMIT NO: 15050131
OWNER'S NAME:
SAN JOSE, CA 95132
PHONE NO: (408) 282-7026
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E-] COMMERCIAL E]
REPLACE (E)TUB AND LAUNDRY DRAINS IN TO
License Class S. G Lie. 59b? C/
BUILDING SEWER
Gl
�l�E'�1"" te` A - L" ►'Y 3!'7R AA.dra"A? n171:1,M1 1, ?4iI
Contractor /`., /' ,. �_ Date
a) ,I .? ' : t _ URI-E`E
I hereby affirm that I am licensed under the provi roiis`of Chapter
\\
(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: $5900
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32631005 00
Occupancy Type:
ection 3700 of the Labor Code, for the performance of the work for which this
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 QFKff1UWT 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 sav+e180
DAYS F ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgmen
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will compDate:with
all non-point source regulations per the Cupertino Municipal Code, Secti
- OOFS:
918.
r
Signature Da_ter= _ - � 1
All roofs shall be inspected prior to any roofing material being installed. If a roof is
7
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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for theerformance of the work for which this
p
Owner or authorized agent: Date: {:
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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
20966 ALVES DR
DATE: 05/26/2015
REVIEWED BY: PAUL
UNITS
APN: 326 31 005
BP#: 15050131
"VALUATION: 1$8,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: PRWHEAT
WORK
REV #1 ADD WATER HEATER REPLACEMENT TO PERMIT WATER HEATER FEES ONLY AND
SCOPE
REPIPE OF HOUSE p
APPLIANCE / EQUIP TYPE
FEE ID
Plan Check 0.0 hrs $0.00
QTY
UNITS
ES
Elec. Permit Fee:
Water Heater
1 PRWHEATR
(other f le;c. Ins.
1
#
$29
Permil Fee:
Re -Pipe Interior
1PRREPIPE
1
#
$14
PME Unit Fee:
$43.00
PME Permit Fee:
$48.00
Consiruction Tar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fees:
TOTALS:
Travel Documentation Fee: ITRAVDOC
$48.00
$43.00
$1.04
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 vrelimina information available and are only an estimate. Contact the Dept or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
Llech. Ilan C'hc:ckPlumb.
Plan Check 0.0 hrs $0.00
Iilec...l'lan Check
itle& I'eraW Fee:
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fee:
thher Hec•h. Inst,.
Other Plumb Insp. 0.0 hrs $48.00
(other f le;c. Ins.
ttech. Insp. Fee:
llhuilb, Insp. Tec:
0ec. Inst:;. 1"ce:
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 vrelimina information available and are only an estimate. Contact the Dept or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Sz, vp1. Pt::' Fee
PME Plan Check:
$0.00
Permil Fee:
Saspp/. Insp Fee
PME Unit Fee:
$43.00
PME Permit Fee:
$48.00
Consiruction Tar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SITBTOTALS:
$186.04
$0.00 ` . TOTAL FEE:_
Revised: 05/07/2015