15050088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10742 CARVER DR CONTRACTOR:TATS INC DBA MR PERMIT NO: 15050088
ROOTER PLUMBING
OWNER'S NAME:
SAN JOSE,CA 95133 PHONE NO:(408)271-2822
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
INSTALLATION OF PROPERTY LINE CLEAN OUT AND
License Class C Lic.4 a , REPLACE SEWER LATERAL TO HOUSE.
Contractor jr"'1 ✓2, iL " ti Date 5
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. U NNI V
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:$6000
SM I have and will maintain Worker's Compensation Insurance,as provided for by
ka Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37532009.00 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 T 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 DAYS F ED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, c/
costs,and expenses which may accrue against said City in consequence of the Date:
granting of this permit. Additionally,the applicant understands and will cop) y'
with all non-point source regulations per the Cupertino Municipal Codem
9 18.
_ = RE-ROOFS:
Signature Date J All roofs shall nspected 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,aexclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
m
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 l! 51
p Owner or authorized agent: Dat'•'
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
ADDRESS: 10742 Carver Dr DATE: 05/14/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$6,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE: i
WORK Installation of property line clean out and replace sewer lateral to house.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $25.00
77
-IF�leclf. Flan Check Plumb.Plan Check 0.0 hrs $0.00 L'lec flan Check
Wech. llejwait Fee: Plumb.Permit Fee: IPPERMIT /ilea. Permit Fee:
t)thej. /larch. Insp. ET-1— Other PlumLi
b Insp. 0.0 hrs $48.00 Oilm,Elec.Insf�.
;Wech, Insp.fee: 1'lliolb. hash. Fee: Elec.Inch.Fee:
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 Dept/or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff: 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
suppl. .PC Fee
PME Plan Check: $0.00
Pe rinit Fee:
Suppl. 1 ISP Fee
PME Unit Fee: $25.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes (E) No $0.00
,Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.78 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS-"" $167.781 $0.00 ,°' TOTAL FEE:. $167.78
Revised: 05/07/2015