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15090028CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18631 STARRETT CT CONTRACTOR: TATS INC DBA MR PERMIT NO: 15090028 ROOTER PLUMBING OWNER'S NAME: YUEN CINDY H AND SHENG SHINAN-C`HUR 2827 AIELLO DR DATE ISSUED: 09/03/2015 OWNER'S PHONE: 6502833799 SAN JOSE, CA 95111 PHONE NO: (408) 227-1630 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (N) PROPERTY LINE CLEANOUT /'1 2 r / License Class C 3 Lic. I! �� b Z S *W94WvvMt4K S j y' • Contractor y 1� r \ �6 _ Date 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. Sq. Ft Floor Area: N'a I u a do n : $-1-100 I hereby affirm under penalty of perjury one of the following two declarations: APN Number: 37526019.00 Occupy nc� "1"� pc: 1. 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. 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSP CTION. 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 Q J /�� 3LU to building construction, and hereby authorize representatives of this city to enter Issued by: JALaDate: l upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additional,the applicant understands and will comply with RE-ROOFS: all non-point so a regulations Cupertino Municipal Code, Section 9.18. 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 Signature Date9j inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 2. 1, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will r. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. er or author'ze n 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Date: 3 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY fit, 3. 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 ereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. correct. I agree to comply with all city and county ordinances and state laws relating Licensed Professional 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date U -A CUPERTINO GENERAL PERMIT APPLICATION 150go bCY. COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building ftupertino.oro jkl,U?SING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS YROIF.CT ADDRESS / r, j C+ APN n 39756 Qj l ON IERNAME claccu Z PHOTvE E-MAIL (WET ADD �u Y STA , ZIP I FAX b 1 C CO ACT NAME P14ON E-IkkIL STREET ADDRESSCITY, STAT , ZIP ! U L FAX ❑ vmm ❑ ORR.'ER-BuJLoER 0�-QWN R AGENT ❑ CONTRACTOR ❑ CO',17 RACTOR AGENT ❑ ARC'rSECT ❑ LNGIN'EER ❑ DEVELOPER ❑TENANT CONTRACTOR N? 1 LIC 'SE NC ER LI ENSE TYPE BUS. LIC COMPANY N?AME E-MAIL ( FAX STREET Al)r S 7W CITY, STATE, ZIP 5X0 =01te CAG • % PHO / 3 t� .Z97, ARCETECTIENGNEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY (. BUIIDING: ❑COKMCLAL PROJECT IN WIL.DLAND ❑YES PROTECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLERHOM.E? ❑ NO DESCRIPTION OF WORK ,ns til� t(� ✓� �P�w✓�C� c; TOTAL VALUATIO f -have By my signature b0w,I certify to each of the following: application and the information I have provided is correc ordinances and state laws relating�;const3�41u Signature of Applicant/Agent: I am the property owner or authorized agent to act on the property owner's behalf.. I read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local arepresentatives of Cupertino to enter the above -identified property for inspection purposes. Date: 3 i SUPPLEMENTAL II\1\1FORMATION REQUIRED r ONLY - K11;1 rr MEPAIiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ILMADDRESS: 18631 STARRETT CT. DATE: 09/03/2015 REVIEWED BY: PAUL UNITS APN: 375 26 019 BP#: "VALUATION: 1$4,400 'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex # PENTAMATION 1 RPSS USE: Pcrmil F'ee. PERMIT TYPE: 19 WORK Install N property line cleanout SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check0.0 hrs $0.00 QTY UNITS BP FEES 00c. Permit F 'e: Sewer, Sanitary 1 PRSEWER t )cher l aec. hasp 1 # $25 Pcrmil F'ee. suppl. Insp Fee PME Unit Fee: $25.00 PME Permit Fee: $48.00 'onstruclion 1 �a: Administrative Fee: IADMIN $45.00 Work Without Permit? © Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $25.00 Strong Motion Fee: IBSEISMICR NOTE: 11ech. Plant Check Plumb. Plan Check0.0 hrs $0.00 !-Jec. Plan Check leclr. Plumb. Permit Fee: IPPERMIT 00c. Permit F 'e: Other ,,Ucch..fnsp.Lj Other Plumb Insp. 0.0 hrs $48.00 t )cher l aec. hasp 1 PME Plan Check: ee: /nap. 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 vreliminary information available and are onlv an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 E[ 7/U13) FEE QTY/FEE MISC ITEMS Plant Check Fee: Suppl, PC Fee PME Plan Check: $0.00 Pcrmil F'ee. suppl. Insp Fee PME Unit Fee: $25.00 PME Permit Fee: $48.00 'onstruclion 1 �a: Administrative Fee: IADMIN $45.00 Work Without Permit? © Yes (F) No $0.00 /vanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.57 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.57 $0.00 TOTAL FEE: $167.57 Revised: 07/02/2015