15110028r
10
"';` •} t,;,..` :' ,,!: ,: `. CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADb.RESS I0332`STERLING BLVD
CONTRACTOR: TATS INC DBA MR
PERMIT NO: 15110028
ROOTER PLUMBING
OWNER'S 1�AME S AUL?R)`�I .ALT EN =
2827 AIELLO DR
DATE ISSUED: 11/04/2015
OWNER'S PRQNn 40872$1027
SAN JOSE, CA 95111
PHONE NO: (408) 227-1630
13? ' = t LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL ❑
License Clas(s� F , ,, Lic. #
EM OVE AND REPLACE PROPERTY LINE CLEAN OUT (SUNNYVALE
ITARY).
_
Contractor 1 " 1` ;1�'` 1 L.tJ Date
I hereby alt as am!hcensed under the provisions of Chapter 9
(commencing with e; 0) of Division 3 of the Business & Professions
Code apd`that` lrcenso:iSA full force and effect.
affirm one the following two declarations:
I hereby under, lienalty of perjury of
I have hnd,yWill indultam a 00 icate of:consent to self -insure for Worker's
Comp,e,ps }on, as'Iprovided for by Section' 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $3900
performance of the work for Svhicli this permit is issued.
I have and4will maintain,—".. 'er';s Compensation hisurance, as provided for by
Section 3700 of the J.,abor Code,:for the performance of the work for which this
APN Number: 37524014.00
Occupancy Type:
I
Permit is issued °
I c r II+`" I1 ( APPLICANT' CERTIFICATION
I cem€ytliat I have {cad this'applicahon and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct +I,agree tol;comply.wtthi i city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building constriiiuction; Mii,Nand Hereby authorize representatives of this city to enter
upon. the`above„inegtioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemA44nd.k�ep-harmless the City of Cupertino against liabilities, judgments,
land) expenses may ,accrue said City in consequence of the
..{{
costs lwhich' against
Issued by: J�N / G� Date:
grantmg:ohhis: erm”-itl' Additionally,`the applicant understands and will comply
4..
with''all non -point sburce'regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
G Signature. Date 1
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.
❑ I '�l` i'+OWNER`-'BtJILDERDECLARATION
ji , 1
I hereby;'affirmY'that I am!ezempt,from the Contractor's License Law for one of
Signature of Applicant: Date:
the following t*#, reasons i� { , ,
I as' olviie lof the property; or'm' employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do,tha, wurrc; and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code :
I, asowner of theixope,lty; am exclusively contracting with licensed contractors to
!
HAZARDOUS MATERIALS DISCLOSURE
to
construct the pr§j (Sec 7,044, Business &Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
I herep�,i „}r un�le�1penalt}t of penury one of the following three
'; i `
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declaratiops;{�; t{i„}; ;il,hhml ! ;.. :. •, , .. -
I havdindi will man?tam a,eerttficate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
Com�ensat�0. as p� oAded for by Section.,3700 of the Labor Code, for the
i. + I y
b`,ttl� w)}iph this is'issued.
air contaminants as defined by the Bay Area Air Quality Management District I .
will maintain compliance with the Cupertino Municipal Code Chapter 9.12 and
P P P P
performape, WarkOr permit
I Mire d 1 intazn Woil eri Compensation Insurance, as for by
the Health & Safety Code, Sections 25505, 25533, and 534..
provided
Section OOrc�t e iIA6r, Code, foi the performance of the work for which this
%
T. h I
permit is issued, + lll 'g'I +a
Owner or authorized agent: Date:C
I certifyaat m thre'>}�erformance bf the work fof which this permit is issued, I shall
not employ anylpeisort m ahy Imanner so as to become subject to the Worker's
t +' i
Com Cal> fgI' a I,f, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
pens' ationlEtaWs+, of
beco e!9"lcfitd the+�Wor ,e Compensationprovisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
4s
f0 th shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
ith'comply w such” rovjsions or'this permit
l�� <'fil F ,'`I I;,' l
f'i� I' I '`
Lender's Name
I .i I
ICANT CERTIFICATION
Lender's Address
is that the ab ation is
tce'to
coral thwitli allc ihoand come ordinances and staove te laws relating
correck+j al county
�, ty
,+ . ,. ,py, ,.
to building construction; ai d'A'dbby authorize representatives of this city to enter
upon the above; ei�tFoned'property for inspection purposes. (We) agree to save
indemnify, k ep harin1G§s thq'City of Cupertino -against liabilities, judgments,
ARCHITECT'S DECLARATION
and
costs and. exper►sesI�whic 1nay accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of tlusl ermit. Additionally; the applicant understands and will comply
with i� non point sourceE�reguiations.per the Cupertino Municipal Code, Section
Licensed Professional
A
r
Sign��iire9.
3 ' Date
!i' 1-A. �4,l, + a `
CUPERTINO
MOW
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMiENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build in0eCUoerino.orgM. I
/,�7j / 6(,1) gs
LUA/LBIIv(a ❑YMCRIkNTICAL ❑ ELEC—IMCA—❑1\11SCELLANTEOliS
PROT CT ADDRrSSV C)�Q Vk U1 k vA I AP?N
= / %� - e5? Al 'O /
OZNTiR TAME _
I Pl/ /�
' l� ?
]✓�= ��
STREET ADDRESS �� Y
�
STAi�, QIP
` I FA..X
� �
C
CONTACT 1:. J,E I PHCN3
E-?�LSII
STREETA.DDRESS
I CITY, STATE, ZIP
FAX
❑ OWI, -k ❑ ORR F.R-BUILDER ❑ om\-E:tAcEi,-r C0\7?,ACT0R ❑ COYT ACTORAGDE 'T ❑ ARC -F=' -CT ❑ ENGWz—rR ❑ DE\ELOPER ❑ T'_NSTi
CONTRACTOR T?J\-=- � � / l I � �E'��SE :�ti'h E
/
� I LICTSE i�'PR , /
I BUS. LIC
COI✓3ATYTA✓
E -NSR,
FAX
STREET / TSD
CII
IZI/dam G�
I PHOG�
.RCMECT/EI -GitiEERNAME
LICENSE NWBER
BUS. LIC r
COWANY \AIJ,
E-IJAR.
F a
STREET ADDRESS
I CITY, STATE, ZIP
I PHONE
USE OF ❑ SF7 orDU?LE". ❑ bRiLTI-FAMILY I . PROJECT LN wIIT)LAND ❑ YLS
?ROiLCT LN ❑ YES
IS THE BLDG AN ❑ -n:S
BUITDL\1G:❑COhC•��'CLA UR3PNL�TERFACLAREA ❑ TO
FLOOD MIME El ),m
EICFZERfiON.2? El ] O
I
DESCP.IPTION OF \FORK
\ r
A\J'- �
U N
L �1
TOTALVALUATIO'\; UR
C 1'FDL]
By my signatu-e below, I ce-ti y 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 correct. I have - he Descriptor of \rTork and ve iLy it s zccurte. I agree to comply with all applicable local
ordinances and state laws relating to build' construction. I e representatives of Cupertino to enter the above -identified propel'y for inspection purposes.
Sika ure of,'pplic�ntlAgent:
Date: l �� `�(� 1
4
T t— I t I
Si� P_EA4Elt r�
't TAI _'FORvIATI01\ REQLIRED
s_ F y
'
_ _ -
x.
OFF;dCELSE E4. -K ,, Nos=
3
a
i S r m .
1<,j'EP3�173C,lDp_2011.doa remised 06121/11
CITY OF CUPERTINO
FFF. FCTTMATnR — RUII,DING DIVISION
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer; Sanitary: 1 PRSEWER 1 # $25
TOTALS: $25.00
ADDRESS: 10332 Sterling Blvd
DATE: 11/04/2015
REVIEWED BY: Sean
t !ilech: F'ee•mi[ Fee:
APN.'
BP#:
*VALUATION:
1$3,900
*PERMIT TYPE,: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY'
USE:...: SFD or Duplex
Elec. Insp. Fee:
PENTAMATION 1 RPSS
PERMIT TYPE: A
WORK.
Remove and replace property line clean out (Sunnyvale Sanitary).
SCOPE -
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer; Sanitary: 1 PRSEWER 1 # $25
TOTALS: $25.00
NOTE:. This,•estimate does not includetees due to other uepartments (Le. manning, ruotic moms, rlre, Junuury newer -s-ria, 1—L
L---.4 -- 41.. and aro nnhy an octimato_ rantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
L1ech In(an C heck.
Plumb. Plan Check 0.0 hrs $0.00
Elcc..Plan Check
t !ilech: F'ee•mi[ Fee:
Plumb. Permit Fee: 1PPERMIT
Elec. Perm Fee:
it
Oiher, llech: Inr .Li
..� ,• 5;
Other Plumb Insp. L2. hrs $48.00
Otlier Elec. Insp.Li
:i1i c{z Inst', l ee:,
PhimG. hup. Fee:
Elec. Insp. Fee:
NOTE:. This,•estimate does not includetees due to other uepartments (Le. manning, ruotic moms, rlre, Junuury newer -s-ria, 1—L
L---.4 -- 41.. and aro nnhy an octimato_ rantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
Phan Check Fee:
5'upp'G.;.PG I'ee i a
'PME Plan' Check" •
$0.00
Per. nit Fed
PME Unit tee:
$25.00
,PME,'Permit Fee:
$48.00
i � 1 •,, 1 I
C;oristi ucti,r?,n17'n�
Adiniriistrative Fee: 1ADMIN
$45.00
Work,Without:Permit? Yes No
$0.00
Advancecd PMn in"' Fees::
Travel'Documentation'Fee: ITMVDOC
$48.00
Strong1!Mtiori'F,'ee':; IBSEISMICR
$0.51
Select an Administrative Item
M& Sids! Commission Fee: IBCBSC
$1.00
I.SUBTOTAL5xs
i
$167.51
$0.00 TOTAL FEEi
, . tai
Revised: "10/01/2015