The URL can be used to link to this page

15120149CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18644 LOREE AVE CONTRACTOR: TATS INC DBA MR PERMIT NO: 15120149 ROOTER PLUMBING OWNER'S NAME: TED SUL AND AMY CHENG 2827 AIELLO DR DATE ISSUED: 12/16/2015 OWNER'S PHONE: 4085296109 SAN JOSE, CA 95111 PHONE NO: (408) 227-1630 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REPLACING 3 FEET OF SEWER LINE BETWEEN _ License Class`s Lie. 4 �g� ��% S PROPERTY q � Contractor & \ AL Date A& -1 � — k � LINE AND BUILDING AND INSTALL (N) PROPERTY LINE ;T+t CLEANOUT. 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. 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: $4400 I, have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37525070.00 Occupancy Type: Section 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 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 DAYS FROM LAST CALLED INSPECTION. 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 b Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations Cupertino Municipal Code, Section 9.18. �_ � + � � Signature - /f Date RE -ROOFS: 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 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 O5, 25533, an 34. Section 3700 of the Labor Code, for the performance of the work for which this , , 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 4 CUPERTINO` GENERAL PERMIT APPLICATION C0N)IMUNI TY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (4-08) 777-3228 • FAX (408) 777-3333 • buildinoO)CUDertino.orcl �PLTjl\�DNCT ❑MECHa:NICAI, ❑ELECTRICAL MISU rblooi qq ❑ A asCELLAu\TEOUS PRorCTADDPEss e CPN OWTiR1�A�J-E� PHOT\ jrIlPP {( � I i=-I✓1.�Z Y - �� ADDBESS ICITY ,euT F:XSTREET 1044 Y co?:TAcr I A E ►(� KV`QZ J C PHO: 46 q30- bq�� E-I✓�Lt STREET ADDRESS CITY, STATE, -ZIP FAX ❑ ov\-_,2 ❑ ovm-,_Burzi-p ❑ OR'I.atACm\'T I\COTTIRACTOR ❑C0K-lMkCTORAGM= ❑ ARC?=CT DE�cLOPER ❑ TcNS1� CONTRACTORNA.], UV�e LICE QSENUAf � ,, llLz I LICENISETYPE n I BUS. LIC= C01d�PA2`Y 1::S1J�r� � E -NAIL FAX STREET ADDRESS ' CITY, STATE, ZIP PHONE AaCIETECTrNGII�EER N.SA,E LICENSE .Xn=R I BUS. LIC10 C01/3A_NY Nt IC E_W__ . I FAY STREET ADDRESS I CITY, STATE, ZIP I PHONE USE Or ❑ SFD or DUPLE: ❑ MMLTI-FANCILY ?ROIECT W WU DLA )\'D ❑ Y_S PR0T.CT.N ❑ YES IS THE BLDG AN ❑ l z -s BUL DL G: ❑ CONDI=CIAL UR3A2\'121 P.FACE AREA ❑ NO FLOOD ZOITE ❑ NOEICY? �$OIJ.E? ❑ No DESCRIPTION'OF 1;'ORI: peg 6 3 claS'evU Q . TOTA.LVALUATION: Gt (> REC�Iti Dia o t` By my signati,-e below, I cer if to each of the follmvinQ: I —the prope owner or authorized ag" t to zct on the grope. �y o;; ner's behalf. zve read this application and the information I have provided is co_.ect. I � ad the Description of'Work and verify it is zecurzte. I agree to comply �;'ith all applicable ]oczl ordinances and state la;;'s relatInG to ' ildirg construction zu` Drize representatives of Cupertino to enter the above -identified property for inspection purposes. 12 — (C, Sika l re of A.pplic�n /Agent: Date: �-15- SUPPLEMENTAL Ll\TO-TU IATION REQULRED � :._�OFFSCELSEDLl ten.'_: 9x:x: %. ]OVEF THECOMTFR a ,.: DOERR, ,: pg " x� IS 1GO 3 x h Zug y"✓i. �S S� T�ZAJOR_. i Al,=_A,'I'isC,'DP_2011.do0 revised 06121111 CITY OF CUPERTINO FO-0-07FFF FNTIMATOR — BUILDING DIVISION lkADDRESS: 18644 Loree Ave DATE: 12116/2015 REVIEWED BY: Phuong al APN: 316 25 070 BP#: *VALUATION: 1$4,400 "PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex —7 # PENTAMATION � PERMIT TYPE: 1 RPS WORK Replacing 3 feet sewer line between property line and building and install n property line cleanout. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 2 # $50 r71.-., I Tr'• "��:; PME Unit Fee: $50.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: 1TR11VD0C $50.00 Strong Motion Fee:_ 1 BSEISMICR Plumb. Plan Check0.0 1 hrs $0.00 -le Plumb. Permit Fee: 1PPERMIT 7/,,., ;�. ,'t. t;J•�, Other Plumb Insp. 0.0 hrs $48.00 A'Aec:ii. zi't, t . '.:s:. 17'';x7{,J(i:. 1,"��,�� rx'cc. I ::ot'C:. t„��3,%. i't'e NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public worKs, Clre, Jallnary Jewer U[strlct, Jcnoo[ 1... .,.1 .,... 111. Cmitart the Dent for addn'l info. FEE ITEMS (Fee Resolution] 1-053 L!, -f ? IiI3) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 r71.-., I Tr'• "��:; PME Unit Fee: $50.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: 1TR11VD0C $48.00 Strong Motion Fee:_ 1 BSEISMICR $0.57 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: , $192.57 $0.00 TQTAL FEE: $192.57 Revised: 10/01/2015