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B-2016-2601CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I t CONTRACTOR: PERMIT NO: B-2016-2601 7375:ROLLINGDELL DR CUPERTINO, CA 95014 (359 33 012) TRIPLE A PLUMBING SERVICES LET STINKY DO IT CORP SANTA CLARA, CA 95054 OWNER'S NAME: ROLLINGDELL LLC DATE ISSUED: 08/29/2016 OWNER'S PHONE:. 408-996-1006 I 1 PHONE NO: (408) 855-8099 LICENSED CONTRACTOR'S DECLARATION License Class C-36 Lic. #943638 Contractor TRIPLE A PLUMBING SERVICES LET ' TINKI' DO IT CORP Date 07/3172018 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's f Compensation, as provided for by Section 3700 of the Labor Code, for the ,performance of the work for which this permit is issued. z I have and will maintain Worker's Compensation Insurance, as provided for byN, f Section 3700 of the Labor Code, for the performance of the work for which this is issued. APPLICANT CERTIFICATION I certify Katelave 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 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 reguons PAr the Cupertino Municipal Code, Section 9.18. Date 8/29/201 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3760 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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 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 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 forthwith comply with sudh provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. BUILDING PERMIT INFO: BLDG —ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPAIR (E) 30 L.F. SEWER LINE AND INSTALL 1 CLEAN OUT AS REQUIRED Sq. Ft Floor Area: I Valuation: $9967.00 APN Number: Occupancy Type: 359 33 012 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 08/29/2016 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. Signature of Applicant: Date:/28 9/2016 ROOF COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as dermed by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Co , ec ' s 25 , 25533, and 25534. Owner or authorized agent: Date: 8/29/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228,• FAX (408) 777-3333 • building(d)cupertino.org PROJECT ADDRE� APnj �, D l C .� jV OWNERNAME 4E PHONE 6, Q G(G7 E MJAIL STREET ADDRESS Y%1 g�,� V CJn CITY, STATE, ZIP f'T G'11J� CONTACT NAME::f g6�PH 7 p _ G[ ✓e^ E-MAIL STREET ADDRESS -- p� _` CITY, S ,TyE, FAX ❑ OWER ❑ OWNER -BUILDER ❑ OwNFRAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT +- ❑ ARCHITECT ❑. ENGLNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1 LICENSFr ER LICENSE TYPE BUS. LIC T ZeI 1 !lU A COMPANY N.A 4ETP �r /� / ` v UJA E-MAIL FAX STREET ADD SS ��� Ula( 1 CITY, STATf, ZIP �y' P — y �- —� �J ARCHITECT/ENGINTERNA-ME LICENSENUMBER BUS. LIC= COMPANYM61ME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OFp�SFD Or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WrILDLAN'D URBAN INTERFACE AREA I PRGJECT IN ElYes Fl, NO FLOOD ZONE ❑ Yes ElNO DESCRIPTION OF NA70RK TOTAL VALUATION: By my signature below, I certify to each of the following: I ain the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have jina= co ect. I have read the Description of Work and verify it is accurate. I ap ee to comply with all applicable local ordinances and state laws relatn7s to iI ction. I authorize representatives of Cupertino to enter thefied 61 aboeor woses.f Signature ofApplicanUAgent / z TION REQUIRED 4 .XEPhlfiscAlpp_201 Ldoc revised 03116111