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B-2016-3256 CITY OF CUPERTINO BUILDING P RMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3256 19694 AUBURN DR CUPERTINO,CA 95014-2412(316 35 021) ROOTER HERO PLUMBING INC MISSION HILLS,C• 91346 OWNER'S NAME: KUO ROBERT DAH-CHEUN AND WOO MARIANNA MAY-Y DATE ISSUED:12/12/2016 OWNER'S PHONE:925-568-6689 PHONE NO:(888)929-4376 LICENSED CONTRACTOR'S DECLARATION BUILDING PE' 1 T INFO: License Class C-36 Lic.#973014 • Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 X BLDG ELE IT X PLUMB MECH XRES I I ENTIAL COMMERCIAL 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. - JOB DESCRIPTI it N: REPLACE SEWE MAIN-PROPERTY/HOUSE 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 Compensation,as provided for by Section 3700 of the Labor Code,for the 7 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. Sq.Ft Floor Area: Valuation:$7400.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 35 021 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 PERMIT E 'IRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 18 I DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS F' OM LAST CALLED INSPECTION. Signature ��`�" Date 12/12/2016 Issued by:Kim D I ar Date:12/12/2016 OWNER-BUILDER DECLARATIOP[ I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be ins.ected prior to any roofing material being installed.If a roof is i. I,as owner of the property,or my employees with wages as their sole installed without first.btaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applican contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/12/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROO COVERINGS TO BE CLASS"A"OR BETTER 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. H •RDO S MATER AL D L•SURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the ha ardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Healt &Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliant•with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety ode,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the materiaL Addition" y,should I use equipment or devices which emit hazardous air contaminants as ,efmed by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain comph nce with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the \ the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. 'Owner or authorized agent: APPLICANT CERTIFICATION Date:12/12/2016 I certify that I have read this application end state that the above information is CONSTRUCTION LENDING AGENCY correct,I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. SiSignature Date 12/12/2016 Licensed 9 Professional \\40,,,,,„, GENERAL PERMIT APPLICATION M E P TV COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .rQ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 .FAX(408)777-3333•CUPERTINO _ buildinq�cupertino.orq M S C I � 1 LJ PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS/ / 0,22 /a'�f(/ OWNER NAME pob / / p// PH01#ZS 5 i dylP.. E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX -1 I V / t7. rr�1G' qtr ,:rte.- CA- Cf S a CONTACT NAME .n (T w( t ° PHONE _ E-MAIL 0 �. `2- STREET ADDRESS CITY,STATE,ZIP FAX •- ID OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER I!3'TENANT CONTRACTOR NAME LICE VS ELIC: TYPE f/l.iC COMPANY NAME y :20, - FAX �� e E (/i STREET ADDRESS, II f PHONE fs ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE • USE' OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN ❑ IS THE BLBGAN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZO 0 NYE:O EICHLER HOME? 00 NO DESCRIPTION OF WORK D e / r�l1t f TOTALMIMIIIIIIIpjIIIIII VALUATION: RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o i the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is a curate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the Bove-identified property for inspection purposes. Signature of Applicant/Agent: .`/ Date: Z✓f SUPPLEMENTAL INFO'4 ATION REQUIRED Q> OVER-THE Ci?UNTER '-� fes. E 0'EPtES U ❑ STANDARD kf D .LARGE+'`' '©'1VIAJOR MEPMiscApp_2011.d,oc revised 06/21/11