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B-2017-0109 CITY OF,CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0109 1136 SCOTLAND DR CUPERTINO,CA 95014-5051(362 28 015) ROOTER HERO PLUMBING INC MISSION HILLS,CA 91346 OWNER'S NAME: MOIRADE MARCOS REV TR DATE ISSUED:01/20/2017 OWNER'S PHONE:408-858-2761 PHONE NO:(888)929-4376 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#973014 Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)ofDivision 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: PROPERTY LINE CLEAN OUT;REPLACE SEWER MAIN I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 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. z. .- 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:$14208.70 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 362 28 015 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 EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulati per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature �� Date 1/20/2017 Issued by:AbbyAygnde r Date:01/20/2017 OWNER-BUIL DER DECLARATION 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 inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining 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) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:1/20/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance 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 Code,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. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper'no Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec ons 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: 4 4 APPLICANT CERTIFICATION Date:1/20/2017 I certify that I have read this application and 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. 1 understand my plans shall be used as public records. Licensed Signature Date 1/20/2017 Professional lJ[09 GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 G1.6PEEiT(N,O (408)777-3228•FAX(408)777-3333•buildina(a?cupertino.om MISC LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1-36 ,j / APN# `Z,Q„2- U 0 11 OWNER NAME 4 4( `� yn, Q �9�(7 1 ! 1 C PHONEY VF`�U'y��\.[ E-MAIL STREETADDRESS CITY, TATE,ZIP FAX � j l e r 4, t,,(,'7 CONTACT NAME {{ PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-Bui DER ❑ OWNER AGENT. ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �� � f LICENSE NUMBE 130` ` LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL /(� FAX � r e STREET ADDRESS 6 -11CITY,§TATE,ZIP A y/ PHONE ARCHITECT/ENGRI EER NAME LICENSE NUMBER / BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAME.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑NO DESCRIPTION OF WORK G ;, TOTAL VALUATION: f G . v� RECEIVED BY: By my signature below,I cern to each of the following: I am the property owner or authorized agent to act on the property own 's beha£ I have read this application and the information I have pr ided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ' g construction. I authorize representatives of Cupertino to enter the abo e-identiedy property for inspection purposes. Signature of Applicant/Agent: Date: ` PPLEMENTAL INFORMATION REQUIRED oFrcE USE ONLY. W' OVER-THE-COUNTER .. L" -❑ EXPRESS x _ STANDARD a © LARGE ❑. RIAJOR MEPA4'iscApp_2011.doc revised 06121/11 CUPERTINO SANITARY DISTRICT a�~\�p SAI7I7ARyd��ry 20863 Stevens Creek Blvd#100, Cupertino,CA 95014 Tel (408)253-7071 • Fax(408)253-5173 `csT4Autm p'e CUPERTINO SANITARY DISTRICT PERMIT IT�I'ER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over-the-Counter) EZISingle Family Project ❑ Multi-Family Project ❑ Commercial Project Project Address: gCG_kt ✓1A Permit Number: ?D'Zo1l — 0109 Scope of Work: N` rP,lyl (tA A,0A 9Z (kms _ G1�PA v► D� ► � t��-i v��� �k� eti Owner/Applicant Name: &� 2tn , rye r, . Phone: Address: aS a1 -PCi e 1i o Ir So,h Su� C� Stt t Date: ` Prepared By: 4ity Authorized Representative 1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements will be met and all required fees will be paid prior he approval of final inspection for proposed project. Date: 1-- at( Signature: caner/Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre-inspection Required Final Inspection Required Date Scheduled: (Date: i-- �0 —i`1 Conditional Approval By: d-- Authorized R presentative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc City of Cupertino. P Inspection Fee Paid Date Paid: �-0 Inspection Fees: $250/unit-Single Family Residential already connected, but new cleanout is required 0 $150/unit-Single Family Residential already connected with existing cleanout in working order $350 Minimum—Commercial and Retail Actual Amount: 0 $200/each—Disconnect and/or abandon lateral service Connection Permit Fees: $350/unit-Single Family Residential connecting to existing lateral $650/unit—Single Family Residential connecting with new lateral D $100/unit—Multi, Hotel, Living Units, etc. Actual Amount: D $500/connection -Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): Area and Frontage Fees Amount: Residential Excess Fees over 3.5 unit/acre Amount: D Commercial and Retail Connection Fees Amount: Commercial and Retail Change in Use Fees Amount: Dater — Final Approval By: ^� Authq'ri ed Representative Cupe no Sanitary District