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B-2017-0125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21968 OAKDELL PL CUPERTINO, CA 95014-1161(326 18 046) OWNER'S NAME: SCHUETZ CHARLES WAND WINIFRED W TRUSTEE OWNER'S PHONE: 408-253-2130 LICENSED CONTRACTOR'S DECLARATION License Class C_-J� Lic. #973014 Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. tC� , 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. APPLICANT CERTIFICATION 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-pyr the Cupertino Municipal Code, Section 9.18. Date 01/24/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the CONTRACTOR: PERMIT NO: B-2017-0125 ROOTER HERO PLUMBING INC MISSION HILLS, CA 91346 DATE ISSUED: 01/24/2017 PHONE NO: (888) 929-4376 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE BUILDING DRAIN LINE IN CRAWL SPACE Sq. Ft Floor Area: Valuation: $8682.00 APN Number: Occupancy Type: 32618 046 1 { PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 01/24/2017 following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, 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) 2. 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: 01/24/2017 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 3700 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 such 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. Signature Date 01/24/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S o s 25505, 25 3, and 25534. Owner or authorized agent: Date: 01/24/2017 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. Licensed Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 UPEEtTtt�i� (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org. —13 —Z a—+_ I m 19PLUMBING I IMRCHAWAT. P(-T'RTreT n1„rT0=TT A PROJECT ADDRESS � � � APN 9 OWNERNAME E-AZAIL G �Tz PHONC/O& z s-3 - Z 1 STREET ADDRESS G (� CITY, STATE, ZIP FAX [/-/ CONTACT NAME 1 PHONE E-MAIL 4/0P - ® sn%C [t?.GCf OSr7/Llr t7t orS'. STREET ADDRESS CITY, STATE, ZIP el F ❑ OWN"ER ❑ OWNER -BUILDER ❑ OW'.VERAGENTT . ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAi4E --7V A ` / G-3 LICENSE TYPE LICNSENUIviBE/RL 0 C. C. BU .LICn 7 COMPANY NAMEE-MATT FAX STREET ADDRESS r- CITY, STATE, ZIP PANE 7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E -MATT. FAX STREET ADDRESS CITY, STATE, 'LIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROTECT N WILDLAND ❑ YES BUILDING: ❑ COMMERCIAL I URBAN' INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES I EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o the property owner's behalf. I have read this application and the information I have pr ' d is correct. I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ild' construction. uthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: PPLEMENTAL INTFORMATION REQUIRED r OFFICE,USE ONT,1 Xm E OV ER -THE -COUNTER -- > © EMi SS IW El STA1\DARD.. El 7 zaJgR h1EP1✓lisc,Ipp_2011.doc revised 06121/11 01-`, CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 ea a CUPERTINO SANITARY DISTRICT PERMIT LETTER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over-the-Counte6 [P Single Family Project ❑ Multi -Family Project F-1CommercialProject /Project Address: Permit Number: Scope of Work: _C�)k- -s tA-e Owner/Applicant Name: Phone: gC91- t!o Address: Date: Prepared By: City 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 to the approval of final inspection for proposed project. Date: Date: Signature: Owner / Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre -inspection Required Final Inspection Required Date Scheduled: IM Conditional Approval By: Authorized Representative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupeyino. Inspection Fee Paid Date Paid: Inspection Fees: O $250/unit - Single Family Residential already connected, but new cleanout is required $150/unit - Single Family Residential already connected with existing cleanout in working order D $350 Minimum - Commercial and Retail Actual Amount: O $200/each - Disconnect and/or abandon lateral service Connection Permit Fees: D $350/unit - Single Family Residential connecting to existing lateral D $650/unit - Single Family Residential connecting with new lateral D $100/unit - Multi, Hotel, Living Units, etc. Actual Amount: O $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): D Area and Frontage Fees Amount: D Residential Excess Fees over 3.5 unit/acre Amount: D Commercial and Retail Connection Fees Amount: Commercial and Retail Change in Use Fees Amount: Date: Final Approval By: Authorized Representative Cupertino Sanitary District