14090098 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10574 STERLING BLVD CONTRACTOR:GOGO ROOTER PERMIT NO: 14090098
OWNER'S NAME: MIKE DILIAVIN 2530 BERRYESSA RD STE 509 DATE ISSUED:09/16/2014
OWNER'S PHONE: 3236914755 SAN JOSE,CA 95132 PHONE NO:(408)282-7026
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
<Z- INSTALL(N)PROPERTY LINE CLEANOUT(SUNNYVALE
License Class T D ( Lic.#� SANITARY)
Contractor 'c Date ZZ
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:$5000
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:37523028.00 Occupancy Type:
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 PE IT 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 ED 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 —D�—
granting of this permit. Additionally,the applicant understands and will comp sued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signat 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. 1 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,Seons2550 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: te:�
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
918.
Signature Date
GENERAL PERMIT APPLICATION VOMEP
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By ny si;n_«re belo;a,I certify to each of the-follol;ing: I am the property ovmr or au horized agent to actr trope o e-half. I have read this -
application and the info:-nation I have provided is correct. I have read the Description of Work and ve if it is accurate. I Pere--to comply vrith all applicable local
ordinances and state laws releing to buildiae co I authorize r epresentativeS of Cup--;ano to enter the above-identi-ed property for inspection puTpeses.
S i—�na ure of:-palicar"t'Agent: Date:
SUPPLE--.NTAL •TFOR-I!ATION RE TIRED
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IF2�PnA c�pp_2011.doc rel-ised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
7ADDRESS: 10574 STERLING BLVD DATE: 09/16/2014 REVIEWED BY: MELISSA
375 23 028 BP#: 'VALUATION: $5,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: p PERMIT TYPE:
WORK INSTALL N PROPERTY LINE CLEANOUT SUNNYVALE SANITARY
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1 PRSEWER 1 # $25
TOTALS: _ $25.00
ih,E;h, Plan Check Plumb.Plan Check 0.0 hrs $0.00 Chock
14erh. Pemr it Few: Plumb,Permit Fee: 1PPERMIT
L
Other Plumb Insp. 0.0 hrs $48.00 011cer I'lec'_lns/��.
/ez.3p. cit': PharnL hasp. Fee: 1ak"('_Insplee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These -f
-fees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
1'cimzt? F'-
PME Unit Fee: $25.00
PME Permit Fee: $48.00
ConsfrticlP.On Tax:
Administrative Fee: /ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Strom Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item
Bldy-Stds Commission Fee: IBCBSC $1.00
'$167.65 $0.00 TOTALFEE�s. $167.65
Revised: 08/20/2014