14100066CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21885 ALMADEN AVE
CONTRACTOR: OVERMILLER INC DBA
PERMIT NO: 14100066
ROTOROOTER
OWNER'S NAME: LEYLA OTA
356 MATHEW ST
DATE ISSUED: 10/13/2014
OWNER'S PHONE: 4082557892
SANTA CLARA, CA 95050
PHONE NO: (408) 727-9850
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
PROPERTY LINE CLEAN OUT
•�G�
License Class Lic. #
Contractor OL,,f C1Mt 11r. C' AL Z C Date
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
Sq. Ft Floor Area:
Valuation: $2750
performance of the work for which this permit is issued.
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
APN Number: 35715090 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 RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT AYS 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 DA S FROM L LLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in consequence of the
l(f
costs, and expenses which may accrue against said
Issued by: Date:
granting of this permit. ant understands and will comply
with all n in s ceertino Municipal Code, Section
2regul
91
Mpe
ign Date_,Z07J3—/4/
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.
❑ 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. I 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 devicesich emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Qualient District I
performance of the work for which this permit is issued.
will maintain compliance with the Cu tino unicipaF34. .12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sec ' 5505, 25
Section 3700 of the Labor Code, for the performance of the work for which this
en ate: y
Owner or auth 4%y /
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
CON RUCTION 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
9 18.
Signature Date
GE NERAL PERMIT RPPLIGATION
COIVNUNITY DEV=LOPKIiENT DEPARTMENT - BUILDING DIVI5101,:
iD300TORRE AVENUE - CUPERTINO, CA 90014-3200
(408) 777-3228. FAX (408) 7777-3333 - building.5,cuo=t'no.Ora
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2011.doc revised 06/%1/11
CITY OF CUPERTINO ,
FFF FSTIMATOR — BUILDING DIVISION
ADDRESS: 21885 almaden
FEE ID
DATE: 10/13/2014
REVIEWED BY: Mendez
UNITS
APN:
BP#:
VALUATION: 1$2,750
PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
$25
PENTANIATION 1 RPS
USE:
fllwiib, Insp. Fee: 1-, 16,c.
MV-
sp'. 1-c.,
PERMIT TYPE:
WORK
Mperty line clean out
SCOPE
$25.00
PME Permit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
1
#
$25
Other Plumb. Insp. Fol hrs $48.00 ofber t=ic( fnsp .
E
/C,,i, /tp1":�
; ;�
I �, C(,
fllwiib, Insp. Fee: 1-, 16,c.
MV-
sp'. 1-c.,
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construct`o�,,, 7'0.v
Administrative Fee: )ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$25.00
Strom Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, tire, Sanitary 3ewerUistrict, 3cnool
otn 1 Thoca foac nra havad nn tho nrofimi"any infnrmatian availahlp and are an1v an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
J*
%g
Plumb. Plan Check 0.0 hrs $0.00 1, -le",
/,/an (,h'?C4
Plumb. Permit Fee: IPPERAfFT
PME Plan Check:
0,,icr �kvh� lrlsf�
Other Plumb. Insp. Fol hrs $48.00 ofber t=ic( fnsp .
E
/C,,i, /tp1":�
; ;�
I �, C(,
fllwiib, Insp. Fee: 1-, 16,c.
MV-
sp'. 1-c.,
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, tire, Sanitary 3ewerUistrict, 3cnool
otn 1 Thoca foac nra havad nn tho nrofimi"any infnrmatian availahlp and are an1v an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Che"k 1`ee:
suppl. PC 1"L'('
PME Plan Check:
$0.00
Perini! 1-ee:
suppl,
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construct`o�,,, 7'0.v
Administrative Fee: )ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
�, � 7VOIX'C,,i 111m,11fing 1,'ees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.001
$167.501
$0.00[ , TOTAL FEE:
$167.50]
Revised: 08/20/2014