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15070161CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20337 VIA PALAMOS CONTRACTOR: OVERMILLER INC DBA PERMIT NO: 15070161 ROTOROOTER OWNER'S NAME: GUO CHAU-HOM AND FANG SHU-JEN 356 MATHEW ST DATE ISSUED: 07/22/2015 OWNER'S PHONE: 6502833799 SANTA CLARA, CA 95050 PHONE NO: (408) 727-9850 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ lj�/' REPAIR/REPLACE (E) SEWER LINE License Class to Lic. # Contractor VEa(["i1�dZj{�ate .— 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: $3875 rformance of the work for which this permit is issued. 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: 31601176.00 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 PERMIT 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 DAYS FROM L LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments costs, and expenses which may accrue s say City in consequence o e Date: ZZ granting of this permi Additionally, t li t understands and will comply Y: with all non- source regal ipal Code, Secti n 9.18. RE-ROOFS: Si Date — S 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 o zardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or de ces which mit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay A a Air Qua District I performance of the work for which this permit is issued. will maintain compliance wit apertino M clpa e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety tions 25505, 255 , an 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or a or Date: 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 CONSTRUCTION LENDING AGENCY 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 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.org // C� 7`016 jm I S C ®PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑A11SCELLANTEOUS PROJECT ADDRESS �. -AF,1 A AP -IN", f — O — f O�3JNtRNAME 6-UP-UPOTv-E E-MAIL STREET ADDRESS A.3 ' „ CITY, STATE, ZIP— oaz y FAX CONTACT NAME H NTE E-MAIL STREET.ADDRESS_ CITY, ST. TE, ZI Vqbs) i S66F CA f 1 ❑ Oti?`ER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTrRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAS ' LICENSE NU7 SER (. LICENSE TYPE / L BUS. LIC CONP.ANY NAME E-MAIL, F � r i STREET ADDRESS CITY, ST. E, ZI HONE Ar g 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 ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES B=LNG: ❑ COMMERCIAL URBAN LNTI'ERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DES CRIPTI ONOF WORK � / J TOTAL VALUATION: C+-c>all NAN By my signature below, certify to each of the following: I am the property owner or authorized agent to erty owner's behalf. I have read this application and the information I have ed is correct. I end the Description of W it is accurate. I agree to comply with all applicable local ordinances and state laws relating uilding constructi�11��sntativ ertino to enter the above -identified property for inspection purposes. Signature of Applicant/ Date: S S PLEME TAL INFORMATION REQUIRED ,OFFICE LSEO1 OVER THE COUNTER'; Mrn A Izn 4 -z MEPA7iscApp_2011.doc revised 06/21/11 ��—�� CITY OF CUPERTINO I'��l% I FEE ESTIMATOR — BUILDING DIVISION �( ADDRESS: 20337 VIA PALAMOS DATE: 07/22/2015 REVIEWED BY: MELISSA UNITS APN: 316 01 176 BP#: 'VALUATION: 1$3,875 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex $25 PENTAMATION PERMIT TYPE: 1 RPS i WORK REPAIR/REPLACE E SEWER LINE SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check Fo.0 hrs $0.00 QT1 UNITS BP FEES 11< Sewer, Sanitary 1PRSEWER Other Elec. In. 1 # $25 Permit Fee: Supp/. Insp Fee 77 PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: T -T Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes O No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $25.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School fflwrict etch These feet are hated on the nreliminary information available and are only an estimate Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) h,. Plan Check Plumb. Plan Check Fo.0 hrs $0.00 I-lec. Plan Check �1ech. Plumb. Permit Fee: IPPERMIT 11< Other Rlech. Inslr Other Plumb Insp.0.0 hrs $48.00 Other Elec. In. PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School fflwrict etch These feet are hated on the nreliminary information available and are only an estimate Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS "lan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Insp Fee 77 PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: T -T Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes O No $0.00 Idvanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $167.50 $0.00 TOTAL FEE: $167.50 Revised: 07/02/2015 �� SMOKE !CARBON MONOXIDE ALARMS . c OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 C U P E RT I N O (408) 777-3228 • Rky, (408) 777-3333 • buildinana cuoertino ora AWL 0.S 'Y, FEPN311 CANNOT REFIl��ti - ':_ H:iS ilEEti:SIf� .3n PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM COAL*kr\I Outside of each separate sleeping area in the immediate vicinity of the X I X bedroom(s) I On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire \Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarrn(s) referenced above haslhave been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. S Smote cna LUJOI-M coc reversed Vlif dli 4