15040145 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21885 ALMADEN AVE CONTRACTOR:OVERMILLER INC DBA PERMIT NO:15040145
ROTOROOTER
OWNER'S NAME:
S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL(N)PROPERTY LINE CLEAN OUT
.cense Class_ Lic.# ?Z�)3 ?:,69
Contractor 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
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3472
ave 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 IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O + NUANCE 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 F 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
granting of this penni dditionally,the applicant erstands and will comply Iss y: Date:
with all
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 devices w ' mit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba rea Air Quality ement District I
performance of the work for which this permit is issued. will maintain
L42 r
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 3
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
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21885 ALMADEN AVE DATE: 04/21/2015 REVIEWED BY: MELISSA
APN: 35715 090 BP#: 'VALUATION: 1$3,472
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: p PERMIT TYPE: i
WORK INSTALL N PROPERTY LINE CLEAN OUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: �� $25.00ter,
U -fps .'
;
y,� k 4�ry ' '' •� et
_51
... a n . flP� �
Mech. Plart Check Plumb.Plan Check 0.0 hrs $0.00 Flee.('beta(37eck
;Meth. Petvai[Fee: Plumb.Permit Fee: 1PPERMIT l lec- Permit Fee,
C)iher EIF
,Meeh. Irt:rp. Other Plumb Insp. 0.0 hrs $48.00 othea�Alec_Msp.
Ller,Ea. hasp. Fe("': Pharr/?. Lash Fee: ESlec'.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le-Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (I'ee Resolution 11-053 E . 7ff /1113) FEE QTY/FEE MISC ITEMS
Plan Check:la'ee:
Sg)j)l. .P('I'ee
PME Plan Check: $0.00
Permit Fee:
.5zg2pl. litsp P'ee
PME Unit Fee: $25.00
PME Permit Fee: -T-T- $48.00
Construction TUX:
Administrative Fee: 1ADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
,Advanced Planning 1%ees:
Travel Documentation Fee: 1TRAVDOC $48.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
B1dyStds Commission Fee: IBCBSC $1.00
$167.501 $0.00 TOL FEE $167.50
4
Baa —n�
Revised: 04/01/2015