15060090CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19645 STEVENS CREEK BLVD CONTRACTOR: OVERMILLER INC DBA PERMIT NO: 15060090
ROTOROOTER
OWNER'S NAME: PORTAL PLAZA LP 356 MATHEW ST DATE ISSUED: 06/12/2015
OWNER'S PHONE: 4088575819 SANTA CLARA, CA 95050 PHONE NO: (408) 727 -9850
MCI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
PORTAL PLAZA - REPLACE (E) SEWER LINE (BY PIPE
License Class � Lic. # 2j'1! /j� BUSTING) & INSTALL (N) PROPERTY LINE CLEANOUT
Contractor ql'6 i! %f �/Gv 6 Date �?_ ��o'a -le, rl in t °-
I hereby affirm that 1 am licensed under the provisionsof` apter 9 %e�
(commencing with Section 7000) of Division 3 of the Business & Professions f�• ".�'(
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 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: $25500
A 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: 31620083 19645 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 WITFI ' 180 DAYS OF UANCE 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 A 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 / z
granting of this permit. Additionally, t applicant understands and will com ssued e: b
with all non- 'nt source regulatio the Cupertino Municipal Code, n
9 18.
RE- ROOFS:
igi atur - Date C� ?' `�j 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
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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 wh' h emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay -Area Air Qua,' nagement District I
performance of the work for which this permit is issued. will maintain compliance with-ti a Cyyp{rtmo Municip hapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code', Sect' r-9 25505, 255 , a 534.
Section 3700 of the Labor Code, for the performance of the work for which this % /
permit is issued. p Owner or authorized a - — Date:V
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, l 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECTS DECLARATION
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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(cDcuoer0no.or4
CUPERTINO
VUMBING [I MECHANICAL ❑ELECTRICAL nMISCELLANEOUS
PROJECT ADDRESS 1 I APN R -3 I L, — a O i z,
�
O��Tt�'ERN .�
A1vIE ,A
L— i PHOI� � �` E -MAIL
( 7 '
STREET ADD S (t L l' / z
V
SATE, ZI1�9 C 17 q
'V
CONTACT NAME PHON
'� - `
E -MAIL
c , e.. A V
STREET ADDRESS.
CITY, STATE, ZIP
❑ OWNER ❑ OW'NTER- BUILDER ❑ OW!TTERAGENT CONTRACTOR ❑ CONLRACTORAGEN-r ❑ . ARCHITECT ❑ ENGRITER ❑ DEVELOPER ❑ TENANT
CONTRACTOR IxTAl IE J y LI .'SE LICENSE TOTE
A
BUS. LIC 4 E LiL
CON.PANY NAME (
1 `-
E -MAIL
FAX
��� -
(,/60
STREETADDRESS 6 ! V r � i
C TY, ST. TE, ZIP
PHONE
ARCH]TECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC n
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI- FAuILY
PROJECT IN wILOLAND ❑ YES -
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
OMMERCL y9
Bi L'\'G: At 51/
URBANI UERFACEAREA" El NO
FLOOD ZONE ❑ NO
EICHLERHOMET El NO
I
DESCRIPTION OF WORK 1 ,T
�� d ^ _�
a
TOTAL VALUATION:
.xc�is�,u;�;.�z
By my signature below, I ce ify to each of the following: I am roperty owner or authorized a� o act on the erty own ehalf. I have read this
application and the in I haLe.provided3s correct I ha read the Description of Work and verify it is ac te. I to comply with all applicable local
ordinances and state laws r atin to uitdin cons ction. u e representatives of Cupertino to enter the above- Identified property for inspection purposes.
Signature ofApplic t: o " ` " "`" Date:
UP LE 4 T I FORMATION REQUIRED
Y
S� BaPJtES �!'.SK�' K
AePATiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
19645 STEVENS CREEK BLVD
DATE: 06/12/2015
REVIEWED BY: MELISSA
UNITS
APN: 316 20 083 1
BP #:
*VALUATION: 1$25,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
#
PENTAMATION
PERMIT TYPE: 1 CPS i
WORK
REPLACE E SEWER LINE BY PIPE BUSTING & INSTALL N PROPERTY LINE CLEANOUT
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1 PCSEWER
1
#
$25
l'ertnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tay:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
U
$25.00
Strong Motion. Fee: IBSEISMICO
Xlech. flan Check
A ech. Permit Fee:
Other Alech. lash.
Ilech. Insp. Fee:
Plumb. Plan Check 10.0 1 hrs $0.00 El,,. Plan Check
FP Permit Fee: IPPERMIT flea Permit Pecs:
Other Plumb Insp. 1 0.0 1 hrs 1 $48.001 Other 1Iec. Insp.
Phanb. Insp. Fee:
I lec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary sewer District, Schoot
Pic /riot aJn 1 Thaca foot ara hacad nn Jha nraliminaru infnrmntinn ovailahle and are anly an ovdinate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11 -053 Eft'. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek I ;c'e:
Suppl. PC Fee
PME Plan Check:
$0.00
l'ertnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tay:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning F'ees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion. Fee: IBSEISMICO
$7.14
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$175.14
$0.00 r .. " ,TOTAL FEE:,
$175.14
Revised: 05/07/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19645 STEVENS CREEK BLVD CONTRACTOR: OVERMILLER INC DBA PERMIT NO: 15060090
ROTOROOTER
OWNER'S NAME: PORTAL PLAZA LP 356 MATHEW ST DATE ISSUED: 06/12/2015
OWNER'S PHONE: 4088575819 SANTA CLARA, CA 95050 PHONE NO: (408) 727 -9850
MCI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
PORTAL PLAZA - REPLACE (E) SEWER LINE (BY PIPE
License Class � Lic. # 2j'1! /j� BUSTING) & INSTALL (N) PROPERTY LINE CLEANOUT
Contractor ql'6 i! %f �/Gv 6 Date �?_ ��o'a -le, rl in t °-
I hereby affirm that 1 am licensed under the provisionsof` apter 9 %e�
(commencing with Section 7000) of Division 3 of the Business & Professions f�• ".�'(
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 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: $25500
A 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: 31620083 19645 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 WITFI ' 180 DAYS OF UANCE 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 A 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 / z
granting of this permit. Additionally, t applicant understands and will com ssued e: b
with all non- 'nt source regulatio the Cupertino Municipal Code, n
9 18.
RE- ROOFS:
igi atur - Date C� ?' `�j 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
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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 wh' h emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay -Area Air Qua,' nagement District I
performance of the work for which this permit is issued. will maintain compliance with-ti a Cyyp{rtmo Municip hapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code', Sect' r-9 25505, 255 , a 534.
Section 3700 of the Labor Code, for the performance of the work for which this % /
permit is issued. p Owner or authorized a - — Date:V
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, l 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECTS DECLARATION
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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(cDcuoer0no.or4
CUPERTINO
VUMBING [I MECHANICAL ❑ELECTRICAL nMISCELLANEOUS
PROJECT ADDRESS 1 I APN R -3 I L, — a O i z,
�
O��Tt�'ERN .�
A1vIE ,A
L— i PHOI� � �` E -MAIL
( 7 '
STREET ADD S (t L l' / z
V
SATE, ZI1�9 C 17 q
'V
CONTACT NAME PHON
'� - `
E -MAIL
c , e.. A V
STREET ADDRESS.
CITY, STATE, ZIP
❑ OWNER ❑ OW'NTER- BUILDER ❑ OW!TTERAGENT CONTRACTOR ❑ CONLRACTORAGEN-r ❑ . ARCHITECT ❑ ENGRITER ❑ DEVELOPER ❑ TENANT
CONTRACTOR IxTAl IE J y LI .'SE LICENSE TOTE
A
BUS. LIC 4 E LiL
CON.PANY NAME (
1 `-
E -MAIL
FAX
��� -
(,/60
STREETADDRESS 6 ! V r � i
C TY, ST. TE, ZIP
PHONE
ARCH]TECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC n
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI- FAuILY
PROJECT IN wILOLAND ❑ YES -
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
OMMERCL y9
Bi L'\'G: At 51/
URBANI UERFACEAREA" El NO
FLOOD ZONE ❑ NO
EICHLERHOMET El NO
I
DESCRIPTION OF WORK 1 ,T
�� d ^ _�
a
TOTAL VALUATION:
.xc�is�,u;�;.�z
By my signature below, I ce ify to each of the following: I am roperty owner or authorized a� o act on the erty own ehalf. I have read this
application and the in I haLe.provided3s correct I ha read the Description of Work and verify it is ac te. I to comply with all applicable local
ordinances and state laws r atin to uitdin cons ction. u e representatives of Cupertino to enter the above- Identified property for inspection purposes.
Signature ofApplic t: o " ` " "`" Date:
UP LE 4 T I FORMATION REQUIRED
Y
S� BaPJtES �!'.SK�' K
AePATiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
19645 STEVENS CREEK BLVD
DATE: 06/12/2015
REVIEWED BY: MELISSA
UNITS
APN: 316 20 083 1
BP #:
*VALUATION: 1$25,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
#
PENTAMATION
PERMIT TYPE: 1 CPS i
WORK
REPLACE E SEWER LINE BY PIPE BUSTING & INSTALL N PROPERTY LINE CLEANOUT
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1 PCSEWER
1
#
$25
l'ertnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tay:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
U
$25.00
Strong Motion. Fee: IBSEISMICO
Xlech. flan Check
A ech. Permit Fee:
Other Alech. lash.
Ilech. Insp. Fee:
Plumb. Plan Check 10.0 1 hrs $0.00 El,,. Plan Check
FP Permit Fee: IPPERMIT flea Permit Pecs:
Other Plumb Insp. 1 0.0 1 hrs 1 $48.001 Other 1Iec. Insp.
Phanb. Insp. Fee:
I lec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary sewer District, Schoot
Pic /riot aJn 1 Thaca foot ara hacad nn Jha nraliminaru infnrmntinn ovailahle and are anly an ovdinate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11 -053 Eft'. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek I ;c'e:
Suppl. PC Fee
PME Plan Check:
$0.00
l'ertnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tay:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning F'ees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion. Fee: IBSEISMICO
$7.14
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$175.14
$0.00 r .. " ,TOTAL FEE:,
$175.14
Revised: 05/07/2015