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14050084W CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10840 MINETTE DR CONTRACTOR: PRO ROOTER PERMIT NO: 14050084 OWNER'S NAME: ROD KAMALVAND 438 SAN LEANDRO BLVD DATE ISSUED: 05/13/2014 OWNER'S PHONE: 4084238000 SAN LEANDRO, CA 94577 PHONE NO: (510)670 -1115 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL ❑ INSTALL (N) PROPERTY LINE CLEANOUT (SUNNYVALE / / / License Class c 3 Li.. # 6 3 6�b 2' SANITARY) FoV�P/L '�( 1 Contractor 1PY6 Date I3 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: $2000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37531029.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 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 AST =CAWSPECTION. 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 granting of this permit. Additionally, the applicant understands an d will co Ue y: a e: with all non -point source regulations per the Cupertino Municipal Code, ection RE- ROOFS: 9 18. Signature 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) 1, 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 2553 , and 25534. A// Owner or authorized agent: 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 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 9 18. Signature Date X110 � s GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 �O ISC (408) 777 -3228 • FAX (408) 777 -3333 - buildlna(a.CUDertino.Orq an sun V.TInAMT-KtP-- MWA- Pr- ua-nnreT- 7Tuipr-mTrAT- 7MESCELLANEOUS PROJECT ADDRESS © D ,- APN # OWNTERNANS I! lam l Zj 5 - Gv 00 E- LAIL It `l/`r4 STREETADDRESS `FD �" I CITY, STATE, ZIps j? - GjoS Z I FAX (�( t, CO'N'TACT N9h.E % PHONE 0 E-MAJL 00 "I O�YI by r6Y1a PD . com STRESTADDRESS CITY, STATE, ZIP FAX ❑ OWNER -0 OWIvM.BULLDER ❑ OR7.'ERA= ❑ CONTRACTOR ❑ CON1iLACTORAGENTT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONIFACTORNAME �� p LICENSENUMBER / /� LICEKSETYPE 0 © U R �j b BUS. LIC # COMPAAY NAh ,1-� D O p -p� 1 E MAb p C1 D P� �r ' ( " 1 (N dl 0 b . ('6A fL ry n n j^ F S�O J 2 (7 0 STREET DRESS 5,a �Yb V j CITY, STATE, ZIP �- N I d tab PHO'� -/O rj (� ARCHTTECT/ENGReER NAME LICENSE NUMBER. BUS. LIC 9 COMPANY NAM.. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD oc DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN ❑ YES BUIIDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD TONE ❑ NO IS THE BLDG AN ❑ YES EICHLEP HOME? ❑ No DESCRIPTION OF WORK Cb vl b j TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized aeent to act e property o s ehalf. I ha , this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. rte to c all applicable local ordinances and state laws relating to building c construction. I a ' or' repr ntativeS of Cupertino to enter the above�n - e pro erty for inspection purposes. SienatureofApplicant /Agent:_ —_��s- ` Date: I3 i SUPPLEMENTAL II\rFORAIATION REQUIRED ' �. 11� AR£COL3aTE' --; mm MEN MM WEZ llw MEPMiscApp_2011.doc revised 06/21/11 !���I CITY OF CUPERTINO FFF FRTIMATOR — BUILDING DIVISION im, ADDRESS: 10840 MINETTE DR DATE: 05/13/2014 REVIEWED BY: MELISSA APN: 375 31 029 BP #: *VALUATION: 1$2,000 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p PENTAMATION 1 RPSS USE: $24 PERMIT TYPE: WORK INSTALL N PROPERTY LINE CLEANOUT SUNNYVALE SANITARY SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $24 f1erinid Fec: Su'!) /?l, hisf7 I-' -e PME Unit Fee: $24.00 PME Permit Fee: $47.00 C `oaa: t vcfion i ff Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $24.00 Strong Motion Fee: IBSEISMICR it- 1<rc11. t'ian �'�ie;ck Plumb. Plan Check 0.0 hrs $0.00= r���'. ".rn in:ck Plumb. Permit Fee: 1PPERMIT Fk r Other Plumb Insp. 10.01hrs I $47.00 (lrhes 1siec I s. In phenlhs hasp. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, rtre, 3amtary Newer tnsrrtcr, ,3cnoor n.*- .-...s ..s.. 1 Tl....... f:.,... n n t. ('.nntart the Dent for addn'l info. FEE ITEMS (&e Resolution 11 -053 Eff. 711113) FEE QTY/FEE MISC ITEMS I'ic ?rt Check Fee: PME Plan Check: $0.00 f1erinid Fec: Su'!) /?l, hisf7 I-' -e PME Unit Fee: $24.00 PME Permit Fee: $47.00 C `oaa: t vcfion i ff Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 i 45 $163.50 $0.00 TOTAL FEE:` $163.50 Revised: 04/01/2014 �,g"C.19s`f Address PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a.cupertino.org 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 R314 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 CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X 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 r p s or alterations do not result in the removal of wall and ceiling finishes or there is no access by me �; basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An e re d for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) rdfk`fenced above has/have 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. I have read and agree fib om�vlyith the t rms nd AiQns of this statement Owner (or Own r A nt's) N m: r �.j J......... Sinature ..... .. ... .. :..A .................................. ............................... bate: ..... Contractor Name: P&64fV 6VLAJ1) Si nature. .. Lic.# I ...... Dat • ..f� Smoke and COform.doc revised 03118114