08060036 CITY OF CUPERTINO
BUILDING DIVISM)PI PERMIT k,, _C0NTIUGTQPQNF( - "IM,
BUILDING ADDRESS: PERMMNO.
1.0541. LARRY WAY ABLE SEPTIC 08060036
OWNER'S NAME: PERMIT L%UE DATE
I� 0 PU RAMALINAM P 0 BOX 24819 06/05/2008
N LE (408) 377-9990 SANITARY NO. CONTROL NO.
ARCHITECT[ENGINEER: BUILDING PERMIT 140
BLDG ELECT
=1
0 0'z LICENSED CONTRACFOR'S DECLARATION
I thereby affirm that I wo licensed under provisions of Chapter 9(commencing, Job Description
;iU with Section 70DU)of Division 3 of ft Business ad Prolcosionst Code.and my license,is SEWER CONNCT -&--SEPTIC ABATEMENT
i. ..a u
=4 Lufllf no
Dt2 umclaaa� e.—qz LIC.11,
Contractor
ARCHITECTS DECLA
I undicurmand My pholl mall no usal 0 public roconds
D�u
C W t; Licensed Prolossi...I
OWNER-BUILDER DECLARATION
I Mchy,afforn than I arn exempt froon the Contractor's License Law for the
C 0 roloventil (Section 703 L5.Business ad Professions;Code:Any city or county
C4 which nol.i.a pennit to Construct.after.improve,&..Ibh.or need,my structure,
priorto its kutunce.alm requires tha applicat for such Permit to file asigned mucrecra
that he ct licensed pubmant to due provisions of ths,contraunes Licause,Law(Chapter 9 Sq.Ft. Floor Area Valuation
$7335
go
(comon ncing with Section 7fs)0)of Di%rision,3 of the,Business and Professions Cale)or
thus ha"racept therefrom ad ft Mus for the alleged camption,Any violation of
Section 7031.5 by Any APPlicuent for I Permit WbjCCC3 the aptleCaL to a Civil Penalty of
not...unts five hundred dollm.(35M. 31602019 Number Occupancy Type
0 l,umnuofthepmpmy,ormyempioymwi�wAp3uftirmic�pemdon.
will do Un,anokmal dausuccc..es.mituoulad oraffered I..al.(Son.7044.Businans
ad Prof..ims Code:The C.rumme,Licesse La.doc;at apply On.Owner of Required Inspections
Focialywho buildsor improves flarecon.ubdw1md=suChmr1c himuselfordwough his
druntemploybous.immichni that much unp.caus mR interstand orefferad for sale.If,
however.tho building our ionpronormat is mid within one yew ofccouplesion.the Owner.
truilder will ban the bunden of proving dust he did not Mid Or inumerve for purpose of
sale.).
[]1.as Owner of dr,property am exclusively contrund,with licensed countracton on
Construct tls�Project(Sec.7()44,Business ad Professions CoIC:)Thc Conerator's U.
Co.Law does an,aloply to a...,Of property,who Wilds or unpro.thatem.ad.
who contracts for such projects arith a contracter(s)Reenact Formal to the Contrumon's
Lic'.La .
0 laboampotooders. —.9&PCIorthisrusumn.
,Am TARY
.A= 7-
,ATION DECILARAMON/-7
1 hereby affirm under penalty of pedury one of the following dechraboures:
I ban ad will rabutsm-Cernifican-fC-..'to self-Wao fier Warlec",Cmrupen.
all...as provided for by Sued..3700 Of 0,Labor Code,(a,da perform.of do t
.,it for which this permit is Wood.
1 ban ad will trunnion Worlon's Compensation Insurance.sut buttoned by SccOmo
37M.1 the Labor Code.for tho Fefforrat.ce,.f the woure for which this Perron is issued.
My Worlear's Compensation busennee cariu ad Policy number me:
C-Mer Policy No.:
CERTIFICATE OF EXEMPTION FROM WO"ERY
COMPENSATION INSURANCE
or has.)(Thus mcdon nand not he Completed it[be Permit is for one hundred dol IS IM)
I tenuity dust in One,perfuncomm.of Orc.,it for which this Permit is isseed.I mail out
employ a"Furman in my mannerse a an thecarm,subject to ft Worom'Compecommon
Laws of California-Da,
Aipplicum,
NOTICE TO APPLICANT.If.after reatiting this C-Mireate Of Es.-ptimm.you should
tneorm,subjm to the Woremr's Compecoustion pmvWom of on,Lan,Con,you most
*z forhunilt comply with such Provisions"this Permit shail k October! kCd.,
*CD CONSTRUCTION LENDIN6 ACENCY
1 hereby afTno then Olson,is a emarectim,landinji.litrey for tho perforroan.of
the",it for which this parmit 6 Wood(Se,3097,Cm C.)
Leminn's Nanc
z Leralme,Address
U C I conify that I ban read this applicams.und sume dust the man information is
U� P coarrom I agree to comply with all city ad county ordinances;and suda lawat mlarl On
C)U Owilding construction.ad hCrebyathorim of Ois city to onter upon ft
ahn.rocutiored propcity for impection purpox&
(we)agree to an.indemnify ad ItCCP hournalmal thO City Of Copurfirut. in"
fl.bilitica,judgments.coms and expenses;which may in ury my jCC,C sigacuL samcui,
z in coutseelconcC Of Lho grating Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT jorp—
SOURCMELAIIONS Issued by: Date -Z5 P
Re-roofs
StlipsoneofAFtHeouccuorator Duln,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or hadle handouts,frabonj]
as dellnud by the CO1,1m.Municipal Code,Chapter 9.12, no the Health ad Safety
Caude,Section 25532(a)7
0y. ><No All roofs�shall be inspected prior to any roofing material being installed.
PiWill One applicrunt or future building eacculeat usto equipment or devices which If a roof is ihstalled without first obtaining an inspection,I agree to remove
t ha?,adou air counuuminunds a defined by the Bay Area Air Quality Management all new materials for inspection.
counet?
0y.
I ban read the hancondous materials nottionnews underChapW6.95 offfic Cakfor.
.Is Has]"SfClyCdC.StcoonsZ5505,25533 ad!25534.1 unnordand thalifuloc building
does not currundy have a unnat,dna it is my responsibility On nobly the occulaut of the
roquirmov which ants�nnal poor ho musuce,of a Cerolicate of Oc,opm
Signature of Applicant
Date
td agent
All roof coverings to be Class'�W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31602019 . 00
DATE ISSUED. . . . . . . : 06/05/2008
RECEIPT # . . . . . . . . . : BS000005003
REFERENCE ID # . . . : 08060036
SITE ADDRESS . . . . . : 10541 LARRY WAY '
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GOPU RAMALINAM
ADDRESS 10541 LARRY WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2034
RECEIVED FROM . . . . : ABLE UNDERGROUND
CONTRACTOR. . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC
ADDRESS P O BOX 24819
CITY/STATE/ZIP . . . : SAN JOSE, CA 95154
TELEPHONE . . . . . . . . : (408) 377-9990
•
FEE ID UNIT QUANTITY AMOUNT.: .__. PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------= ---------- ---------- ----------
1BSEISMICR VALUATION 7, 335 . 00 0 . 80 0 . 00 0. 80 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRSEWER UNITS 1 . 00 20 . 40 0 . 00 20 . 40 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 . 78 0 . 00 102 . 78 0 . 00
METHOD OF PAYMENT AMOUNT . REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102 . 78 #8121
---------------
TOTAL RECEIPT 102 . 78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ---------------------------- -----
-- -------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO
y2 REPIPE/SEWER/MAIN SERVICE
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN # � Date: ,
l Joao/9. o
Building Address:
105-111 InLt �A
Owner's Name: Phone#:
Copo (0jo y5g-
ih a �
Contractor: Phone#: 377-py.2 0
A6/l A ? Fax #:
Contact: Phone#:
Gtiyz AP..
Fax#:
Contractor License#: 4- 77c175-
Cupertino
77y7sCu ertino Business License#: ZI yo
Job Description:
SC�t✓ Cohntvf f S�P�-c a1z,�c��
Residential Commercial
Valuation:
i;33S
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the.
application or if applicable, include in plan set & the sheet index.
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ 1BSEISMICR Seismic Residential P
/ 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE -
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
IBPWSVCS Water Service P 1CPWS or
1RPWS
1 PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
1 PPERMITFEE Plumbing Permit Fee Issuance P •
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
?� J; Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: PERMIT #
/05w burr A-M (_��U 4o UU
OWNER'S NAME: iVel- PHONE # 377- g990
GENERAL CONTRACTOR: 4//e SC C FAX #
I am not using any subcontractors: aA� ' 6 5�
gnature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
/Tile •- /}� `
Own /Contractor Signature Date
FROM :CUPERTINOSRNITRRYDISTRICT FAX NO. :4082535173 Dec. 09 2008 02:35PM P1
• `gyp bpMlrAq�o
DISTRICT MANAGER-ENG NEER ��� �► BOARD OF DIRECTORS �
MARK THOMAS&COMP LI
NY,INC. V WILLIAM A.BOSWORrH
RICHARD K.TANAKA JOHN M.GATTO
P£AA9 01- CURTIS B.HARR15ON
DISTRICT COUNSEL 5'C AV1C76 0 WENDELLH.KERR,JR.
ATKINSON•FARASYN. P- fPr.IB(tll4fcV 1+� CHRIBT'OPHER C.LEE
HAROLD S.TOPPEL
208393YEVENS CREEK BOULEVARD,SUITE 1Db .
CUPERTINO,CAI..IFORNIA 9501 d-2154
(AOS)2337071 PHONE • (408)253.5173 FAX
www.cuportinosaniterydistrict.com
File: CUSP)–MOP
Building Dept. -• Cuperti o
City of Cupertino
Ann.: Building Depav tment
10300 '1'orre Ave.
Cupertino, CA 95014-3202
Subject: Abandoned exist. Septic System and Connect to Sanitary Sewer
Name: Ciopu Rarnal nam
• Address: 1.0541 Larty Way
APN: 316-02-019 y,��
Permit No. 08061103
Videotape a d Property Line Cleanout inspected.
No addict nal conditions/req
u
i
r
e
ments by the District .
Inspector: 3 e Sullivan.................' . 11.r. ....V.0
Date:-12- 9-2008................... Sanitary Sewer Location:
cc: Pr4erty Qwncr
5' lit P/L 43' Long 4.2' Deep
•
SUPPLYING SANITARY SEVVE GE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS '\