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CITY -0F CUPERTINO
BUILDING DIVISION PERMIT,ONTRAGTQi'I1UE1lA'.I(1N
BUIL I
YTPBT�OREE AVE
DRAIN MASTERS
PERMIT NO.
08040218
ER's NAME:
PERMIT ISSUE DAIS
ATHERINE GHODRAT
2356 LUCRETIA AVE STE 3
04/30/2008
PHONE:SANITARY
NO. CONTROL NO.
(408) 963-7272
ARCHITECTAENGINEER:
BUILDING PERMIT INFO
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LICENSED CONntAC(OR'S DECLARATION
Job Description
hereby affirm Nal 1 am licensed under provisions of Chapter 9 (commencing
with section 7IXg0 afoivixion 3 of Ne Business and Pronasions Com.,nd my lion is
SEWER LINE RPLCMNT FRM HSE CLENOUT TO PROPLINE
I. full forte and attest.
License Clue Lic.N
CLNOUT
Dam Comracmr
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ARCHITECTS DECLARATION
1 understand my plana shall he used as public records
Licensed Pormssu oat
OWNER -BUILDER DECLARATION
1 hereby offimt that 1 am aacrept from die Contractor's License Law for the
following reason. (Section 713I.S, Business and Prefcuinns Code: Any city in county
which requires a permit in convict, alter. impmvC, de rmlish, Or repair any structure
prior m its iauama. also requires the Applicant far such Permit to file a signed aummanl
tite Contractors License Law (Chapter9
Sq. Ft. Floor Area$3800
Valuation
that W to licensed pursuant in the provisions of
(commend., with Section 70(0) of Division 3 of me Business it Professions Code) or
. Nat he u second murefi am and the buts for me alleged exemption. Any violation of
3 7 519 013 AdW Number
Occupancy Type
Section 7031.5 by airy appliea.t fora permit subjects me applicant in A civil Penalty of
nal mom One Rw hundred dollar! (5500).
❑ 1, u owtlu of the property, ar my employee with wages u their sum compenudon,
Required Ins actions
willdo the work, and mosmlcmte is notineendcd or offered fanam(Sm. 7(X4,1husinea
and Profession Code: The Consommes License Law don not apply m an owner of
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property who build, m im prow memo., and who does such work himself or mmugh her
own employee, provided Nat such improvements are not Intended aroffered forsake. If.
however, the Wilding orimpmvement is sold within one you orcomplmon. the owner.
Wilder will have Our burden of proving mat he did not Wild in improve per Purpose of
ale.).
❑ 1, as owner of to Pmpeny, am exclusively conuacting with licensed concessions; m
c ... Won me proien (See 7044. Business and Rofeauons Code:) The Communities Li-
.
cave law dote not apply man owner of props ny who Wilds or improm thereon, and.
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who contracts for such pmpc%wit a coma comm) licensed pursuant m the Contratofs
_
Lkeme law.
❑ Iamvemptunder Sec .B&PCfurtharrawn
v Dam
f� I vel
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penury of pcdmy one of dee following declamations:
\U\
❑ I have and will me.uin aCeniOum ofC...l m self maure for Worker's Compen-
udon, as pmvided for by Section 3700 of the tabor Code, for the parliaments: of the
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work for which this permit is issued.
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❑ 1 have and will maintain Workch Compensation Ivurance, as required by Semon
3700 of Ne labor Code, for Ne performance of Ne work furwhtch rots permit is Issued
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My Worker's Compensation I.suranm artier aha Policy number m:
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Carver. Polley Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thts section and else be comPleed if the Moral le fm one hummed dallus ($100)
fir levo)
1 unify mal in the performaec of the work for which rots Permit ts Wood. t shall not
employ any person in any candor so a in become abjees m the Weeken' Cmnpeendmi
taws of Califamia. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Cenificam of Exemption, you should
become subject m me Worker's Compensation previsions of ma Labor Code, you mute
r foMwith comply with such provisions or this permit shall W darned revoked.
j CONSTRUCTION LENDING AGENCY
1 hareby afOrm Nat them is a construction lending agency for the performance of
' the work per which this permit is issued (Sm. 3(97. Civ. C.)
sander's Name
Lemmas Address
I unify Out I haw rend this application and sum that me am" information is
corm.. I agree on comply with all city and county on innate and sum laws relating 19
building mnwucdon, and hereby authmire representative of Nis city to now upon Ne
above-mcmoned property fo ivpcedon purposes.
(We) agree to ase, indemnify and kap harmless the City of CupcAna against
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liabiliOnjudgments, casts and expenses which may in any way acocoa agents said City
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in consequence of me granting of this permil.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signet= of ApplicanpCommolor Data
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future Wilding oceupanumre orhandle haarmus material
as donned by the Cupenimo Municipal Code. Chapter 9.13* and the Hnith and softy
nd, Section 255334)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yin ONO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicam or future Wilding occupant use equipment or devices which
emit havar mus air conmminants a defined by me Bay Area Air Quality Maniprearl
all new materials for inspection.
Disuict7
❑Yv ONO
I have mail the haaNnus materials requirements undm CWPmr6.95 of LmCalifor-
niaHmlN&Safety Cam, Secdav 25505,25333 and 21534.1 undenund thuifNe Wilding
does amt currently have a ¢nut, Nat it is my resiumobilily to neatly the mcupant of On
requirements which mal be mal Poor or Mitimt of a Cenileam of Occupancy.
Signature of Applicant Date
All roof coverings to be Class'%?.,' or better
Owner or auNorivtd agate Dam
FILE No.108 05/01 '08 10:12 ID:SUNNYVALE PUBLIC WORKS FAX:4087307286 PAGE 1/ 1
•
May 1, 2008
City of Cupertino
Building Department
10300 Torre Avenue
Cupertino, CA 95014-3255
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Subject: On-site Sanitary Sewer Pipe Replacement @ 18705 Loree Ave.,
Cupertino, CA 95014
To Whom It May Concern:
• Please be advised that the proposed project will not have any adverse impact on the City
of Sunnyvale's sewer system. According to City of Sunnyvale's record, the existing
sewer lateral is at 21' east of westerly property line on Loree Ave.
L1-1
Please call me if you have any questions at 408/730-7413.
Very truly yours,
`--
J y Chu, P.E.
Senior Civil Engineer