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04060167CITY OF CUPERTINO PERMIT-^O4\tl..Td=�• a�^a ��ak �f�T� IL144 �R1YAsY.�I011 ¢� BUILDING DIVISION BUILDING ADDRESS: MSI ENGINEERING & IMPROVEM gNf04060167 21821 MC CLELLAN RD OWNER'S NAME: PERMIT WIDE DATE IRENE KUNG & PHILLIP YEN 17250 BUENA VIST 004 ONE: SANITARY NO. CONTROL NO. (408)399-9733 ARCHITEC (ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description i1 bunchy affirm Nm I am limneed under provision i of Ompmr 9 (commencing wBh�cturn 70f1U)uf Division 3 ofths,a cos and Pmfessione Code, and my license is a indeffem. inful[Vy Licen 'C°lesa Lic. p 91.3 INSTALL' SEWER LATERAL & PUMP z _ Date C Qw" M S7 ARCHITECTS DYMARATION 1 understand my plans shall W used as public records s Licensed Pmfcsxwnal < OWNER-BUILDER DECLARATION 0 I herebysplice Nal I am exempt from Ne Comment's License Law for the s following reaso. (Section 7031.5, Business and Professions Cods: Any city or county g which requires a permit m construct, altar, improve, demolish, or repair any swctum$27000 to prior m its issuanm, also requires the applicant rorsuch permit to file a signed statement Contractor's License Law 9 Sq. Ft. Floor Area Valuation s� that he is licensed pursuant to the previsions ofthe (Chapter a, $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or Nat he is exempt Nmnfrom and the basis for Ne alleged exemption. Any violation of -3 4IA`N*0V"ar0 0 Occupancy �r e p y •J p Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of not more Nan rive hundred dollars ($500). I, as owner of the property, or my cmployeas with wage+u their able compensation, red Inspections will do the work and the swctum Is not intended or offered Russia (Sm. 7044, Business and Professions Code: The Convector's Lt.. Law don oat apply to an owner of property who builds orimprovesthereon, andwhodms+uch work himselfortho ugh his own employees. provided thatsuch improvemenesare notintended oroffe nd forsale. if, however, the building or improvement is sold within one year of completion, the owner. builder will have me burden of proving that he did not Wild or improve for purpose of 10/ sale.). ❑ 1. as owner of the property. am exclusively contracting with licensed contractors to 0� ,towel Ne project (Sec. 7W, Business and Professions Cade:) The Comraeter's U. cense Law does not apply in an owner of property, who Wilds or improves thereon. and, who contracts for such pmjec%with a conuncxr(U licensed pursuant to Ne Common's Lkenx Taw. ❑ 1 am exempt under Sec. . B & P C for this some Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declensions: 1 have and will maintain a Car ifintc of Consent self-inure for WmkcraCompcn- xllon, aprovided for by Section 3]00 of the labor Code, for the performance of the wink for which this pewit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 37W of Ne Labor Coac, for the performance of Ne work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carry �-E V F-140 Policy ^Y + C. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if tW permit is (outs hundreddollam (SIM) or less.) I certify that in the performance of Nc work for which this permit is ismud, I shall not employ any person in any mannerab u to become subject to the Workers' Compensation Laws of Califoroia. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject in the Worker's Compensation provisions of be Labor Code. you must foMwith comply with such provisions or this permit shat] W deemed revoked. O tiCONSTRUCTION LENDING AGENCY (hereby splice Out Ners isacomwclinn lending agency lm the performencc of ^p the work for which this Permit Is Issued (Sec. 3097. Co. G.) Lamers Name Lender; Aaemas z 0 1 certify that I have read this application and sloe that the above information is : J Fcorrect I agree to comply with all city and county eminences and soon laws relating in V building construction, and hereby auohorire representatives of this city to enter upon the 4$i ahon-mentioned property for inspection purposes. P. (We) agree to save, indemnify and keep harmless Ne City of Cupertino against /s res liabilities, judgments. costs and ..pm. which may in any way accrue against said City "Z " in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Il// Issued by: Date J S RCE EGULATIONS. -Wu Re-roofs &gnuur pplicanUC for Date HA RDOUS MATERIALS DISCLOSURE - Type of Roof W' 1 Ne applicant or future building occupantstore or handle ha undoes material as defined by the Cupenmo Municipal Code, Chapmr 9.12, ..it Be Health and Safety ods, Section 25532(x)? ❑ Yu 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 Will the applicant or Toluic building occupant tax cyuipmcnt or devices which Bit hansoms air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes JQtvu I have tend the hossude smaterials ncquimments under Chapter 6.95 of the Califon nu Health & Safety Code, Sections 25505,25533 and 0534.1 undemund the if he building docs not eurtendy have a tenant. Net it is my respomibility IF ry Ne occupant or Ne require mc w'nnme+tW riermiss9anneeracerlJin ran army. Signature of Applicant Date �amV "B" All roof coverings to be Class or better Owner or or'.eJ agent CITY 0, UPEI�TINO Building D Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 JOB ADDRE � kL/ � (/�c. lC �J I PERMIT # 041(1(. a C � C OWNER'S : vt . 0 3 77 GENERAL CONTRACTOR. /tf C-4- FAX # M y7j 2-- / I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Date 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 Date PERMIT S-1233 <<CUPERTINO SANITARY DISTRICT'' Santa Clara County 20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173 Cupertino, California 95014 Phone(408)253-7071 LATERAL SEWER PERMIT It shall be unlawful for any person to install or construct any sewer for connection to, or make connection to, the District sewer system in a street within the District, who is not a master plumber or contractor, whichever applicable, licensed under the State Contractor's License Law. All such contractors must register with the District Manager prior to commencing r 'cable, any such work within the District. Sewer Connection Permit No. P – 0 v "71/urf R.O.S./P.M./Tract No. Lot No. A.P.N.: Book Applicant Address: Pone: Parcell` Sirs: (1/,We) hereby Said property is owned by: for a permit to construct 48 HOUR NOTICE Required For Sanitary Sewer Inspection sewer to serve the if different: Ir 1 cosy~ IN CONSIDERATION OF THE GRANTING OF THIS PERMIT, THE APPLICANT AGREES: '/� 1. To comply with all existing Ordinances, Rules and ��F6e,g,,�la��tions of the Cupfiereafter amended. 2. To apply for an Encroachment Permit from the ofpartment, when required by the District. An application therefore shall be attached to thisCli of the applicant. 3. That all excavation and backfilling within the street right-of-way shall be done in accordance with the requirements of the Engineer of the public agency having jurisdiction thereover. 4. That all sanitary sewer laterals within the street right-of-way or within the District Easements shall be constructed in accordance with the approved plans, materials and the Standard Specifications of the Cupertino Sanitary District. 5. To notify the District Engineer two (2) working days in advance of starting any of the work. 6. To guarantee this work for a period of one (1) year after installation. 7. To call Underground Service Alert (USA) 1-800.227-2600, at least forty eight (48) hours prior to starting grading or digging operations. (Location of existing utilities shall be the responsibility, of the permit applicant.) ❑ ENCROACHMENT PERMIT APPLICATION ATTACHED (Lateral Sewer Permit Applicant responsible for ALL fees). FEES: Lateral Sewer Permit Fee:$ %)6 Construction Charge: c Other: TOTAL $ rn Considerations and Restrictions of this Lateral Sewer Permit are hereby agreed to and acknowledged by the undersigned applicant. Failure to comply will void this permit. �,�� Acknowledgment ,r Receipt of $ �A/ U r acknowledged and permit granted. f BE Description of Work: MARK THOMAS & CO., INC., District Manager -Engineer Approximate Paving Cut: feet, 6_"v(P—main, l[ deep ❑ NO WORK TO BE DONE, DISTRICT OWNED LATERAL # , Y CUPERTINO SANITARY DISTRICT Santa Clara County 20065 Stevens Creek Boulevard, Building C Cupertino, California 95014 Telephone 408-253-7071 Date PERMIT P-1 6 5 8, STl N1� N6. 1071S IS E, ERMIT � APN: BookL52 0Z 7--- � Page 4—Parcel_ p Property Owner: 1�� /Cpl ROS/PM/Tract No. Lot No. IVF, ��ii11% `�V1s Mailing Address: 0,114T NQ l CA.X121+ G/We), being the owner(s) (owner's agent), hereby make application for connection of the at: Z 19 2-1 !' consisting of the following Type of Builc Residential: Single Family Dwelling_; Multi Family Dwelling_; No. Units_ Commercial ; Industrial ; Other No. Units Do hereby request a permit to connect the sewer system of the Cupertino Sanitary District. IN CONSIDERATION OF THE GRANTING THIS PERMIT, THE OWNER AGREES: 1. To comply with all existing Ordinances, Rules and Regulations of the Cupertino Sanitary District as now or hereafter am 2. To maintain the House Sewer (that portion of the sewer within private property) which includes a serviceable cleanout to and accessible located within five feet (5') of the point of connection with the Lateral Sewer (that potion of the sewer in i street right-of-way of District easement. 3. To acquire a Plumbing Permit from the ofnr Building Department inspections and approv 1 prior to use. u Building Department and obtain the reqs 4. To expose and inspect for serviceability the Lateral Sewer prior to statjming construction of the House Sewer. 5. That this permit does not constitute a request for the issuance of an encroachment permit for sewer construction in the street/public right-of-way of the agency having jurisdiction thereover. 6. To connect to sewer within one (1) calendar year from the date of issuance of this permit. 7. To call UNDERGROUND SERVICE ALERT (USA) 1-800-227-2600, at least 48 hours prior to starting construction. 8. SPECIAL PERMIT CONDITIONS: T fi '.' Iii �f'�1?1Srl�Bf IGTfI I/ l?1(nT,ntllratviY „—.,,.ra.v yr rmu rr;U J IVE DEVICE shall be installed to protect the above property by the owner. Type of de and installation shall comply with the Plumbing Code Requirements of the jurisdiction shown in 3 above. Fees: q� Serer Service harges to Jy ne 30, v1 No. Unita a S J(/ Uv /month x _ G no. months � Backflow Protection Device Inspection Fee � _ � Connection Permit Fee: (31020) �' ,� (31010) Additional Connection Fees � Total:�— Considerations and Considerations of this Sanitary Sewer Counection Permit with attached Exhibits, are hereby agret and acknowledged by the undersigned Owner (or Owner's Agent). Failure to comply may result in termi ation of Pei Acknowledgement: Owner's Agent: 50 (!f Signing for Owner Please Print Your Nan Receipt of /acknowledged and permit granted. MARK THOMAS & CO., C., district Manager -Engine, Revised 5/00 By: NOTE: See Details on other side ofthis permit � 9� a 0 0 Ll CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICEV l PERMIT APPLICATION FORM APN # 35. I, 1 u 4L, Date: 6 ' k u , Building Address: I a Z� a „A IR I I �� / C J Bldg. Permit Fees BUILDING BPFIXTURE ' l CC PLUMBING Owner's Name: Main Water Service Kvr16 1LL1/ _/tF4y Phone #: Contractor: `L Phone: �� 7�5•� y✓Y License #: SIJ Y i ?- Contact: I Phone: Cupertino Business License #: Building Permit In o: Bldg ❑ Elect ❑ Plumb M7 Job Description: L Residential Commercial ❑ Cost of Project: Z1 Orb Eicab A] Fee ID Fee Descrintion Fee Groun PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING