06060128 (2) CUPERTINO :r-�+ taS3 `z " '*�`•"`"''�""p""- e
DIVISION PERMIT `.,COF�ITRA OR`INTOIiMA'CIO r.
BUILD) ADDRESS: ' AMERICAN RESIDENTAIL SERV 0006060128
10428 S FOOTHILL BLVD
'NER'S NAME: PERMIT ISSUE DATE
GERRY LUI 1479 BERGER DR 6
NE: SANITARY NO. CONTROL NO.
'(408) 287-2165
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uij LICENSED CONTRACTOR'S DECLARATIONIdi - Job Description
I bemby affirm thatw I licensed under provisions of Cbapbr 9(commencing
with Section 7001))of Dirlslon 3 offt BuaineasMd Profassions Code,and my licenso is
n In fall ra...d.flo INSTALL PROPERTY LINE CLEANOUT
Z License Class Lu.' '�-�'��'��
Data Contractor
ARCHITECTS DECLARATION
I unscented my Plans shall M coed as public recruit
gas Licensed Professional
S O Oat I am exempt
rn Me CoATION
zoo hereby.(Rens that 11. eempt from the Comunat O Liana taw for mMe
y
zoo O (allowing wan.Permit
t 7M 1.5,Business and Improve.
rim nt Code:Any city or county
S$ which requlras•pnmit re c0nnm0.alar.hnprosu h Permit t fl cash any awaum $2515
thtrmiuiensedp pursuaAlse nt
to theeat the provisions
for suehmctor's ileac Lrod Caumem
F (comma cingwidPuntion7 M)ofDivisvofthe atMeBuiness lJavclsion,OPbf9 Sq.Ft.Floor Area Valuation
m€$
(commencing with Section 70M)of Division 3nf the Business and ProfevinneCode)or
Q that he is exempt therefrom and the basis for the alleged exempdan.Any violation of
Section 7031.5 by cry applicant for a permit subjects the applicant to a civil panty,of Occupancy TYPe
nal more than five handed dollen
❑1,u owns of the property,or my employees,with wages as their sale cmmpevetion.
will do the work,and the structure b not lnheded Worland Waaie(Sec.7011,Business Required Ins eChO
and PefCbION Cade The Conaaebr's LieeM1m Law does net apply b an.1 of q P
pmpenywho Wilda orimprma Namn,wd who doessuch work hbmelfortuough his
Own emplayas,provided osatauch improvereemu are net inedd aoQard far sale H.
however,ose aw th g ar lmPmsement 4 sat he di in orc yw of amove for the swear {
builder will have the arrdm ro proving Mol W did tot Wild o improv far Purpose Of
ale.).
❑I.as owner Of the property..Business uelusiv ad cmuasing with)lamed numctoa .
comms La the es a a(Sec to an ofad property
fecadonstwine Wi Cade:)The COmrator.Li-
cave law cora os,appy je an sorra of ommons wca Wdes rs hoposarl u,me,Comore and.
who concocts for such projects;with a convanart+I licenred puauam to she Conuantors
License Law,
❑lwax tempt under See .Bk PC far this reason
Data— )y
WORKER'S COMPENSATION DECLARATION
I hereby affmm under penalty of perjury aro of the following doclasdav: aw
1 have and will mainuln•Catifiam of Conant to salf-insum for WarkeesCompcnS/kNITAR
-
sation,u provided for by Section 3700 of the labor Code.far the penfonnanse of Ne /
wart(e which Nu permit u ivud. /_/OVA((�
1 have and will maintain Workeh Compensation Inures,u myuired by Section /1f}(rl/� (!/ O`e/
3700 of the labor Cade.for the performance of Ne work for which this permit is ivatl. �'�!(
My Workers Compensation Insurance aria and Policy number ae:
Cartier:01A ir-19
Policy No.W CR%EPS 0�
CERTIFlCATEO EXEMPTION FROM WO
COMPENSATION INSURANCE
(Thissedon road not W complewd if Mu pont is fororo hundreddagan(SIM)
or leu.)
I anify tat in Ne performance of the work for which this Permit It imue0.I chair not
cmplay my person in my mamherm as to become subject to theWoftre CompenatiOn
Laws of California.Dau
Applicants,
NOTICE TO APPLICANT:If,after matin{N6 Certificate of Exemption,you Mould
become Subject to the Workers Compevdan provision of the Labor Code.you must
.JO foMwith comply with such proviYav or NU Permit Mail the dames muted.
z V1 CONSTRUCTION LENDING AGENCY
F^ Iberebyaffirce Net dhere is.conamdnn lending spotty fa the perfusmma of
t7i
the work for which NU permit u is..d(Sea,3097,Civ.C.)
W�Q Lenders Name
D Z lenders Address
U O 1 cereify Nat i Mw mad Ws applications ad sum that the Move information u
ll. ^ correct.I a{rte to comply with all city and county ONirunas and sou lava relating to
0 SV" building construction.and hereby authome repmsenutiva of Nis city to cnterapnn Ne
UJ above-mentioned property for inspection purposes.
(Wt.)agme to ave,indemnify and kap harmlaa the City of Cupertino&&ME
y Iiabilite,judgmenu,eom and expenses which may in my way sec*a against said City
of this
U mconugance flirt trmMn/ �s•va�'S^s .
APPLICANT ERSTANDS DWI COMPLY WITH AL NON•yl�+INT Issued by: Date S-'LJ 6
S R CU 0
err Re-roofs
siywart or ApplianuCo�nu .wr Dm
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Me applicmt or future Wilding oaupantroro or handle hmardoes maerial
de(Ind by Ne Cupenine Municipal Code,Chapter 9.11,and Ne Health and safety
dc,Section 21531(a)? All roofs shall be inspected prior to any roofing material being installed.
[:]Yo o
Will Me,applicant or future Wilding mcupmt uso cqulpmmt a devices which If a roof is installed without first obtaining an inspection,I agree to remove
At Aaardnw air contaminants a+defined by Me Bay Am+Air Quality Management all new materials for inspection.
District?
❑Yea
1 have read duh uat dausmaterials re rchavents undcrChap m&95ofoseCaiirof- .
nu Hal"Safety Cade,Smug u2SN5.25533and 25531.1 command Melrose Wilding
does not cu have•hen y removability b tm ry dyf!"2 t of Ne
eyuire cxxwhl� W et b mancOra Certificate, spm Signature of Applicant Date
1�^"'^' tor//ro7k - All roof coverings to be Class"B"or better
caner ar a� uNo� — base
SUN-20-2006 14:22 MARK THOMAS CUP 4082535173 P.01/01
CC)
SANlrgq�,o'�
DISTRICT MANAGERENGINEER 'ID+ BOARD OF DIRECTORS
N�
MAR COMPANY INC �`' M WILLIAM A.BOSWORTH
K THOMAS Ik
F.BROWN
DAVID E R099 DR.JOSEPH
JOHN M.GATT /
DISTRICT COUNSEL �'f' CURTISS.H RRISON
ATKINSON•FARASYN.LLP
KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104 WENDEL .
CUPERTINO.CALIFORNIA 950142154
(408)2537071 PHONE 0 (408)75&5173 FAX
File: CuSD—MOP
Building Dept.—Cupertino
Community Development Department—Building
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Install Property Line Cleanout
Name: Gerry Lui
Address: 10428 S Foothill Blvd.
APN: 357-03-071
Permit No.: 06060128
• Videotape and Property Line Cleanout inspected.
No additional cond7*qwrei its bythe Districtinspector: Tony Soares. ................................
Date: 6-20-2006......................
P/L Cleanout Location:
cc: Home owner 20' long
c 6' deep
30' Lt PL
SUPPLYING SANITARY SFYYPAGI S(IYICFS FDR: CITY OF CUF(RTINO, Po nems OF THE CITIES OF SARANOI,SommAU, LOS Ams AND SUIIDUNYIND UYINCoKIDIATID ARFAG
www.cuocrtinosaniturydisItic1.com
TOTAL P.01
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . I . . . . : 35703071 . 00
DATE ISSUED. . . . . . . : 06/15/2006
RECEIPT # . . . . . . . . . : 34871
REFERENCE ID # . . . 06060128
SITE ADDRESS . . . . . : 10428 S FOOTHILL BLVD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GERRY LUI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RESCUE ROOTER
CONTRACTOR . . . . . . . : BUREL, MARK T LIC # 21504
COMPANY AMERICAN RESIDENTAIL SERVICES
ADDRESS . . . . . . . . : 1479 BERGER DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112-0845
TELEPHONE . . . . . . . . : (408) 287-2165
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPSEWER SEWER SYSTEM 1. 00 21 . 58 0 . 00 21 . 58 0 . 00
PPERMITFEE FLAT RATE 1. 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 59 . 95 0 . 00 59 . 95 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ----=-------------
CHECK 59 . 95 003854
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408) 777-3228
� aClOF Fax(408)777-3333
UPEf�TINO
Building Department
JOB ADDRESS: i �J �D t �/ PERMTT # O J„o 10Z)12Z
OWNER'S NAME: ( PHONE # 2-
GENERAL
GENERAL CONTRACTOR c FAX #
I am not using any subcontractors. 15'f )(O
Signature Date
Please check applicable subcontractors and complete the following information
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEW.ERS/MAIN SERVICE
0 OF
�CUPEkTINO PERMIT APPLICATION FORM
Date:
Building Address:
Owner's Name: ly Phone#: Zz t,Uc,/
Contractor^ 1 ,/gam Phone: 51�6 License#:7 H57t
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb `f'1�
Job Description: r
l., 6' 11 ypro - LI l
Residential Q. Commercial
=0stof
Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers <fzl, PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING