05110060 (2) CITY OF CIJPERTINO '""�' t sp '•""° °' �" "`'` `"
• BUILDING DIVISION PERMIT
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BUILDING ADDRESS' ABLE SEPTIC PERMITNO.05110060
°10181 HILLCREST RD
OW NER'S NAME: FEfRMrr^W"UR DATE
` JUDY GRCE 520 REED ST
NE: SANITARY NO. CONTROL NO.
(408) 377-9990
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BU �. ELECT PLUMB MECH
i .kt n
on.
LICENSED CONTRACTORS DECLARATIONV C
l Yi 1 homey aRrm Wt 1 Re limnsed under pmvWons of Ckapmr 9(comenu aacing lob Description
with Section 7000,ofDivUi 3 of the Baaineaa ad Professional Coda,and my hoense is
in ren forte and atHaL r Q SANITARY SEWER LINE . NpV1
2 Lim=Clan Lie ll �f
Dale jf O ContractorDECLARATION
ELL /`O5
5 ARCHITECTS DEC O a
IundcnudJ my plane WWI homad as Public rtcmW
u
yo Licensed Pnttcawnd 4
7
OWNER-BUILDER DECLARATION
i Qi I Malo .(Tiro o n 1 m exemal lwro P Conoctars License law for do
p O hollowing roam n.(Section 703 1.5,Bushiest and Pm.&mull Code:My city or county
9�+ which requires a patron re<orwrucl.deer,nnpmow,dPermit,or repair ed ULMM L 6 470
_Z'y^ Searms Seemed purmamcquima the apomictr msuehpemr License
Lew(Chapter
G thnhehlkcnadpuruhntmlMpmvWoluaflheConlracmralJanrei�w(CMpI«9 Sq.Ft.Floor Area Valuation
S (mmanem'ing with Seeder 7000)of Division 3 of that Business Rad Prehatlons Code)Mr
that he ta exempt Lmvfrom and the basis for he alleged exemption.My violation of
Section 7031.7 by any applicant for a pemlt subjects the applicant m a dell IMMSY Of 3 UR KgWru U Occupancy Type
nor mom than flue Wra iN doles(SSW).
❑1,u owner of the property,or my employees who wages u Wn mm compcmdon,
win do thework,and We sanctum 4 mtimended«o@rtd f«sda(Sec.7044.Business Required Inspections
and Professional Cade:The Conucmrs I kml a law Oats not apply m u'wares of q p
property who builds orlmplovn ihemon,andwho d«aauchworkhb ale far dough his
own employees,provided thatench Impoo m out are amt Intended oroRertd forsele If,
how sm.the building or improwmem haold Whin aro year attemped".the owrm-
Wilder win have the house of proving that he did an,bard or improve for purpose of
sale.).
❑1,as come,of that property am eselusiwly corm ming with Hemmed temmuses m
temet the project(Sec.7061.Bnsiowse and Profession;Cade)The Contractors U-
assn Law does out apply in an owner of propertywho Wilda or Improve Nems,and,
who comm us for such projects with a corneclor(s)Beca%d pursuant to that Communes
License Law.
❑Imexempsunder See .B/PCI«dlhmswo
1370(lof
Owner DohATIWORKERS COMPENSON DECLARATION1 hereby affirm under penalty of perjury ane of the following dedarWorlc
1 be.and WillmWII nna Cutincate afCmtsml m self-Wort fee Warner.Compte-
on,u providedfee by Section 3700 of dm LabLabelCode.f«the performance of Oatrk f«which this permit is issued.
1 haw and will maintain Workers Compemation Iuuma,as myuimd by Section
the LAW Cade.for the PerformPerformanceaance often work f«which dun permit 4lssuedy WorkMn Compensation N/m/�ma carrier and Policy number ort:
cmder,"; "j GIJN'�Policy No.:Ili
C7FATIR OF EXEMPTION FROM RKERS'
COMPENSATION INSURANCE
CMM Section need not W camammd if Om penin Is f«am hundred dollen(SIW)
Or leu)
1 cenify that In the pedommte of the walk for which this permit is issued,l nlWl not
employ any person In say mmrmr an es m became subject to the Worter'CmpensWon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,caner making this O mineale of Exemption,you should
become subject in the Workar's Compensation provhima of the lane,Code,you mad
.J O forthwith p
th comply with h provisions;or Nu "Iho deemed mwkad.
ti CONSTRUCnON LENDING AGENCY
Cd Which
thumepe haed(Sm.30 len dint m'eamy(per thepMoman«tar
C> use work r«omen teas Permit b dialed(Ste.]071.CH.C)
0D Q Lenders Nme
z Lenders Addrrm
U O I coolly that I Mw mud this sppliwion and ohm that the show itdor dW is
coma I agree in comply with all city and county aNiurcen and ohm Ian misting to
0 building construction,and hereby mthorim reprueairdwe of this city,to enter upon the
Liz shove-mentioned properly for impeNm purposes
yy (Wal)agree m Raw,indemnify and keep hamkn the City at Cupertino agsim
N liabilities,judSmemi case and expeihes which may in my my Scene against said City
U in consequence of the Spending of this permit.
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: Date
SOU! REGULATIONS.
C.n,P 1,.is Re-roofs
Sigmure of ApplcmJCanuacmr Data Type of Roof
HAZARDOUSLO
MATERIALS DISCLOSURE
Win the applicant or future Wilding ateuputttore w handle naurdaus MR" _
as dcOned by the Cupertino Municipal Code.Chapmr 9.11.and the Health and Safety
^adc.Smion 253324)7 // All roofs shall be inspected prior to any roofing material being installed.
❑Yes cl Na
Will W applicant or hilum building accupent sax equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hautdo«all wntmirunu as dcfl and by the Bay Arta Air Quality Management all new materials for inspection.
C mk17 1
❑Yea L Nu
I haw mad the banadau matMals requhemems under Chapter 6.95 of the Calif«-
MR Health&SafmyCade.Sections 25505,25533 am125534.1 Usimm nd dean the Wilding
does not currently haw a ammL that It h my responsibility to notify the occupmt of the _
roqulr tits whkhmmhomel pdormiuuanca alfa CutiBum ofOccupatmy.
Signature of Applicant Date
,fuer �s All roof coverings to be Class iB"or better
Own.,or mthmi.d agent Dam
Z1 CITY OF CUPERTINO G n
«�', REPIPE/SEWERS/MAIN SERVICE
CITY
PERMIT APPLICATION FORM
APN # n 2 / G O Date:
Building Address:
Owner's Name: Phone#:
J Q u5 5 2
Contractor: Phone: License#:
�d
Contact: Phone: Cupertino Business License#:
bS e 9'D
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
i
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping Sy stem Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
DEC-05-2005 08:56 MARK THOMAS CUP 4082535173 P.01i01
�� enA.P.gRyO
DISTRICT MANAGER-ENGINEER Qom@ i BOARD OF DIRECTORS
cis a
MARK THOMAS 6 COMPANY,INC. � WILLIAM A.BO5WORTH
DAVID E.ROSS DR.JOSEPH F.BROWN
l �, yeo JOHN M.GATTO
DISTRICT COUNSEL f J-40L rS NES AS% CURTIS B.HARRISON
ATKINSON•FARASYN,IIP WENDELL H.KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 950142154 `pC
(408)253J071 PHONE1/ (408)2535173 FAX oO
\ �
File: CuSD—MOP
Building Dept. —Cupertino Gj,C ��
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino,CA 95014-3202
Subject: To abandon existing septic system and connect to sewer
Name: Donna V. Grce&Lazor J. Gree Trust
Address: 10181 Hillcrest Rd
APN: 326-16-050
Cu Connectio Permit No. 17082
Sanitary sewer disconnected and capped.
No additional conditions/requirements by the District.
Inspector: George Santos/Tony Soares...................................... :.
Date; ...11-18-2005................... Sanitary Sewer Location:
/0' L tom.
cc: Property owner
SUPPLYING SANITARY STOWS[St NYlC6 FOC CITY Or CUPERTINO, POPfIONi Or THE CITIES Or SAIATOGA, Su wr, TOS ALTOS ANO SURROUNDING UNIN(ORPOIATID AREAS
www,(ODNIr(n os Nlil rO/ydlftl if f.tom
TOTAL P.01