06010172 (2) CITSS OF CUPERTINO "4•?
BUILDING DIVISION PERMIT ,C ONTRACTnRRINFORMATION k
BUILDING ADDRESS: ABLE SEPTIC PERMIT NO.06010172
441 TULA LN
ER'S
NMIISSUE DATE
JANET MARIE BERTAINA 520 REED ST. 01/31/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 377-9990
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0
u0o LICENSED CONIRACOWS DECLARATION Job Description
U 1 knotty affirm that I am licensed under provisions of Chapter 9(commencing P
with Section 7")of Division 3 of the Business and Profccsiom Cade,and my license e
n infmlforceandeffect. INSTALLING NEW SEWER LINE,AND PROPERTY LINE
3yz Litm.Class Lc.•
;-'c Da CunDECL CLEAN OUT OINKED�
fry As mail dre DECLARATION
W U 1 undcmonJ my plans shall W used as public recnNs
X03 Lkcrtscd Prefcssional I`sFifRy o
(\ 2oOr.
OWNER-BUILDER DECLARATION
.�<I I hereby of i m that 1 am exempt from the Contractors License Law for the
00 following modem.(Section 703 L5,Business and Professions Cade:Any city or county q
K Q k
which requires a Permit to construct.alcor,improve,demolish,m repair any structure Q �'dijg P,Ilda }�
yxi prior to its issuance.also oquioa the applicant for such permit to fileaaigmndsucmem a
< dual he is licensed pursuant to the provisions of thc Contractor's License Law(Chapter 9 Sq. Ft. Floor Area t� }lac (&h 'Valbatl
Y1- (commencing with Section 7")of Division 3 of the Business and Professions Cnde)or �_/
-
that he is droop,therefrom and the base for the alleged exemption.My violation of
SOcdon 7031.3 by airy applicant fora permit subjects the applicant as a civil penalty of
trot moo than five Wrolmd dollars(M). 3 APN N�II80 . 00
0 . 0 0 Occupancy Type
❑I,tlowller of lhC pmperLY•IXmY empleyeG wllk wagU 8a lllLvaolC CUmpCRLllem, CSC-)99 33
will do the work and the awclure is not mumded On ofc.d fosaa1O(Sec.70aa,Business
ar
and Professions Code:The Contrtor's License Law des net apply to an Owner of Required Inspections
property who Wilds On imprimis thereon,and wir.doesmachowankloposcIr.,through his
own employees,provided Nal such improvements are not mended oroReud for We.IL
however,the building ar improvement is sold within one year of completion,NO ower-
Wilder will have the burden of proving that he did not build or improve for puryose of
.tile.).
O'l.as owner of to propeny,am exclusively contacting with licensed contractors in
construct On,project(Sec.706a.Business and Professions Cade:)The Conuactur's Li-
cense law isms not apply to an owner of propeny.who builds or improves themoe.and
who contracts for such projects with a Bono smKs)licensed punuam to the Contactors
License Law.
am cacmpi under See ,B&P C forhe mason
t
;r� satr -al-o�
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under porosity of perjury one of the following declarations:
❑I have and will maintain a Cesditwm ofConsen,to self-Insure for Woreces Comport.
cation,as provided for by Section 37M of the Labor Code,for On performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,az required by Section
37W of the labor Cade,for the performance of the work for which this permit is issued.
My Workce.Compmesmim Insurance carrier end Policy more,are:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section coed not Wcompleud if Ile permit isforom hundreddmlars(SIM)
or Mas)
1 certify Out in the performance of the work for which this perm.,is issued.l shall not
employ any person in any mantur s9 az to hecame suttl'ect to ftworkers'Lompcnsation
Laws of Californi.Date 3 y ` •�
Applicant j ��Ytye-[�zg �
NOTICE T0�LICANT.If,after making the ceniRcau of Exempmn,you should
become subjoet in to Workers Compermtion provisions of the labor Cock,you mum
.,z forthwith comply with such provisions or this permit shall W deemed milud. -
z CONSTRUCTION LENDING AGENCY
[-� Iherebyalarm that there is is cormruc,inn lending agency for the perfmonsamm f
Ci thc work for which this Fermi,is issued(Sec.3097,Cii,C.)
W 1<ndcr's Name
.a7 z Lender.Address
U Q 1 terrify that 1 have read this application and sou that the above information is
W f-' COMM I agree to comply with all city and county ordinsn ms and sou laws relating to
0 building mnswction,and hereby authorize opmxnedims ofthis city to enter upon the
W move-mentioned property for inspection Purposes.
M
(We)agree to ave,indemnify and amp harmless the City of Cupertino against
F'W liabilidesjudgmcnts,costs and expenses which may in dray way atemW
c against dCity
(„)Z in consequence of the granting of this permit-
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCEREGULATIONS j
S S. r ,
11
_3 t Re-roofs
.'S tum of ApplicanUContactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applinn,or future Wilding occupant mom or handle hamvdous maudal
fined by the Cupenum Municipal Code,Chapter 9.11,and that Health and Safety
..Setion 25532(a)?
❑Yo BIS All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding necdInt us equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamolous air contaminants az dnfrned by to Bay Area Air Quality Management all new materials for inspection.
Dison? P
❑Yea
1 have mad the ha eNrms armcnalsoquiomcm underChaper 6.95 of Oc Califor-
run Hodp&Safety Cade,SecOns 25505.25533 am12551a.I unhrsoM thuifdc Wilding
docs not currently hese a¢namthat it is my rio onsibility to notify Inc occupantuof the
ogdi mawhtrhm be me,p. to d`CeniIII fOcetpanry. Signature of Applicant Dale
�,Ovpleroraulhomcdagent pati All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
• Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO
Building De fitment
JOBADDRESS:
4 1 Tli� - PERMIT # O(d) ) o I
OWNER'S NAME: L-,w_I µ , er-, ' o PHONE # 37? - Q 990
GENERAL CONTRACTOR: 111,0 sEPrr v FAX # gvss - q 4 2
I am not using any subcontractors:
61 Signature Date
Please check applicable subcontractors and complete the followin information:
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
61 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
��Lt• � J — 31 —Cs,6
Owner/Contractor Signature Date '
MAR-09-2006 09: 10 MARK THOMAS CUP 4082535173 P.01i01
DISTRICT MANAGER-ENGINEER j l9 BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. " "" WILLIAM A.BOSWORTH
�— DAVID E.ROSS DR,JOSEPH F.BROWN
• 4N` �p
DISTRICT COUNSEL JOHN M.GATTO
�r'4BL 1 S H EID app CURTIS B.HARRISON
ATKINSON�FARASYN,LLP
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104 WENDELL H.KERR.JR.
CUPERTINO,CALIFORNIA 950144154
(408)253-7071 PHONE • (408)2535173 FAX
� IVW
4 (P
File: CuSD—MOP
Building Dept. —Cupertino
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino,CA 95014-3202
Subject: To abandon existing Septic System and connect to Sanitary Sewer
Name:Janet M Hertaina
Address: 10441 Tula Ln.
APN: 359-13-080 /
Cupertino Connection Permit No. ]7173
• Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the District.
.
Inspector: George Santos/Tony Soares...............I..............cl-`.:......
Date:...3-08-2006................... Sanitary Sewer Location:
cc: Home owner
SUPPLYING SANITARY S[W[IALF SGYICFS FOR: CITY OF CDIFOINO, PORTIONS OF THE CITIES OF SAAAiOGA, $IINNYYA R, LOS ALTOS ANO SURROUNDING UNINCORPORATED AREAS
w ww,EupwinosNn lrorydis)ri[t.rom
TOTAL P.01
®• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35913080.00
DATE ISSUED. . . . . . . : 01/31/2006
RECEIPT ##. . . . . . . . . : 33013
REFERENCE ID # . . . : 06010172
SITE ADDRESS . . . . . : 10441 TULA LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JANET MARIE BERTAINA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2935
RECEIVED FROM . . . . : JANET BERTAINA
CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC
ADDRESS . . . . . . . . . . : 520 REED ST. .
• CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . (408)377-9990
FEE 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 7012
TOTAL RECEIPT 59.95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO 0(00 1
a' REPIPE/SEWERS/MAIN SERVICE
•CUPERTINO PERMIT APPLICATION FORM
APN # 050 Date:
Building Address:
Ib ot-\-u�
Owner's Name: ` Phone#:
�J CLvLeN- 1 �9-1 ���'1 czi v�c3_ 2 5 17 R 7,-�
Contractor: - iC: Phone: qe - K7-R4,? License#:
-5;?
o ww o+�s
Contact: < < Phone: Cupertino Business License#:
q og '7°-t q 4,?n
Building Permit Info: u�� a53L� �e U9
vW U-
Bldg ❑ Elect ❑ Plumb ❑
Job Description:
Residential Commercial ❑
Cost of 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 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