07090129 CITY OF CUPERTINO a
BUILDING DIVISION PERMIT � 1-RT� �1°`
PERMIT NO.
BUILDII�{(i,AWrLINDA VISTA DR EVULICH JOSEPH TRUSTEE & ET 07090129
l v Z5 0 / PERMIT ISSUE DATE
OWNER'S NAME:
EVULICH JOSEPH TRUSTEE & ET 10867 LI\TDA VISTA DR 09/20/2007
SANITARY NO. CONTROL NO.
.SON :
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0
p Zo LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing INSTALL NEW SEWER LINE
Z with Section 70110)of Division 3 of the Business and Professions Code,and my license is
r'y in full force and effect
v�Z License Class _Lic.S
FDate
Contractor
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)dU
O ti Licensed Professional
OWNER-BUILDER DECLARATION
ja I hereby affirm that 1 am exempt from the Contractors Liccnsc Law for the
.p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement 1Z q,Ft.Floor Area Valuation
of the Contractor's License Law(Chapter 9 $4 0 0 0
-?< that he is licensed pursuant to the provisions
e.tZ-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type
permit Section 7031.5 by any applicant for a subjects the applicant to a civil penalty of 35606002
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the mwner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
,as owdr
14vof the property,am exclusively contracting with licensed conuactors to t
construct the project(Sec.7044,Business and Professions Code:)Inc Contractors nd
ccnse Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. TARY
❑I am exempt under Sec. B&P C for this reason
Owner f 3 4tl ele�= Date�— -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a certificate of Consent to self-insure for Workees Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.)shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califo Date
Applicant
NOTICE TO APPLICf NT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
E.r mfr I hereby affirm that there is a construction lending agency for the performance of
LY+> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lenders Name
az Lender's Address
1 certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said city ✓�
V Z in consequence of the granting of this permit. Date
►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGULAT NS.
Re-roofs
Signature of A10licantfCOMMIOr Date Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant Store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes tT9.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,.1 agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Yes o ,
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date
req�
ter rents which must be met prior w issuance of a Certificate of Occupancy. Signature of Applicant
(i Ora 940= 41/2fA L All roof coverings to be Class'B"or better
Owner or au hori-red agent Date
CITY OF C'UPERTINO 0?09' �12�
REPIPE/SE I W
kTAIN SERVICE
CUPE �NO PERMIT APPLICATION FORM
APN# 3.�- �v C) Date: -;y12v/07
Building Address:
51f9 /D 0,
Owner's Name: Phone#:
80 v L Cy/- / c /-/ 41t-F- > Y / '-V 12
Contractor: Phone: License #:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ET--
Job Description:
,A►5 llc.L—
Residential Commercial ❑
Cost of Pro14/1
CRUD '—
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE PI ambing Permit Issuance PLUMBING
BPREPIPE Rf; i e of Fixtures PLUMBING
BPFIXTURE PHg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work author:-zed by this permit
B. — A portion of the work
C. — None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. — All of the work
B. — A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s)other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' Corr pensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.........................................................................................................
I declare under penalty of perjury that the at ove is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: s Date: lL O �6
Job Address: /D 9)6 7 ,C/.UDg f//ST14 p T M Permit#
_Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
OCT-17-2007 15:40 MARK THOMAS CUP 4082535173 P.01i01
``moo ShNIT46j40,fo
BOARD OP DIRECTORS
D187RICT MANAGER-ENGINEER
A
�� STEPHEN C.ANDREWS
MARK THOMAS&COMPANY,INC. �b + WILLIAM A.BOSWORTH
DAVID E ROSS
'YEA tS :F JOHN M.GATTO
STRICT COUNSEL ;Flvlz� CURTIS B.
DIATKINSON•ARASYN,LI-P. 4%9 .18, nO ,%" 0 -4 WENDELL H.KF-RR,IJR.
HAROLD S.TOPPEL 20OW STEVENS CRETE K BOULEVARD,SUITE 104
CUPERTINO.CAL IFORNIA95014Z154
(408)253.7071 PHOT JE • (408)2535178 FAX
www,cupertinosenitarydistrict,com
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: Evulich Residence
Address: 10867 Linda Vista Drive
APN: 356-06-002
Permit No. 07090129
s Videotape and Property Line Cleanout inspected.
No additional eonditilons/requirements by the District.
Inspector: George Santos/Roger Santos
Date:...10-1.7-2007................... Sanitary Sewer Location:
68' R/PL
4' Deep
37'Long
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPE ZTWO,PORTIONS OF THE CITIES OF SARATOGA,SUNMNALF,LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS
TOTAL P.01
OCT-19-2007 14:25 MARK THOMAS CUP 4082535173 P.01i01
DISTRICT MANAGER-ENGINEER '` BOARD OF DIRECTORS
MARK THOMAS IN COMPANY,INC. iE
STEPHEN C.ANDREWS
DAVID E.ROSS WII,LiAM A.BOSWORTH
'YEAR :OJOHN M.GArrO
DISTRICT COUNSEL 3ER'fI� CURTIS B.HARRISON
ATKINSON•FARASYN,LLP. �`%Iissso WENDELL H.KERR,JR,
HAROLD S.TOPPEL
20893 STEVENS GRA EK F30UI..EVARE7,SUITE 104
CUPERTINO.CP LIFORNIA 95014-2154
(408)233.7071 PH(INE • (408)2335173 FAX
www.cupertinosanitarydistrict.com
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: Evulich Residence
Address: 10867 Linda Vista Drive
APN: 356-06-002
Permit No. 07090129
■ Videotape and Property Line Cleanout inspected.
No additional conditions✓requirernents by the District.
Inspector: George Santos/Roger Santos –
Date:-10-17-2007................... Sanitary Sewer Location:
68' RIPL
4' Deep
37'Long
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPER nNO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE:,LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS
TOTAL P.01