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07050294 CITY OF CUPERTINO BUILDING DIVISION PERMITS I} RATIQN: '. p A S�� PERMIT NO. BUILDING 3§i.' 4I LLER AV TBD — TO BE DETERMINED 07050294 J V PERMIT ISSUE DATE OWNER'S NAME: KIRKMAN JAMES C AND ALETHA M 05/31/2007 SANITARY NO. CONTROL NO. JNE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description W^ I hcrcb affirm that 1 am licensed under provisions of Chapter 9(commencing `�F y REPLACE 25 FEET OF THE MAIN SEWER LINE IN FRONT Z� with Section 7000)of Division 3 the Business and ofcssi Co liccrtsc is <y in full force ind effect ? License Lic.M OF I F w Date ARCHI7ECTSS DDEC1 A N BUILDING a< I understand y plans shall he used as public records )4U ' U.y Licensed Professional O< OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the no following mason.(Section 7031.5,Business and Professions Calc:Any city or county i which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior ro its issuance.also requires the applicant for such permit to file a signed statement t' .Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 v rq $6000 a 1=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 914 0 3') �Number Occupancy Type not mote than five hundred dollars(5500). ❑I,at 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 does trot apply to an owner of property who builds or improves ihereon,and who does such work himself or through his own employees,provided that such improvements are trot intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cale:)The Contractoes L- eone 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 LiRY cense Law. SANITA ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 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. ❑I 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 Workee Com nation In tante c 'er and Policy numb (y r 10 Cartier.S Policy NJ �`� d• -CERTIFICATEOF EMMON FROM WORKERS' COMPENSATION INSURANCE (Ibis 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,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) Q Lender's Name 04 0 z L.cndces Address U 0 I certify that 1 have read this application and state that the above information is Ct. ►• correct.I agree to comply with all city and county ordinances and state laws relating to tion,and hereby authorise representatives of this city to enter upon the U building consuuc U above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against Hy fn liabilities,judgments,costs and expenses which may in any way accrue against said City U,z m co uence of the granting of is permit. ► 'A L NT UNDERST D APS LL COMPLY WITH ALL ON-POINT Issued by: Date SOU E ON . Re-roofs fgnatureo[ UC tractor Dare T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant.store or handle hazardous material as defined by the ertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a. All roofs ;hall be inspected prior to any roofing material being installed. C]Yes � Will the applicant or future building occupant use equipment or devices which If a roof i;i installed without first obtaining an inspection,I agree to remove emit hazardous an taminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes Nu I have read the harardcxrs 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 c �"",yh have a tenant,that it is my res nibilfly to nouf the occupant of the reyufremc mus el pri to' uan of a Ccrtificats o cup Signature of Applicant Date i All roof coverings to be Class"B"or better Oer onxcd t are CITY OF CXPERTINO REPIPE/S W S/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM APN # �/-`1 Date Building Address- 0 wner's Namur one# A �1 ho License#: ntact: Phne: Cu ertino B siness License#: Building ermit Info: Bldg ❑ Elect ❑ Plumb Job Desfription:, � Q 1S\D,Qs- Residentia Commercial ❑ �V,6-Qp- ��gk Cost of Projei-v&OWv Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Pipin System Fee PLUMBING PPERMITFEE F lumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE F big. Fixture PLUMBING BPWSVCS Vain Water Service PLUMBING BPSEWER c ewers PLUMBING BPSEWAGE S ewage Disposal PLUMBING / BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: p'(' PHONE # O d GENERAL CONTRACTOR: FAX # O I am not using any subcontractors: ; a 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 SEP-21-2007 11:06 MARK THOMAS CUP 4082535173 P.01i01 DISTRICT MANAGER-ENGINEER ��o r®�,/� BOARD OF DIRECTORS MARK THOMAS&COMPANY,INC. � � $ � STEPHEN C,ANDREWS a DAVID E.ROSS ` WILLIAM A.SOSWORTH YEARS JP JOHN M.GATTO DISTRICT COUNSEL 3 E I V I � fSYN,LLP. �� ATKINSCN•FARACUF7TIS 6.HARRISON B[isN60,ed wENDELL H.KERR,JR. HAROLD S.TOPFEL 20833 STEVENS CRE;rzK BOULEVARD,SUITE 10e3 CUFIRTINO.CALIFORNIA 950142154 (408)2597071 PHOT'19 • (408)253.5173 FAX www.cvpertinosanitarydistrict_com File: CuSD—MOP Building Dept.—Cupertino City of Cupertino(, r Attv.: Building Department 10300 Torre Ave. Cupertino,CA 95014-3202 Ez Subject: Replace onsite sewer line ► Name: Kirkman Residence Address: 10353 Miller Ave APN: 369-14-035 Permit No.07050294 ■ Videotape and Property Line Cleanout inspected. No additional conditions/► Te is by the District. Inspector: ...Roger Santos..........4 .......... Date:...09-21-2007................... Sanitary Sewer Location: 4'.5 Deep 31' Long cc: Property Owner 36' L/PL SUPPLYING SANITARY SMRAGE SERVICES FOR:CITY OF CUPERT INO,POfzTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ATOS AND SURROUNDING l ININCORPORATED AREAS TOTAL P.01