09070080 CTTY OF CUPERTINO
BUILDINGDIViSiON PERMIT ' (......
PERMIT NO.
PBUILDING ADDRESS:
33 0 MANN ABLE SE ' PERMIT iSSUEDATE
S NAME:
A CONTROL NO.
PHORRi1PkZ TERRENI el 111 _r
:
(4 0 8) 3 77-9 9 9 0 BUILDING PERMIT INFO
ARCHI7ECIfENGINEER: BLDG ELECT PLUMB MECH
0 0 o a
ce Z LICENSED CONTRACTOR'S DECLARATION Job Description
V
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Pro ons C and my license is
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INSTL P,'L CLEANOUT/ABATING A SEPTIC TANK
A- in full force andeff
j vn Z License C�}ss `4 I'�•
CZ CZ Date �+_ Contractor
IT
ARCHECTS DECLARATION
i understand my plans shall be used as public records
m<
�yU
L o H Licensed Professional
OWNER-BUILDER DECLARATION
Ay11
cnsc Law for the
i hereby affirm that i am exempt from the Contractor's Lie
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
t m which requires a permit to construct,alter,improve,dcmolLth,or repair any structure Valuation
u"y prior t°its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area
Z< that he is licensed pursuant to the pmvisions of the Contractor's License Law(Chapter 9 9 2 0
zr (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars($500). 32645003 . 00
❑I,is owner of the property,or my employees with wages as their sole compensation. Required Inspections do the work 44
and the structure is not intended or offered for sale(Sec.70 ,Business
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 owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.). 1"
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who Wilds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's at
License Law.
I am exempt under Sec B&P C for this mason
❑
Owner 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 Worker's Compen-
ton,as provided for by Section 3700 of the Labor Code.for the performance of the
work which this permit is issued.
I have and will maintain Workees Compensation insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workees�Coom-pyosation InsuranFe carrier and Policy nu her arc*
Carrier. 1`+►f►IcA�t 03� Policy No.: t`' '+J.,7"
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for oris 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
0� CONSTRUCTION LENDING AGENCY
F~•r JA I hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
=
Z
Lender's Address
U 0 I certify that 1 have read this application and stare that the above infomtatiun is
V.H correct I agree to comply with all city and county ordinances and state laws relating to
OV building convection,and hereby authorize representatives of this city to enter upon the
1117
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
F"y rA liabilities,judgments,costs and expenses which may in any way accrue against said City J��v
U Z in consequen f the ting this it WITH ALL NON-POINT Issued) Date /
�+ AP A ND A D I y
SOU R L NS. :2�rjtZ_Ut i
Re-roofs
Signature of Applicant/Con for Dare T of Roof
HAZARD US M S DISCLOSURE Type
Will the applicant or future Wilding occupant store or handle hazardous material
as defined by the Cupertino Mun'cr 1 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.
[3 Yes If a roo 7 is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wild'occupant use equipment or devices which
it hazardous air contaminants as d cd by the Bay Area Air Quality Management all new materials for inspection.
trio?
❑Yes °
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code, ns 25505. 533 and 25534.1 understand that if the Wilding
d t currently ave a t it is ility to notify the occupant of the Date
u' n w et uance of a Ccr ifica of Oc panty Signature of Applicant
All roof coverings to be Class" "or better
Owner or authorized agent Date
CITY OF CUPERTINO Dq
'' REPIPE/SEW�ER/MAIN SERVICE
CUPEi�TINO PERMIT APPLICATION FORM
APN# „ Date:
Building Address:
1.
OlK) L~I`Ii
Owner's Name: P ne#
l �� • ��t-� '� 253�2 c��l
Con r: Phone#:
cr Fax#:
Contact: Phone#: ) U
�l Y Fax#:
Contractor License#: b 17 cf7 s
Cu ertino Business License#:
Job Description:
Residential Commercial ❑
Valuation:
Project Size: ExpressEl Standardo Largeo Major❑
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial r,;-pipe per fixture P 1CPRP
1 PGASCOM Commercial Gas Piping System P _
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
- , CITY OF C'UPERTINO
REPIPE/SEWEBj"N SERVICE
0TYCUPEIZTINO FEE SCIJEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
J 1PRSEWER Residential building P 1RPSS
r sewer/sanitary sewer
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1 PPRSEWG Private Sewage E isposal System P
1PCESS Cesspool P
1 BPWATER Install/alter Wate,-Pipe P
1 BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/;as Insp. P
r 1TRAVDOC Travel & Documentation Fee B
1 BUSLIC Business License B
Community Development
10300 Torre Avenue
�,sw�V
Cupertino CA 95014
Telephone(408)777-3228
CIV OF Fax(408)777-3333
CUPEkTINO
Buildi.n De artment
JOB OADDRESS: PERMIT # O 02 O
;�-3
OWNER'S NAME: L PHONE # -
GENERAL CONTRACTOR: l i ; FAX #
I am not using any subcontractors: zz—L
S-.gna�ure Date
Please check applicable subcontractors and com Tete the following information:
SUBCONTRACTOR BUSI]vESS 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
2--Cg -c�
Owne Contr or Signature Date
FROM :CUPERTINOSANITARYDISTRICT FAX NO. :4032535173 Mar. 03 2009 03:28PM P1
DISTRICT MANAGER- NGINEF-R &
4 BOARD OF DIRECTORS
MARK THOMAS&C PANY,INC. 4 . WILLIAM A.BOSWO TH
RICHARD K.YANA ' M JOHN M.G:ATrO
DISTRICT COUNSEL YfA2$OF CURTIS 8.HARRISON
9F'RVIZFSO
1w WENDELLH.KERR,JR.
ATKINSON•FARAB LLP. 1*4.Is"SID%%*4 CHRISTOPHER C,LEE
HAROLD S.TOPPEL
20833 STEVENS CREKK BOULEVARD,SUITS 104
CUPIWRTINO,CALIFORNIA 95014.2154
(40S)2158.7071 PHO'VE • (408)253Z173-FAX
www,cupertino;anitarydistrict.com
File: Cu$D-- MOP
Building Dept. — Cupertino
City of Cupertino
Ann.: Building Def artment
10300 Torre Ave.
Cupertino, Cts 950..4-3202
Subject: To Aband n Existing Septic System And Connect To Sewer-Approved
Name: Garrity Re idence
Address: 10330 Ma n Drive 1 I
APN: 326-45-003
Permit No. 090200 0 #17617
■ Videotape a d Property Line Cleanout inspected.
No addict nal conditions/requirements by the District.
.Inspector: ( eorge Santos/Roger Santos................. ..........................
Date.-...03-(3-2009................... Sanitary Sewer Location:
cc: Property wn.er R/P1, 9'
Long 27'
Deep 6'
SUPPLYING SANITARY SEWER GE SERVIGES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND
SURROUNDING U JINCORPORATED AREAS
0 ;�
March 02, 2009
City of Cupertino 902001FO
Building Department
10300 Torre Avenue
Cupertino,CA 94014
RE: 10330 Mann Drive, Cupertino
Dear Building Inspector,
I have been contacted by Able Underground C instruction who is currently working on a project
located on 10330 Mann Drive in Cupertino. T ie contractor has requested a letter from the
Department of Environmental Health verifyi &the abandonment of the referenced property's
septic tank.
The contractor has forwarded several digital photographs to the Department of Environmental
Health. Several submitted photographs depicting the contractor in various stages of septic tank
abandonment,including a photo depicting a man made hole at the bottom of the septic tank.
From the submitted digital photos,the septic t tnk appears to have been properly abandoned to the
satisfaction of the Department of Environmental Health.
Should you have question or comments,pleas;contact me at 408-918-3435.
Sincerely,
Darrin Lee,REHS
Environmental Health Specialist
County of Santa Clara,Department of Envira amental Health
Consumer Protection Division
1555 Berger Drive, Suite 300
San Jose, CA 95112-2716
Cc: Able Underground Construction
County of Santa Clara *� C°` I) T�
Department of Environmental Health
3 J i
,onsumer Protection Division
GGG 13crcr Drive. Suite 300
San josc, California 95 1 12-2716
(408)918-34o0 1-AX(408)258-5891
w�ti�n.Gl linto.ori;
March 02, 2009 By 7
City of Cupertino
Building Department
10300 Torre Avenue
Cupertino, CA 94014
RE: 10330 Mann Drive,Cupertino
Dear Building Inspector,
I have been contacted by Able Underground Ccristruction who is currently working on a project
located on 10330 Mann Drive in Cupertino. TI-.e contractor has requested a letter from the
Department of Environmental Health verifying the abandonment of the referenced property's
septic tank.
The contractor has forwarded several digital photographs to the Department of Environmental
Health. Several submitted photographs depicti ig the contractor in various stages of septic tank
abandonment, including a photo depicting a m<<n made hole at the bottom of the septic tank.
From the submitted digital photos,the septic tank appears to have been properly abandoned to the
satisfaction of the Department of Environmental Health.
Should you have question or comments, please contact me at 408-918-3435.
erely,
W
Darrin Lee, REHS
Environmental Health Specialist
County of Santa Clara, Department of Environmental Health
Consumer Protection Division
1555 Berger Drive, Suite 300
San Jose, CA 95112-2716
Cc: Able Underground Construction
l3oitrci of Supervisors: Donald I:. Gagc. George til. Shiral:aw<t, Dave Concse, hen Yeagcr. Liz t:niss 85
.Acting Count' Executive: GilIx A. Graves