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11090081 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11346 S STELLING RD CONTRACTOR:ABLE UNDERGROUND PERMIT NO: 11090081 CONSTR INC OWNER'S NAME: WONG TONY AND KATHERINE PO BOX 24819 DATE ISSUED:09/13/2011 ER'S PHONE: 4082559050 SAN JOSE,CA 95154-4819 PHONE NO:(408)377-9990 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT f— PLUMB License Class - C Lic.# 0 11 (E� ? MECH F RESIDENTIAL COMMERCIAL i Contractor A Q Date 6_,),]—11 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONNECT TO EXISTING LATERIAL&ABATE SEPTIC (commencing with Section 7000)of Division 3 of the Business&Professions TANK Code and that my license is in full force and effect. WITH CLEANOUTS I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$7860 permit is issued. APPLICANT CERTIFICATION APN Number:36225047.00 Occupancy Type: I 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. _ Issued byi. Signature S Date V OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owne or authorized!gent: forthwith comply with such provisions or this permit shall be deemed revoked. ��fo 1rJCDate: O ^1 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save �mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address s,and expenses which may accrue against said City in consequence of the ranting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36225047. 00 DATE ISSUED. . . . . . . : 09/13/2011 RECEIPT #. . . . . . . . . : BS000014738 REFERENCE ID # . . . : 11090081 SITE ADDRESS . . . . . : 11346 S STELLING RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : WONG TONY AND KATHERINE ADDRESS . . . . . . . . . . : 11346 S STELLING RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5023 RECEIVED FROM . . . . : ABLE UNDERGROUND CO CONTRACTOR . . . . . . . : MARSHA M. MILLER LIC # 29014 COMPANY . . . . . . . . . . : ABLE UNDERGROUND CONSTR INC ADDRESS . . . . . . . . . . : PO BOX 24819 CITY/STATE/ZIP . . . : SAN JOSE, CA 95154-4819 TELEPHONE . . . . . . . . : (408) 377-9990 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41. 00 0 . 00 41. 00 0. 00 1BCBSC VALUATION 7, 860 .00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 7, 860 .00 0. 79 0 . 00 0 .79 0. 00 1PPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0. 00 1PRSEWER UNITS 1 .00 22 . 00 0. 00 22 .00 0. 00 1TRAVDOC FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 152. 79 0. 00 152 .79 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 152 . 79 #17699 --------------- TOTAL RECEIPT 152 .79 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING 109 (D c )EI CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777.-3333•buildingacupertino.org ❑NEW CONSTRUCTION ❑ ADDITION LTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS (I i y c> • APN# ` -2- 6 2 O OWNER NAME ��y�� r PHONE `�r� E-MAIL STREET ADDLE S,4L;. �� '� f CITY,�TA ,ZIP` _ ^ ��Iq FAX CONTACT NAME �Jt/ `L ` 1 PHONE �-t ( u (+r E-MAIL 1 STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I/_ �..-.� 1.�, LICENSE NU�B�„R' 1 � LICENS TYPE, BUS.LIC# COMPANY NAME /� ��` n el r E j C 1_(��vii,`C A FAX411 7 r h g STREET ADDRESS r F�L� - �1(� CITY,STATE `z� `�t u PHO T1^�j c--) 0+ ARCHITECT/ENGINEER NAME f ` LICENSE NUMBER ('lI L BUS.LIC# "� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP _ DESCRIPTION OF WORK 11f' L �� j Ile v l EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY [-]YES BEING ADDED? NO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: ` TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I ve rov ed Jisorrect haver d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rely ng to di g co I u presentatives of Cupertino to enter the above-identified rpr(operty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for "OVER TIE-COUNTER Q-'sUtLriING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ 'PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ ''PUBLICwORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 i Cupertino, CA,,-- La A,,-- + Telephone: 408-777-3,L, . C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# ( OWNER'S NAME: Q a / C, PHONE # 0 O GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: UJ - C *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ��h C 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 Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date "4,40* DISTRICT MANAGER-ENGINEER �q,'�� ( BOARD OF DIRECTORS MARK THOMAS&COMPANY,INC, �44r `�`� WILLIAM A,eOSWORTH RICHARD K.TANAKA JOHN M.GATTO YEARS pB CURTIS B.HARRISON DISTRICT COUNSEL WENDELL I-I.KF-RR,JR. ATKINSON•FARASYN.LLP, r'�BLISNEV �� CHRISTOPHER C. EE HAROLD S.YOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104 CUPERYINO,CALIFORNIA 990 14-2154 (408)2537071 PHONE • (408)253.5173 FAX r www.cuportinosanitarydistrict,com File: CuSD—MOP Building Dept.—Cupertino City of Cupertino Attu.: Building Department 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Convert from Septic to Sewer- Install Property Line Clean Out. Name: Wong Residence Address: 11346 S Stelling Road APN: 362-25-047 Pen-nit No. 11090081. ■ 'Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the District. Inspector, Tony M Soares ony J Soares/,Toe Pressnell......Y.:C1j6*1 VV...... Date:...09/22/201.1................... Sanitnry Sewer Location: cc: Property Owncr 18' Lt PAL 46' Long 6' Deep Installed Sewage Pump SUPPLYING SANITARY SEWERAGE SIFRVICES FOR'CITY OF CUPERTINO,PORTIONS OF TI-IE CITIF_$OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATCD AREAS