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10100057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7436 FALLENLEAF LN CONTRACTOR:AMERICAN PLUMBING& PERMIT NO: 10100057 DRAIN ,""VNER'S NAME: RUTH A LELLI 1346 THE ALAMEDA STE 7-194 DATE ISSUED: 10/06/2010 NER'S PHONE: 4082050500 SAN JOSE,CA 95126 PHONE NO:(408)205-0506 f7 LICENSED CONTRACTOR'S DECLLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F License Class 6 Lic.# 9S� V t ` r MECH RESIDENTIAL COMMERCIAL Contractor�'��,�{� �\,�\, ` \\ Date "' 6r3� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SEWER REPLACEMENT&CLEANOUT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 911 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. Sq.Ft Floor Area: N Va,t h $300 I have and will maintain Worker's Compensation Insurance,as provided for by _ v. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:3593. Octpancy Type: APPLICANT CERTIFICATION K I certify that I have read this application and state that the above information isNO t. correct.I agree to comply with all city and county ordinances and state laws rela ing ` to building construction,and hereby authorize representatives of this city to ente, PERz I� pl.XPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save IT IT 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply �, with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: _ Datei ��Q 9.18. y S nnature Date�LJ- w U JL� RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for on a of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensa ion, Signature of Applicant: Date: will do the work,and the stricture is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I sh:ill not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I r lust forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relz ting to building construction,and hereby authorize representatives of this city to enter Lender's Address n the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgment: :.,.s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$3,000 ;;�PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARYSFD or Du lex t >,r, : PENTAMATION 1RPSS USE: p �- Jr 11.£ PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 ,;c;, ,F,c ',': c k71 Plumb.Plan('heck 0.0 hrs $0.00 t t_ .<_ P,oo;"F _ Plumb.Permit Fee: IPPERMIT Other Plumb [nsp. 0.0 hrs $42.00 Li NOTE. Thesefees are based on the preliminary in ormat'on available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS(Fee Resolution 09-05/ ]TEE QTY/FEE MISC ITEMS Pharr C;hecA, Vee PME Plan Check: $0.00 PewrrnrE E i:�c: Supp/, larsp 1°'tr�> PME Unit Fee: $21.00 PME Permit Fee: $42.00 C.onsli-iwfi lai Tax � , ,�i'(ttfstit;ctl f�t't'ieti;V<`c': Work Without Permit? 0 Yes No q$42.00 Plcanuiaa" l"c'c',': Travel Documentation Fee: ITRA VDOC Strong Motion Fee: $0.50 Select an Administrative Item Bldf:Stds Commission Fee: IBCBSC $1.00 --71 SUBTOTALS: $106.50 $0.00 TOTAL FEE: $106.50 Revised: 9/29/2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35928023 . 00 DATE ISSUED. . . . . . . : 10/06/2010 RECEIPT #. . . . . . . . . : BS000011668 REFERENCE ID # . . . : 10100057 SITE ADDRESS . . . . . : 7436 FALLENLEAF LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RUTH A LELLI ADDRESS . . . . . . . . . . : 7436 FALLENLEAF LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MARIO D FRANCISCO CONTRACTOR . . . . . . . : MARIO D. FRANCISCO LIC # 27114 COMPANY . . . . . . . . . . : AMERICAN PLUMBING & DRAIN ADDRESS . . . . . . . . . . : 1346 THE ALAMEDA STE 7-194 CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 205-0506 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 . 00 1 .00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 000 . 00 0 .50 0. 00 0. 50 0 .00 1PPERMITFE FLAT RATE 1 . 00 42 .00 0.00 42 . 00 0 .00 1PRSEWER UNITS 1. 00 21 . 00 0 . 00 21. 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 106 . 50 0 . 00 106 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -------------- - -------------------- CREDIT CARD 106 .E0 VISA -------------- - TOTAL RECEIPT 106 . E0 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -------------------------- -- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ ,)"UBCONTRACTOR LIST JOB ADDRESS: 6 � � L� ��� PERMIT# S OWNER'S NAME: Vl-\ A Le PHONE # GENERAL CONTRACTOR: USINESS LICENSE# ADDRESS: k 3¢6 j�,9("� btie �! CITY/ZIPCODE: .2 (� *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 AJSUONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. OI am not usin an subcontractors: � �� �� �� �Dg YSignature Date Please check applicable subcontraccomplete the following information: V 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 '``�'� SO►NIT/O�p�.o/ BOARD OF DIRECTORS DISTRICT MANAGER-ENGINEER �� �(�k .per MARKTI•IOMAS 4 COMPANY,INC. 4 p� WILLIAM A.BOSWORTH es RICHARD K.TANAKA ca ... JOHN M.GATTO YFA.F5S$0T CURTISS.HARRISON DISTRICT COUNSEL �3P.F �� WENDELL H.KERR.JR. ATKINSON•FARASYN,LLP. rA4 1� CHRISTOPHER C.LEE HAROLD S.TOPPEL 20833 STEVENS CR SEK BOULEVARq,SUITE 104 CUPERTINO.C 4LIFORNIA 950142154 (408)2537071 PHONE 0 (408)253.5173 FAX www.cupertino)sanitarydisfrici.com File: CuSD—MOP Building Dept.—Cupertino City of Cupertino Attn.: Building Department 10300 TO1Te Ave. Cupertino, CA 9501.4-3202 Subject: Install Property Line C/O Name: Lelli Residence Addl-ess: 7436 Fallenleaf,Lane APN: 359-28-023 Permit No.10100057 Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the .District. 17JInspector: David Souza/Tony Soares..... m t. lekl..Vo....:........ ....... Y Date:-.1.0/1.3/201.0................... Sanitary Sewer Location: cc: Property Owtier, 12' Lt P/L 30' Long 5' 'Deep SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPEI tTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNOIN(,UNINCORPORATED AREAS CITY OF CUPERTINO �. REPIPE/SEV)'ER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # -5 Date: (y Building Address: ��4 1 L Owner's Name: V,\ Phone#: ) Contractor: Faxo# # 40 �`� ©�o 6 Contact: � `-� Phone � V Fax #: Contractor License Cupertino Business License Job Description: Residential Commercial ❑ Valuation: Project Size: Expres Standard L Lar€;e 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 re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission, B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Corunercial P Revised 01/07/09