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10010125 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10682 FLORA VISTA AVE CONTRACTOR:ROOTERS ON DEMAND PERMIT NO: 10010125 OWNER'S NAME: SHALANI AZARIAH 32940 LAKE MEAD DR DATE ISSUED:01/25/2010 NER'S PHONE: 6507876518 FREMONT,CA 94555 PHONE NO:(510)475-8271 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT PLUMB License Class -1 AOL _ Lic.# C1 2 La:56� MECH F RESIDENTIAL F COMMERCIAL F Contractor a✓�oN �P�A,n�d" Date_L 2- I herebyaffirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE OLD SEWER LINE W/TRENCHLESS PIPE SYSTEM. (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL CLEANOUTS TO CODE Code and that my license is in full force and effect. 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 UL Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: , Valu n:$5000 permit is issued. ' R"� Occupancy Type: APPLICANT CERTIFICATION APN Number:3260804 .0 � P Y YP read this application and state that the above information is I certify that I have pp 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 savep pI SIF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the `~.... granting of this permit. Additionally,the applicant understands and will comply 1`80 SAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued Date: Signature Date LJ 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, Date: Business&Professions Code) Signature of Applicant: I,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: HAZARDOUS MATERIALS DISCLOSURE 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 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& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 Own r or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: d forthwith comply with such provisions or this permit shall be deemed revoked. Y Olt CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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.I 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 i -unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting 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 I understand my plans shall be used as public records. 9.18. Signature Date �Z 5- f Licensed Professional —(` XAAA0-0 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32608042 . 00 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT # . . . . . . . . . : BS000009605 REFERENCE ID # 10010125 SITE ADDRESS 10682 FLORA VISTA AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SHALANI AZARIAH ADDRESS . . . . . . . . . . : 10682 FLORA VISTA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RANDY MARQUEZ CONTRACTOR . . . . . . . : ARA AZIZIAN LIC # 30848 COMPANY . . . . . . . . . . : ROOTERS ON DEMAND ADDRESS . . . . . . . . . . : 32940 LAKE MEAD DR CITY/STATE/ZIP . . . : FREMONT, C8279'4555 TELEPHONE (510) 475 FEE ID IT QUANTITY AMOUNT PD-TO-DT -THIS_REC- -_NEW-BAL- ---------- ---------- ---------- ------------- ---------- 1.00 0 .00 1 . 00 0 . 00 1BCBSC VALUATION 5, 000 . 00 0 .00 0 . 50 0 . 00 5, 000 . 00 0 . 50 0 . 00 1BSEISMICR VALUATION 1 . 00 42 . 00 0 .00 42 . 00 1PPERMITFE FLAT RATE 21 . 00 0 . 00 21 . 00 0 . 00 1PRSEWER UNITS 1 . 00 42 .00 0 . 00 1 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE ---------- ---------- ---------- __ -- 106 . 50 0 . 00 106 . 50 0 .00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT REFERENCE_NUMBER ___ ________ CREDIT CARD 106 . 50 MC TOTAL RECEIPT 106 .50 ICE ID DESCRIPTION VOICE ID DESCRIPTION VO ------ -------------------- -------- - 202 UNDERFLOOR PLUMBING 106 SEWER & WATER 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUEY T PINO PERMIT APPLICATION FORM APN # Date:(P 0 Building Address: Owner's Name: Phone#: _5h& )qj&i $ P4 to k �aso Contractor: Phone#: Zoc4r r-_s QUI ►-v►A,IJ Fax #: Contact: of Tis e. . rv,,� �o� l Phone#: 9 Fax#: SID e Contractor License#: 1-Z to-So L! Cupertino Business License#: Job Description: �f )a ce es 13 se,.,je r 4 r-r'`X-h-1�6 S �; ✓vti . -�a l l !� �-e OL AJ a NA.4-s +0 G o��L . Residential Commercial ❑ Valuation: Project Size: Express ❑ Standard Large ❑ 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: QuantityFee ID Fee Description Fee Permit Type -Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1 CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPEIS EWER/MAIN SERVICE CIV OF FEE SCHEDULE CUPEI�TINO • Fee Description Fee Permit Type Quantity Fee ID Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanita sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development va� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 U f OF XPEkTINO Buildion D e�PERMIT rtm a nt OB ADDRESS:T # 11.eA?-- �Jorc� Vf S4 A AV�& PHONE # 0�- 7 OWNER'S NAME: FAX # GENERAL CONTRACTOR: Z o a l'd • actors: I am not using any subcontractors: 7 S gnature Date Please check applicable subcontr ors and com lete the f ollowin information: P SUBCONTRACT P(R BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwor Cement Finishing Electrical Excavation Fencing Flooring: eting Linoleum/ ood Glass / GI ing Heating Insulatio Landsca ing Lathing Maso Orn ntal Sheet Metal Pain • g/ Wallpaper Pav• Plast ring PI bing Roo • g Sep •c Tank Sh t Metal Sh et Rock Tile r - / - Z Owner Contr ctor Signature Date X01 gp�llrq�ro BOARD OF DIRECTORS DISTRICT MAN,AGE, --ENGIN��R Eq �� '�� WTL.LJAM A.BOSWORTH II+IARlfCTN6MA3 Be COMPAIVX,INC. � �► JaMN M.CATTO PtCHARD K.TANAKA CURTIS B.HARRISON .�FA512 DISTRICT'COUNSFEL �.� � WENDELL H.KERR,JR. AT'KINSON•FARASYN,1,LP- ��8,��y0 CHRISTOPHER C.1JE_1^ HAROLD S.TOPPEL 20833 STEVENS CgFFK 13OU1,F-VARD,SU1TF 104 CUPeR'T'1NO,CALIFORNIA 950142154 (408)253-7071 PHONE I It a 0)l far C t7C 0 FAX www.cup ertinosan y Pile: CuSD—MO. Building Dept. —Cupertino City of Cupertino Ann.: Building Department 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Sewer Line Repair Name: Azariah Residence Address: 10652 Flora Vista Ave A.PN: 326^08-042 Permit No. 10010125 x Videotape and Property Line Cleanout inspected. ,No Additional conditions/requirements by the District inspector: George Santos/Tony Soares...... .................................. Date;...02-04-2010........ .......... Sanitary Sewer LacAtiQn: cc: Property Owner. 5' nee 29' Lt PIL 1.S' Lang p SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS