14060049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10580 WHITNEY WAY CONTRACTOR:DRAIN DOCTOR PERMIT NO: 14060049
OWNER'S NAME: DORCHAK SARA J TRUSTEE 480 ALDO AVE DATE ISSUED:06/09/2014
OWNER'S PHONE: 4082570587 SANTA CLARA,CA 95054 PHONE NO:(408)370-3082
60 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
f REPAIR/REPLACE PORTION OF BUILDING SEWER.
License Class c. REPLACE
t +/-8' OF SANITARY SEWER LINE&INSTALL(N)
Contractor J'V�, ..--- Date 1Z 1 )AIA PROPERTY LINE CLEANOUT
I hereby affirm that I am licensed under the provisions of Chapter 9
(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:
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: Valuation:$7000
Pave 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 APN Number:36939022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITII N 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY D INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /54
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
A RE-ROOFS:
Signature Date Cir—�(r 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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as 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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's-- material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the IAbor-Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued." will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the workif'or which this Owner or authorized agent: — Date:
permit is issued. 14 ,; 1 '
I certify that in the performance of the wdW-for which'fiis permit is issued,I shall
not employ any person in-any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buildino(a.cuoerino.org M I S
e U P'I`RT11'4Q
❑PLUI✓,BING ❑MECHAt�TICAL ❑ELECTRICAL ❑MISCELLANTEOUS
PROJECT ADDRESS / 0S-0% APx'9 � � D Z
OWNER NA J M `n (
REET PHONE'
STADDRESS v/ CrTY,STATE,ZIP. i O I FAX
CONTACT NA.ASE I PHONE E-1J�SII
STP=ADDRESS CITY,STATE,ZIP FAX
❑ o-A%-m ❑ uwNm.BUILDER ❑ ovntmAGMTr ❑ CO',7RACTOR 11CONTR4CTORAGE1\'T ❑ ARMUTECT ❑ENGW--R ❑ DEVELOPER ❑TEN-Al"T
CO:ITP.ACTOR NAN-- 1 ; LICENSE NUW3ER 1 ^� I LICyE111'SE TYPE/ BUS.LIC R
C01vLDAI YxAME IDV-N V� 9,0 LTA" I E-I✓AII I FAX
S=-r,7 ADDRESS 1 Q^ ` /1 �� I CITY,STATE ZIP Cz d\
V I\ I PHONE
ARCHC IENIGINTEER Nf 111E / LICENSE NUMBER J BUS.LIC
COMPANY INANE E-MAIL FAX
STREET ADDRESS CrrY,STATE,ZIP PHONT-
USE OF ❑STD or DUPLEX ❑ MULTI-FAMILY I PROJECT JN WIIALAND ❑ YES I PROTECT IN ❑YES I IS TIDE BLDG AN ❑YES
BLrI1D➢89: ❑CommmCIAL URBAN DiMERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO -
DFscRrPnoxof woRx wS v" 'i 1\ l ) Q . +yet„
GCor� CV110W
TOTfiI,VP.LUATION: D QJ D
By my signature below,I certify to each of the follwA ing: I am the property owner or authorized agent to act on th erty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and veriy it is accurate. I agree to comply with all applicable local
ordinances and state lams relating to building cons�buction. uutthorize representatives of Cupertino to enter the above identi ed propejrty .or inspection purposes.
Si,-nature of Applicant/Agent: ( Date: (9 -�
SUPPLEMENTALORhI4ATION RE UaED
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1✓EPNiscflpp_2011.doc r evised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10580 WHITNEY WAY DATE: 06/09/2014 REVIEWED BY: MELISSA
APN: 369 39 022 BP#: *VALUATION: $7,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD Or DU IeX PENTAMATION 1 RPSS
USE: p PERMIT TYPE:
WORK REPAIR/REPLACE PORTION OF BUILDING SEWER. REPLACE +/- 8' OF SANITARY SEWER LINE
SCOPE & INSTALL (N) PROPERTY LINE CLEANOUT
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $24
Sewer, Sanitary 1 PRSEWER 1 # $24
TOTALS: $48.00
ife, Pig Che" Plumb.Plan Check 0.0 hrs $0.00
;LFc., Pel;nit Fcte: Plumb.Permit Fee: IPPERMIT
t: 12c'—l'tcch. Other Plumb Insp. 0.0 hrs $47.00 f;I,lresI:=1<>c.Ltsl.
i9L�c z. l;zs�a 1`rL' Phanh. hap. Fee: f e::
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn I info.
FEE ITEMS (Fee Resolution 11-053 EfJ.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check
PME Plan Check: $0.00
Permii h'1—'-
PME Unit Fee: $48.00
PME Permit Fee: $47.00
("rnzstraction TO.V:
J-1
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
:�ci�'Cd7tC'e'�t l�titNfttlit�r /`t.'eJ.
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion Fee: IBSEISMICR $0.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
x '4wSLS $187.70 $0.00 TOTAL FEE: $187.70
Revised: 04/01/2014
DISTRICT MANAGER-ENGINEER �� BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. v "� WILLIAM A.BOSWORTH
RICHARD K.TANAKA JOHN M.GATTO
DISTRICT COUNSEL ��. ��o STEVE C.ANDREWS
l'4BL IS HED WENDELL H.KERR,JR.
ATKINSON FARASYN,LLP. ANGELA S.CHEN
HAROLD S.TOPPEL
20863 STEVENS CREEK BOULEVARD,SUITE 100
CUPERTINO,CALIFORNIA 95014-2154
(408)253.7071 PHONE•(408)253.5173 FAX
www.cup ertiaosanitarydistrict.org
June 9, 2014 File: CSD—MOP#241
Building Dept. —Cupertino
City of Cupertino Approved For Issuing
Attn: Building Department Building/ Plumbing Permits
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Residential P/L C/O Install -Approved
Name: N/A
Address: 10580 Whitney Way, Cupertino
APN: 369-39-022
Permit No.: N/A
The Cupertino Sanitary District has reviewed the plans for the subject project:
■ Sanitary sewer is available and the existing building is connected to sanitary sewer, see
conditions/requirements listed below.
The following Conditions/Requirements are made:
• Install new property line cleanout or locate and raise to grade an existing property line
cleanout. Property line cleanout must be within 5 feet of the property line.
Cleanout shall be the same diameter as the street portion of the service lateral.
Gravity lateral is 4" diameter minimum. (O.C. 4101)
• District inspection is required prior to clearance for City of Cupertino Final
Inspection. Owner to call District at least 48 hours to schedule District inspection.
District to provide Building Department with written notification upon completion
of inspection. (O.C. 5104)
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS
Page 2
1
Subject: Residential P/L C/O Install -Approved
Name: N/A
Address: 10580 Whitney Way, Cupertino
APN: 369-39-022
Permit No.: N/A
All conditions,requirements and recommendations are to be completed at the
(Owner/Developer)'s expense.
Storm water from surface or roof drains, other general surface runoff water or condensate from
any residential HVAC equipment shall not be discharged to the sanitary sewer.
Yours very truly,
MARK THOMAS &COMPANY, INC.
District Manager-Engineer
For: Richard K. Tanaka
If you have any questions or need additional information,please can Julie Chiu or Thanh
Nguyen at 408-253-7071.
U:\Administration\Coirespondence-Generahl-etteis\2014\L.etter#14-241 Cupertino Building Depaitment_Residential_Pl-CO Install_10580
Whitney Way_Approved 6-9-14.doc
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOSAND SURROUNDING UNINCORPORATED AREAS