06080022 F
OF CUPERTINO # ">I«*�»^aes'zLDING DIVISION PERMITC�'TORnINk'QIiMATIIAt ,',ADDRESS: t CHEROKEE CONTRACTING CO. PERMITNo06080022
0 ALCAZAR AVENAME: PERMIT sc4m DATE
RIKA KURAHASHI 356 MATHEW STEET 08/03/2006
NE SANITARY NO, CONTROL NO.
(408) 727-9850
ARCHITE(.-f/ENGINEER: BUILDING PERMIT INFO
BLDG FIECT PLUMB MECH
loo
LICENSED CONTRACTORS DECLARATION Job Description
�Zt I bemby affirm Wt 1.m 0mmrd ualer Prmitiou a Cha%cr 9(=a fts
with Scrion 70DM ofoinrid.3.f the Budno.and Pmr-Word Code-vtl rrYir"11
<� fwlf.mcl CyL INSTALL PROPERTY LINE CLEANOUT p
�? Laccrte C1av Llc.a
. Da
camaamor /y 1 tl>7a
fblARcxnEcrs DECLARATIONoN lee n
n Ion .rd my palm Wall betuJuptk.,b,
LL Lwrn d Pmfcunnal
:O OWNER-BUILDER DECLARATION
<E I bcmhy.ft WI I am a«npt from tto Contractor's IJcam TAW for We `Y a
p O fMl ng moon.(Secdan 70313,Busirc a PM(udom Code:MY city a cg=Y
5 U g which mW[nog.Poon to cantos.W«,snnamc.dcmNlL,or mpair any stirmto :i A $4000
prid,mu iau.,alw mqulmA ibeapplk.nt for such pmmt to fde.sitrcd na le01 IRIA
thato laWccotcd pool to tiv proAdom of the Contractor.Lkm Lal ( hape9 Sq.Ft. Floor Area UIU in
■p®
u�a (comaonang r 0S .7000)of Dividan 3 a(thc Bulnesa tad Proferiom Codc)r
e3— that M is camp th ndfraa rd We baud.for the alkif d rseapion Mr s W{m of
s won 703Is by M at,,rkard for.,trot aobfeas we appfi=l to.civil pcmny Of Occupancy Type
not mom duo f ae btmdmd datum(5500).
❑ do ao rrortne popetY,rmr repbym rithwgnuatio(S tem .Bud eta
win da thenen Cdo,Th,ctwe6na Iu «drtemd(wog WY 1Wn,Bi.a Required Inspections
tad wy My W Calc Tho Co dtrc LSmna far doe tort apply to rL 9war M q P
ria
ovnaMrho LIId.«imbat dtacan.Wrho mrdorh whhimseifa for If.
owa an.l bd.pmv orEthvsuchimps gold artnot hveefod,P riod r«view
bole thebuilding w impro emrsn is gold rdid of oar or camp formeavws-
bwldv wm Woe the burden of Pao^ns dirt to did has bdk r'vopmae for Pmpaa of
»k.L
❑1.v awns of the roperty..m vt kn ly coavanint rhh Oaurd mamm Id
muura the pojeu(Sec.7044.Bond.and Prafeantw Cade)Tle Cmma's 4
«ire IAw duo.1 apply n a awrcr a(pmpny who buil or'anpmms th m and
who aro u for ouch pojeaa NNa aruaatorIs)ncrnad pmvant to tic Coodaa rz
f dao IAL.
I ca.reps uoderSu: .B S P C r«ttia reamo
0. Dor
WORKERS COMPENSATION DECLARATION
I bemby an.tmhr palsy a per)uay mac a th fdlorint,�.u..r:..
v Ihav and will admin a Crsil6aa of Ganem to vJf-i for WoofersCanpcn-
wirt,v p,vihd for by Scedoa 37W of the Labor Cade.(m dr poformvua of de Y
wart for which Ina pool,k ittad.
❑1 bane tad will nmmmid Warkdh Comp�lour .v aeyulmd by srmon .
3700 of the Lahr Cada,for ft pu(ormamm of the cart for rhkh this pant,i+LwN. B
My W.r 'aCanpmW®Inmrvt¢atrir and Polley numbm
CvNc ay-�ls�ryaCi Paltry No.: �7�y/y'l05
CERTIFICATE OPTION FROM WOFU=
COMPENSATION INSURANCE
(This cctitn teed rot to compkab Rth pmmd k frmc hrtdd doBua RIBBI Y.
a kav)
I mtify tla in the prfarmam of We rat for rhkh this pmnh I.W—d.I than
empty my pmsan in my m.onerso u to became subjo l to Ne Wolin Compndoal .
IAL.of California Due
Applied
NOTICE TO APPLICANT:If.after dodging Nis Ccnifiom of Fmoaplan.you thoold
Omatrc a jwt to We Watcfl Campav0en pmvidom of the LAW,Code You data
.J O forthwith damply r to h poviums or thu permu Wil to dc4ad moketl.
'Z "" CONSTRUCTION LENDING AGENCY
N lbembyafrmm thn d.:aeV.mtamctian ladint allay fa the perfarmanm o<
a 7 the fart I.. ich il pvmlt 4 mrd(Sec 3(X77,Civ.C)
W Q IAndrfs Namc
',z Lenders Addroc
V O 1 mNfY oat 1 n.se read tmt apgliaatgn Std tote out tto Wove kfaramtitn k
W F-' evnect I n=to comply With all city and county oNi•.....and State laws mlaunt no
C U Wilding cors tion and hcmby unhano,mprescnudms or this ciry to ca«upnn the
r C almvcmcnbuncd propcny for inspNan purpaes
(WC).4'ru to vm.Indrnnlfy and ItGp haamleva the City of Capnino asWmt
rF'-t h li"Hitie,judgmc«t,cou and c.,rtaat rb m.Y id my way act 'mnaL and City
U in emtmlanee of the starting of this Permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POUfT Issued by: Date -
SOURCE REGULATIONS.
6L
6 Re-roofs /ice
am a toanyc s MATERIALS DISCLOSURE
of Roof
Will Ir ralae dd)dint omtpattwc«lurudle hasedam maerial
v deRrcL by QK CuperWto MmticiNl Coo,Cbapr 9.12 W the Hoith and Safety
Cade.pYoo u"2(01 t3+� All roofs shall be inspected prior to any roofing material being installed.
aavIf a roof is installedwithoutfirst obtaining an inspection,I agree to remove
Wul the applioat ar(.to.bwwlme paa Wtdptoral a de.im.bkn
:tonwadaoamrmamminam..mmadbythe flay AraAirQtWlryMuaapcarat all new materials for inspection.
v'Duarsct70Ya
1 none mad the na uGusvuuMdt mrytetrcw u Chaper6.95o(tneGliw-
naHUlthkSafrty Code.Sauoro19.505,295JJ ad 25531.1tmdcrnud dirt Jtk dvTMns
dao on,e..Lty h.ma trmml thu het my mfpatibilitr to nmif,do-float ar the
myo'ucvtrvs to.1Prior mi"11mmar.Cm.,eararlago . Signature of Applicant Date
�. All roof coverings to be Class "B"or better
vu 0<d"did,
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
46UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
21 1) c v Y-7(e.ez9 Az 06 0c-6022
OWNER'S NAME: Rica ),(,o^ ?A"f 5 PHONE #' 10E- z 7- v
GENERAL CONTRACTOR:Cle.rupke e FAX #
—Kop
I am not using any subcontracto : -3 oG
i e Date
Please check applicable subcontractors and comp ete 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35714033 . 00
DATE ISSUED. . . . . . . : 08/03/2006
RECEIPT # . . . . . . . . . : 35507
REFERENCE ID # . . . : 06080022
SITE ADDRESS . . . . . : 21910 ALCAZAR AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RIKA KURAHASHI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ROTO ROOTER PLUMB
CONTRACTOR . . . . . . . : YATES, JAMES H LIC # 702
COMPANY . . . . . . . . . . : CHEROKEE CONTRACTING CO.
ADDRESS . . . . . . . . . . : 356 MATHEW STEET
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 727-9850
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - - ----- - - - ---------- --- - ------ -------- --- ---------- - ----- ----
BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
TOTAL PERMIT 59 . 95 0 . 00 59 . 95 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- - --- - - - -------- --- - -------- ----------- - ------
OTHER 59 . 95 MASTERCARD
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
s
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE d�
: OF
CUPERTINO PERMIT APPLICATION FORM
APN # — I ���� Date:
1-
Building Address: C'
O
Own is Name: Phone#:
�i V&
Contractor: Phone: License #:
Tek - qO?' - L 9- :3d5411C
Contact: Phone: Cupertino Business License#:
J"�ck Zfmnze�es�-i�e.v of- 6 - 6 SS' 74" 1747A—
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ER'�
Job Description:
Si✓s�,vGl /�,r�pe.�vy 1../,Yc G'/e.��✓ov5�
Residential Commercial ❑
Cost of Project:
4(l4
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•
TB'd �d101
s
DISTRICT MANAGER-ENGINEERQ BOARD OF DIRECTORS
MARKTHOMAS B COMPANY,INC. " WILLIAM A.50SWORTH
DAVID E.ROSS DR.JOSEPH F,BROWN
JOHN M.GATTO
D19'TRICT COUNSEL �fT"4BtlSHE� X90 CURTIS B.HARRISON
ATKINSON a FARASYN,LLP WENDELLH.KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 95014.2156
(408)2537071 PHONE 0 (408)2535173 FAX
File: CUSD—MOP
Building Dept.—Cupertino
Community Development Department—Building
City of Cupertino
10300 Torre Ave.
Cupertino, CA 950143202
Subject: Install PropertyLine Cleanout
Name: Rika Kurshashi
Address: 21910 Aleazar Ave
APN: 357-14-033
Permit No.: 06080022
• Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the District
Inspector. Tony Soares...............................................
Date: 8-09-2006......................
Sanitary Sewer Location,
"eep
PLS
cc: Homeowner
SORRIYIN6 SAPITARY SEWERAGE SLIYILES FOR; (ITT OF COPLRTIIo, PDIIIONS OF THE CITIES OF SAIATO6A, SUNK na, LOS ALTOS AND SIAROUNDIIL IININ(wo RATED AREAS
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