06010169 CITY OF CUPERTINO r$ wap,
BUILDING DIVISION PERMIT ZONTRACFORIINFORMATION .
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BUILDING ADDRESS: AMERICAN RESIDENTAIL SERVI '31TND06010169
21907 ALMADEN AVE
OWNER'SN M PEMMLS511EDATE
1479 BERGER DR 01/30/2006
NE: SANDARY NO. CONTROL NO.
(408) 287-2165
ARCHMIC'VE CINEER: BUB-DING PERMIT INFO
BLDG ELECT PWMB MECH
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up� LICENSED CONIRAC70R'S DECLARATION lob Description
M 1 bmeby Arm Nu 1 amaa
Bad nicer one ri W Clupor 9(cornmaeint p
mNS dkrn 7").fDlvwon 3 of the Badu••W Frraossi Coh.and Crylkatcu
In ran rar¢Werea REPLACE SEWER MAIN-LATERAL 55 '
; � Lkear C1 Lk..
;tp Dente �{o Tr.. contMn
Alrt I ECIS DECI.A ATION
dy IuMcruaM toy P4a"l m umi u public baardu
c liaensd Pro(etooal !/
OW NER-BUIIDER DECLARATION
a� I bamby aRm Nat I M armpt from Nc Cmlrares L...^..Iry for Oto 2
p 0 folkwint mann(Section 7031.5,Budneu W Profadna Cods:My city or aaunty
Which rcgv'ua•;conn b amuun.AV,latfa .mm,ulrh.a mpdr my $10000
_Ia, priorb liccouta.Jrotcquira tis Apiouof for rvonp nnkaaltncauauaxot
< Nn he4liarndpm,n,ntbuKpb.I.ua.oruccnn�rLia=l..ecb+pbr9 Sq.Ft.Floor Area jZ - Valuation
° Ora It,eneingnp moral.
god of D.A.I.of NCBudneuWPafacw Cnh)or r
� Nu Y 4 eamPl NcefNmn alk We WJs fa tW Jktd esemptlon.My HolatWn of
Seedon7031.5 by any.pplicrnt for a permit sabye Ne.ppliew to A civil perulty of ancy 'lTY
pe
not man Nan Rve btadmd dollen($500).
❑1,as awoer of the PAY•a t>ry wploycn Wh wage a Neu hat eompenmdaa.
silldon"`.0ory-Tho Cava I;Inh°°rnwdko; ut Wit,
a'B"d°a' Required Inspections
and Rof¢doa Cods The cnnuaclarN l�Vv don ort apply n an owner of q Pe
bcnva
PrWe^y MIu bullNaimP�Nemo.and who doumch rat IumallIX Wroutli hu
pvacmpkyeu.pi,oui Numm tI. to*dOtic trot Wendelorltla dfor aal�r.
wildrer,pc Willi,the or'vnpbKment I.hard mdno one Sar d mmpkuoa,Ne owed
W Rder Win lace the btvdat of proving Nu be elk pot Ella a impure fa pmpoe of
uk.).
❑1,a owoc of the prnperty,am exclusively cca riot witb Ihrnxa anm w,to
..t Ne pmjm(Sec 7060.Buri.and P rudtms Cade:)The Ccrru h LL
apae lav dors not apply to an Cham,of pr peny.rho dtlWs or Imgow Ocrtan.W
w1a cooaacufa such prrn?nmN•caauaaSar(J licensed quvum to Ne Cunn &.
L .lay.
labi.pttmdc See .Bel PCfordd..
Date
WORICERS COMPENSATION DECLARATION
it 1 bueby affirm under p®hY a!paj one of the IICLID tat holmuua :
I kK ad m l mJnwn aCaUBore of Cmueu b zlf-Nsun fa Wa4Ya Compcty
aunt,as provWM fIX by Senora 3700 of Ne labor Cade,for We Pafamnre of the
work for"ich Cm;crrait is laud.
❑1 base and will mumu'WmkcrS Coatpewnnt I.,u",timd by SCCd n
37(10 of Ne labor Code,for the pertor unce of the hark for which Nu perndi 4ls Ord.
My Wmke(s cctdr co ltuunna earierW Poly nmobcruc
ti // /�
nier: w
7tti �t'M ✓.-lam. . Polk,No.:&I ().- ;2q3S6,; 'r-0 3;
CERTIRCATE OF EKEMMON FROM WORKERS
COMPENSATION INSURANCE
mois=t n pcE as bcauopktN nme pern4 Is for.hurtAcaddlat($100)
orIeN6)
1 unify Net in OC mourm occ of the cork for Which OU p=ft it iarrd.I Audi our
mploy any;aeon In any nuoncr to as in bonne ab}cito NeworkersCompaas ^^ .
Law of CJVaoia.Dur, ..
APPlkun
NOTICE TO APPLICANT:B.AV mating Or Ccnintwe a Etcmpnon.you slack
bnonue aubjct to Ne Wo4or A Compewtbn prwldora a(ft labor u m
bor Cade.your,
,J O (orhwiN a
NmWith ply such faaWdoru or N4;emit A rdl W danuW mutat
zo CONS ULT10N LENDING AGENCY
(-.I I hco,by arum don bon,u a cemnciMa Suadlnt army In,do perrormuta of
C'> tic work for"ib Nis permit a iauM(Sec 3M.Ci,C)
1 A le .NAmc
=z Inndm'N Aa^�^
U0 1 Carly tout 1 have rad dna applkulon W lute d u tic canna informalun u
W P anneal.1 ajme to comply WIN JI city W cam?ordiamca,t W s m,laws Nuing b
OU Wilding anuruNon,rod hcmby adthain rcpresenwi.a of this city to cnbr upon one
W .bout-rrcntiorrd roomy I.urspcnlm pop .
Lin (We)agra to un.IrdrmNfy W keep hannku the City of Capcnim a{alat
Hy lubindajudgmcm.coos rad esPrvu which hay in my way accrue ata Wt a id City
U z toPPcor ofthtnamt ofINN panic y,
ALICANTCAN'r ER
UNDSTANDS AND WILL COMPLY WITH AIL NON-FOAM Issued b Date
SOURCEREG ONS.
�4 Re-roofs _
Sitauof Apel' aasrac Data
um
NAZUIDOUS MATERIALS DISCLOSURE Type of Roof
Will th apprkaat or future Wadiet WE amt IX bans:harsdom ma¢rial
At dcllncd by Ne CuapeNm Munlcilul Cohn ChaW,9.12 W tic Hullft and Safny
Code.Sealkn 25533(J7 All roofs shall be inspected prior to any roofing material being installed.
Cy.
Win do anthema or fuwm Wilding=upam�cquipmem m tkviae which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt haladlnN air conurNnarus AS dcnncd by tic Bay Arra AU nudity Mmkitonem all new materials for inspection.
D wict7
❑Ya Pit
I bave mad the bvudmA maNmab mquvevcns unaxmaptn695 of tW Califon
run HclNk SafuyCoda.Scdmu 75505.25533 uk 75534.I tmdnnuk dutifdc Wilding
Java ort currrndy hate•taum.Nu It 4 any ms'.Wity to mti(y tic occupant of Lc
rcalntarnnmdrbmount Eeancrpnorbsnao,,ofaC=F=xofO" Signature of Applicant Date
�' 7� "�3�tr- All roof coverings to be Class "B" or better
Owner or uh d ttgiint Date
CITY OF CUPERTINO
1� 1 of 1 . PERMIT RECEIPT OPERATOR: quem
COPY # 2
Seo: Twp: Rng: Sub: Blk: Lot:
APN 35715105.00
DATE ISSUED. . . . . . . : 01/30/2006
RECEIPT #. . . . . . . . . : 33004
REFERENCE ID # . . . : 06010169
SITE ADDRESS . . . . . : 21907 ALMADEN AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERITNO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERITNO, CA 95014
RECEIVED FROM . . . . : RESCUE ROOTER
CONTRACTOR . . . . . . . : BUREL, MARK T LIC # 21504
COMPANY . . . . . . . . . . : AMERICAN RESIDENTAIL SERVICES
ADDRESS . . . . . . . . . . : 1479 BERGER DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112-0845
TELEPHONE . . . . . . . . : (408)287-2165
•
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
_________________ ____________ __------_____-____
CHECK 59.95 003687
TOTAL RECEIPT 59.95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
__ ________ ____________________________
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
aOF
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408) 777-3333
&PEI� INO
Building De artment
JOB ADDRESS: PERMIT #
�
60/�/ s
OWNER'S NAME: PHONE # g—b/. q6,?
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: /I2a�0
Sijnaturel Date
Please check applicable subcontractors and complete the followin 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
lOir - �
Owner/Contractor Signature( Date
CITY OF CUPERTINO
�Liu, REPIPE/SEWERS/MAIN SERVICE
�UPEI,TINO PERMIT APPLICATION FORM
APN # L5�7 1�f— x/nS— Date: �h. o/O�a
Bu' in Address:
IM
Own 's Name: Pho #
n2-- to Iu
Con actof: ('CLn / ho : License#-
r S-Z�) 9(0q() �y UZ
Contact: Phone: CupertiVusiness License#:
6 `1O o<
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project: Oa
•
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
06 15:20 MARK THOMAS CUP 4062535173 P.01i01
4Q~`�o 5 An 1 TAq�o'er
r
DISTRICT MANAGER-ENGINEER j BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. ci --R WILLIAM A.BOSWORTH
DAVID E,ROSS DR.JOSEPH F.BROWN
F JOHN M.GATTO
DISTRICT COUNSEL
ATKINSON•FARASYN,LLP CUR715 B.HARRISON
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SURE 104 WENDELL H.KERR,JR.
CUPERTINO.CALIFORNIA 950142154
(408)2537071 PHONE • (408)253,5173 FAX
File: CuSD—MOP
Building Dept. —Cupertino
Community Development Department—Building
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Sanitary Sewer Lateral Installation
Name: N/A
Address: 21907 Almaden Ave
APN: 357-15-105
(j�v0/D/m
Control/Plan Ck No, N/A Cu SD nnection Perm No.15851
• Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the District
Inspector: George Santos..................................................
Hate: 2-07-2006......................
cc: Homeowner
SUPPLYING SANITARY SEWERAGE SERVICES FOR; CITY OF COIRTINO, FDIT10NS OF THE CITIES Or SAIAIDGA, SUNNYIALE, LOS ALTOS AND Stl11OU1DINC UIIN(ORPORATED AREAS
www.rupertoos011ilar),dis rrirr.ram
TOTAL P.01