06060011 CITY OF CUPERTINO
BUILDING DIVISION PERMIT f��ONT RACTOR4NF, ORMATI®N:
BUILD
UI LOING ADDRESS: ABLE SEPTIC P.w r No.06060011
814 BETLIN A
OWNER'S NAME: A PERMIT ISU2 DATE
LEI TIAMMO 520 REED ST. 09/02 / 006
E
SANITARY NO. CONTROL NO.
(408) 377-9990
ARCHITEC7fENGINEEA: BUILDING PERMIT INFO
RLDO ELECT PLUMB NECH
0 0
o�
LICENSED CONTRACTORS to Rp DECLARATION achap �/�ob Description
u Fj 1 busby aR Nu 1 un 11¢mcd vada pro•Wmt M Chapter 9(woken onac h
.z16 villi Seetbn 701L)NDivinaoJaf tle Blalnen atq Prdntlom Cods.and my Gccnteu
<„ amuraama a S BACK FLOW
Igq DLk,o G.v Cmtrrbr
ARC zlib coo DELLA non )I'J� �,/
IuMcm.nd my plARCHTcmcdupublic rtON c1V
O U 2006
.pLicenbd Rmferion.l p
Oat I=..'t R DECLARATION Buxom
<S I hcmhy alTrm N.I I M acme Tenet We Cmlraclara Lkcab law for IhC
.❑O fallowing rc.m.(Scum 7M 13,Bualms amd Profeulou Codr.Any city ar wumy
:29'. rhim rcmdru.permit b anmmct.Ila.holm nL dcmdbb.m mP.b toy v+vcmum $1000
3i} prior to n umyee,auotegucrcs the xPpkamt Trish permit to fila asiPrab smcmcnt
, � dwncnuammpnnnwlnllbP�n„.IwnrlbeePl.r.ea<.I;�bu.(ca.P�9
Sq.Ft. Floor Area Valuation
(eommcot .&with scedm 7000)of Divivon 3mflhe Butinea old P.ff..Cade)«
s that he it avop IbefelmP and the lase for the.11ejfE uevlpfim Ally violation of
Section N3U by ury.ppB fc.pomeft wbjeaa the.ppTmnt b.64 puWp of —tog mrrwr= Occupancy Type
ama mort thav fiw bwdmd da1Wa(1700}
❑I.uawtc of the pvprry.cm0'empbym wisp�'.{nu Ne'v mkcompeeuWn,
win mmewWk,melee Too Cont n sRmd«dr.w(mot apply 10"aQ,amOc of Required Inspections
ud Pmfatlobu code:The ineocce,and
law does not apply ll rt..Zli d q P
m,m why bund.m(bpranettheex,andoho.not hwah him..r-thmu{hh.
L.
awnemplyea,proWded theameh knpawm'mlaerene earofcmoRycd f«ale B,
buil v ORade iling the -dee a pmvitlthan he
c, yev ofxr pfo.ft poowzr-
builda viB ha•e Ili btrNm d pmvlp than k dM Ion bttlW a kvpwe far P«pure or
seta}
0 L u.of Ibe pepcny.am eW—v Y cmuaNm{wire Ikaucd comm cta.b
oono t the pmjen(Sm'1061.Basin total Pmfesdmf Code,)The Cmmxtor.U.
cmx Law does vd.ppy b m owcer o<pmPevl wla hallos«impo•a merema
aced.
oho ceeuaeu fm stcb pmjcw vlth aeawama(s)w..a.d pawul b We Cmannoh
L ane law.
❑Ivo avop vvdc See, ,BkPCfa wla enom
Ow-a Daae
WORKERS COMPENSATION DECLARATION
1 bendy LM m modcr pmahy of perjury me of the fdbwin{declaratid.
I baw and lmiorina Ce Oflwe a Coeem to wr-kmre fc Werle .Compeo-
talo,u pro cod for by savor 3T(10 of the Lab-Code,for the pafamara of the
work f..blah Thu p it u ienomi ,
❑1 bee and win maiaain Watrls Compeuvion I..-ttpuited by Schon .
J'R)0 of Ne,Labmr Coal.fa Ne,pe fomacc of the wart fa which thea Pemolt b rus«d
My Worke .Ca- uMets aniu
perion Metros arta Policy num arc
e,;,k,: t'Irl Vl
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
CTbla maim mated eotbe cacepkaM If the prmh u fame horl6ed da0rs(5100)
«1-s)
I crtiry Nuc in Ibe pufatoaece of the cork ata wbicb tbu pamil it inc I"I ma
employ any petmo to any mamerm u b became mbjcn to the Watan'Coop won
I or Callroma.Date
NOTICE TO APPIJCANT:if.after matin{ibis Certificate a(Euapice.you slmuld
become aeboct b One,Woa e s CanpmUon in ^ ooa of the,labs code,you mue
.,0 fonbwiN amply wbh sech ix ri a tbis petit.hall be dented m•okcd.
z ^ CONSTRUCTION LENDING AGENCY
F-r Ihercbyair.that pert uaaamtucdm kndin{.FoCY f-Ne,Perfarmmce of
fk > be.ort for which ft Pemna Is Ivat(See.3097.CW.C)
UJ Q Ua 'Nroe
7 ,z Lenders Addmev
U C) 1 citify that I have read thea applcWm rid sax tlw the.bow inf.dm 6
f'^ roma I.ye,a campy with dl city and county o lm.and sue laws Nun{to
O() huildingcmuruction.and hemby authoeim mprcmutiws of Nis city to cmer upon the
r Walnw.mnti«ed pmpcny I«iespcc0m Pop•-,
P. (We).yce b uw,indemnify and Yecp harrnkv thle Gly dCuperdn.mmol
F' N H.Wi0u,jud{mecs.rovs and e.pe J which may k any xyacauc a{atwsatd City
Q Z', in cmmegvenc of the yawn{of this Permit. Date
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
TDS 'L (r� t! 6-a Z'0 6 Re-roofs
Sl{ roof ApPlkantlCmuada Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIB Ili applionlafueve buildin{amWaw amrt alurle)e hau ctmauul
m RMed by 0e Cupmitb Municipal Code.Chap-9.11 old the HaIN aea Safety
Code.Section 25532(0+ All roofs shall be inspected prior to any roofing material being installed.
0Ya �No
VAU tib applk m«ftmm builmm{mmPatn ue egdpnamt«dc.iaa 010 If a roof is in without firs[obtaining an inspection,I agree to remove
ii W .air antamfi ,,as deMN by Nc Bay Am Air Quality Nam{cm— all new materials for inspection.
" DivricT � .
0m mho
1 baw toad the havrdousout-Tal.rtgvirnrctlu under Chapb695 ofthe C l fa.
ria HaIN h Safvy Code,sedan nms.2553J v.ivci a.I adcmaod tbaa fYte bulldog
Ikea mat earemly lase•taum WY it is my ievemiwa,to may the ocvpmt a(the
re,ptimmmSignature of Applicant Date
TQCCcyz 0L-01
fi- All roof coverings to be Class "B" or better
Ouncr«au11N(VW aScnl Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36927038 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT 4 . . . . . . . . . : 34655
REFERENCE ID # 06060011
SITE ADDRESS . . . . . : 814 BETLIN AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LEI TIAMMO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . .
RECEIVED FROM . . . . : ABLE SEPTIC
CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC.
ADDRESS . . . . . . . . . . : 520 REED ST.
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 377-9990
IREE 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 3906 ,
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
OF
CUPEkTINO PERMIT APPLICATION FORM
APN # SO 7—? 0 3 E I
Date:
6 - 02- - () 6
Building Address: l
l � .
Owner's Name: Phone#:
Contractor: Phone: � 99 License#:
X4Co
Contact: Phone: Cupertino Business License #:
Jose- z, o w 2fi(o 3L
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
low
Residential Commercial ❑
Cost of Project:
• 1, 000
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 eofFixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•