06030003 CITY OF CUPERTINOz
BUILDING DIVISION pERIyUT ICONIrRAC�TOR"�INFORMAT,101I.r:
BUILDINGA DRESS: PACIFIC PLUMBING "B""O'06030003
808
OWNER'S NAME: PERMIT ISSIIE DATE
Ak NORRIS ABELLA 2138 O' TOOLE AVE 03/01/2006
IF NE SANITARY NO. CONTROL N0.
(408) 452-8633
ARCHREC(ENGINEER: BULLRING PERMIT INFO
BLDG ELECT PLUMB MECH
0
foo LICENSED CONTItAC TOWS DECLARATION Job Description
ro 1 bOro"arm that I am ikenxd under pm isima or CLper 9(caomemmz P
W Scmkn 7")of D1,i i m 3 anhc Bmal.1od Pmfwiae Code.and my lit.u infull foreandeag - -INSTALL SEWER C/O
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^�<]WRCHIIbo DE TON
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my PbJldl nc^s trcd m public mecrN '
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IL I,iccn¢d Ptaealnnai j
O OWNERBUIIRER DECLARATION
I hcrtby.(Sm Nu 1 an cacmpu from tar C.nnnn«'s LiMy c Law far mft y
O wbdrbfollo�nLum,;a jt t 71131 rnu ua1 . oand Nagsimm h.or parr m.r muvy
$ whichmyuitva ,adautoci=nk,ging,imforsahp=ii,a,eryirnYn,tutwe 10-
y pnmbib imwna,abu regains the eppliva for Lori pumitW(no aaiSrcdsummcon
�n Nu he Wli¢nacu putwwnue ptoWslom of the Camcnofa uvarc V*/Chaper9 Sq. Ft. Floor Area .ValuWb
i�g (mmrrxw.&with Smlon 70(10)a Division 3 M tae Busing+end PmfoOld.CWc)a
— that h b earmpt uhvcfrom gid We hAs4 for an,aih,ged ormpd.My v.Wien or
Section 70713 by any appllonu for a puma aub}rtu the appllurd to a rna Perry of r Occupancy Type
not mac duo Ras butdred d.H.(5.500).
❑L as wtv of the Propene or my rmPla¢ vuh wa5g g ubty mk mmpeovtloa
vi0 do,ds wort and 06 n =bn.t lntroded or oRued for sae(Sm.7011,Busiorm Required Inspections
cod Pmfwd an,cod,_The Cmuu ors hire me lag door not apply to an owns a q P
prop,"vin bWlds or in.pular dra n and who dogash Lark himvlfor umm5h hu
oao empkyg poweided Nat such dmpmenmta art On,Irtendcd.named fa a B.
howew.the buaNnL«nmpovemem Issold wWd.ore Year of mMPlwoo.the.ander- .
ddWer wW law:Ile Maden a prwd5 dun k did tun build or hopmae for propos a
ak.7.
❑1,u gamer a ale propene.am gClovls7y cmtouOU,anti 1i mmaamora n
c.Rurum de p,n t(Sec 7061.rival.a,d Prtfgsiau Code')T7e Coo a -LL
cove raw dog not apply m an was of popny'rho huhds«improv mama and
wbo contncu for such plopm adult.cmur.Wl)liunsd paautm to tK Cm e.
Ixcos Law.
❑lamgmoplondu See .Bh PCfartburtasm
DwKr Duo
WORKERS COMPENSATION DECLARATION
I ltmebY Lain.under prulry a Pr+kwY oro a the ro0.winp'-'- -
1 ba.e and win MainWn a CvWil s Cauvn W sdf-tamer«wortefseompen-
sW m,g porided fm by Section S )a the lana code,fa the Porforonerat a on,
oak for which this permit la Lsamd
❑1 Nee land aria maintain W«telt Compemuion 1 yuan¢,m mquued by Smion
3100*tae labor Code.for taepformaocof the gat for wh{m Chia pamin is . ,L
My wakefa CamPa.do Insumurm a mer soul Polky numbs art: i,� '
Caoiv�-Policy rrowrw o` I
OMPE XTION ais INSUR0 w r
COMPENSATION INSURANCE
rrh shim reW not le canpked Ernie Pu is foram hadred moan(5100)
«lea)
1«rTifr dlut in We plftm n.of de work for*hien Nu lermdt IS load.I ahall not
umpt,arry prsm in any Menmr an m to hgamc sobjal to do Worlxrs'Caopumnbo
In.of C Womla Dee
Appligv
NOTICE TO APPLICANT:If,after akin[dads Ceniawe Or Eumpim,you sluwW ^
hecane wbj=m Nc Wokv'.Cmopguion roomit.a de Latta Code,ym tum �[;/Q.,
.J Z fonitwiN mtlgrH aik sock pro.isi«u or Nu Inn.i1 ttJl nc dmaCd rtw4d. ///''' ,L e-
ZO CONSTAUCnON 1FND0tG AGENCY 11L aD
[� > Ih.at imthi than hi uacmRncilrekndin5 a.) the perfumanbsa ay��(
a > Ne&akfu*hkh dub pn.ilbiaued(see 3091.Clr.CJ .
W�QI<nmfa Nae
m
=z Itder't Addmr .
U0 1 comfy that 1 hats mad alis applkW m and auto Nu Ih abow infam of m is
LL
c". crxrctt 1 arra b comply wIN all city and County ordinancs and Lute bars ria ing n
0>, bmildinS camuucu.n.and hereby nNotiJ rtPmsrnuuivv a this City to m6Tupm Nc
W ahove,menuuo4 pmprly r«Impemlm PutpsL
(We)Leta no sas,indemnify and trop barmku the CiuY of Cuprrlim apaimt
tiy IiablInkL JWLnonta,1.and gEtc.Mlthell may to any wsy nate LOW sand City
U in cmn ooros a uc 5rantine.rIndia pvmu.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG S.
0 6 Re-roofs
C SILvw man US MATERIALS DISCLOSURE — Dan, 1 Type of Roof
will do LP$11.Or fuwre bonding occupant Mort a handle hanrdma manvial
n dearth by the Cupmino Municipal Colt.Cbapg 9.11,aha the Ikahh and Safely
oro.sCvfm 25532(a)7! All roofs shall be inspected prior to any roofing material being installed.
❑Yu
If a roof is installed without first obtaining an inspection,]agree to remove
Wi0 Nc air. «fuwm dddinL by Une Bt¢ca Ail Qu Mdcvkv whkh
t haaaN«u air comm�ir.M.u dcOrcd hY Nc Bay Am Air Quality MwLctttM all new materials for inspection.
Dvmict7
❑rba G Brf
I bm rtW the Wardcas mnndalft cWuarcsns dodo,Chap,,495 ode Califon
nb Hgltb k Sarmy Cock.Scillas 75505.25533 tad 75531.1 utA acid do aIle duldin
dao.ml earthy lues.Ieneta and it u my teapoualdliny b eudfy Nc.gsgm,nr me
rWulrttatut which muck priorwimumcc as ccdrin=or OcompeteT. _ Signature of Applicant Date
-� � All roof coverings to be Class "B" or better
Owner a ori LLCM D tt
f Community Development
a1300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
o6 57, D4� --s
OWNER'S NAME: PHONE o
GENERAL CONTRACTOR C< FAX # v ,�
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete 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
/Contractor Signature Date
........;�?�2:'%2 b.08......:32..F A,X....4. A6..7.77...3333................C.I.T1'..CUPERTINO....................................
................. 001/0.0...............
CITY OF CUPERTINO
REPIPE/SEWERSI AIN SERVICE
CUPEILTINO PERMIT APPLICATION FORM
APN # 13 2 Date:
Building Address:
LAAKY
Owner's Name; Phone#:
NDCMQIS MVU.A og-7os_sD4jo
Contractor:W jpv Ph
PLNriIOn a one: ,M-gy At.0 License#-
sewa7#597
Contact: Phone: 9Cpq_$�cF g1RD Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Yob Description:
Residential Commercial ❑
Cost of Projoct:
o�0
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMTfFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFD'TURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
MAR-07-2006 07:51 MARK THOMAS CUP 4082535173 P.01i01
` �QAIN
SAM1l4Rkox
DISTRICTG 4
MANA ER$NGINEER a y BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. " WILLIAM A.BOSWORTH
DAVID E.ROSS DR,JOSEPH F.BROWN
DISTRICT COUNSEL er JOHN M.GATTO
ATKINSON■FARASYN,LLP
f48(1S III T.,0 CURTIS B.HARRISON
HAROLD S.TOPPEL 20833 STEVENS GREEK BOULEVARD,SUITE 104 WENDELL H.KE'RR,JR.
CUPERTINO,CALIFORNIA 95014.2154
(408)2537071 PHONE 0 (408)253-5173 FAX
File: CuSD—MO
Building Dept. —Cupertino
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Sewer Repair
• Name:Abella Residence
Address: 808 S Blaney Ave
APN: 369-27-013
Permit No.06030003
■ Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the District
Inspector: Tony Soares/George Santos..........................................." J
Date:...3-06-2006................... Sanitary Sewer Location:
cc: Property owner
SUPPLYING SaIURY SEWERAGE SERVICES FOL CITY OF CUPERTINO, PORTIONS OF THE CITIES OF SARATOGA, SUNNYVALE, LOS ALTOS AND SURROUNDING UNINCORPORATED ASPS
WMW.(UPPITI0050�1PGlP dIS fl1(L(0(0
TOTAL P.01