06040155F1
CITfOFCUPERTINO
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PERMIT -ate . RM.AT=ION..... -
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r8715
DING ADDRESS: CHEROKEE CONTRACTING CO. P"MRNO06040155
BROOKGROVE LA
ERS NAME: PERMIT LSUEDATE
NELSON ALLEN M AND JOANN M 356 MATHEW STEET 04/25/2006
SANITARY NO. CONTROL NO.
(408) 727-9850
ARCHITECTfENGINEP3L BUIIDINO PERMIT INPo
BLDG EIKT PLUMB MFCFI
1� 0
;0� LICENSEDCONTRACTOR SDECLARATION Job Description
1 hveby arri m that 1 ro li¢.vS under puvidwt of Chapin 9(cconnocreint
with Seetim 7000)of Dlviaun 3 atm BuYrcs+and Pnofamw COde.and my lkc=Is Ir®.
12 kmnr�dapc_z, � t — I INSTALL 4" CLEANOUT r(N/1p�4��
Z Ilnox y
Doc L/- 7—t o a_Caarauar
ARCHITECTS DECLARATION
I utdvvanJ mY P�shall he umd u Pbtic rtsoa,h
'LL t; I.ixwed Pn, u MAY /'O_ 06
`0 OWNER.BUILDERDECLARATION 10
I hereby affirm Nat 1 am eumpt from the Con naemfs U..lar f«the
OO foil nt maom(Savo.7M 13,Buri—and Rofesuom Cod'Any city or coamy
3 29 .bich nayuine,.parnit on cmuuun.alley.i,,no e.do nci b.w co air any awcwrt rlit, $2915
ia- p,orto is iacuantt.aboncquina tis applian fun wch permit u nlc a.ltned aalemem Ft. FIOOr Area n
22 <
than b,itbooucdpurwantuthoitvWanfatheComrct«'sLict. .r(Chap-9 S9•
2�a (cmnnn pint rlth Sec0an 7000)of Divition 3 or the Bod«faund Pmfeviora co&)«
9 tbu be h aempt thgrham and the bails for the allcl ed eaempilou Any Hdati nn of
Section 70113 by any.ppll for a perrWa wbjeas the applicant to a dull prn.hy of of Occupancy Type
tut more than rn<bu>bmd d (S500).
❑I,uowvaf Ne propery,wmy wplvym wvhvwuthe'o svk compeaadm.
riummer.n.nam ne o<bn�t new«nrz�adro a.e(s«. a+.e arca Required Inspections
aM pmfevdoru Cage The Conuanora Litz.lar clow o«apply to at annoy car
9 P
prapmy rbo builds wimprote,Nemo•and rho docs stub runt hicwJf a Woo{i bk
,,,n rmtploy oa,ptovkcd the orb impnomma•,.are tt«intend n!womnel f«ale If.
bowery,bo buikintwinpo.enoed I.addwithin one Ivy of.PWiwt.thearoe-
hudde.iB bee Na booties of po dnt Nat be dlE rot Will or hnp for gnpoae a
ak.l
1,a orwa of tbo pn.PcnY.w adoai r y can.atint rW Uccoxd rahuacus In
cc w t the pnojeea(Sec 7044.Bo dna and Pmfessiwu Cod')The Cmonao's Li-
.rata doe,amt apply to N ormr a pmpmy rm Alike«in —tbo.,enol.
rho mlurwa for auh projects NN.cc.0 ocr(.)Booed puaa.al m the CaotMtca'
❑lam......p trade Sec .B lPC fun Nunevaa .
Orn Dam
WORKERS COMPENSATION DECLARATION
1 bemby afRm under penally or Palu,orc a the(.ponying do,lataiaa:
.prnr1 ha.r aId rN forty oaCSNOaeac LabtCodc.wmIantd— ewllpcn-
satl®. r ,blob ni fun i Secdm 77110 a the Lab«Code.(w the pedamanoc a Ne
waaY f«which thti.prnnit u ImN.
CTI bac and anti maintain Wofte,Co nponui nn Inwmc.u tyahra by Section
37f50 of the lab«Code,fw Ne pcof na of tho rock for which Ibis perms u loud
My WmtetL.Clamm rata amie and Policy lmmborae:
Carrier. J"T AZ /LUt.� PoI'ay W.: �7 J4/ ee
CERTIFICATEOMPIE SATION INSURANCE N FROM WO _
Crbk aclm vecC tut be complccd if Ne perms is fame lbM dalW($100)
orluv) �.IL
I atifr c n in the pafonmawa a Ne rock for which this Nnnit u imN.l"I not
cmpWj.ny prawn in any hvwarao a In bavmc wbjm m th Wakm'Compemllm .
law.aI Califwdi Dale
NOTICE TO APPLICANT:If..fmr matin{Nis CcniBac of Faanpdon•you thunk
becwne ab,=on the WorkrY,Ceohpcunlon ,iicons of the Labor Code,y'v nova
.^I Q ra nb comply with arch paovlb«a w thi patron shall be docmed« IonL
z "" CONhTRUCTION LENDING AGENCY
14 I herby Nirm that dam b a can cn kldint a$awy for the per�a
IY > Ne w I..hich Nu pumit b iaocd(Sec.3097.Cir.C.)
QL cndc s NaNx
r�Tz latdoe,Adds
U O 1 eNfy Nn I haw nad Nu applkaim and lute Na thc.bo.e infonoa i
W V
U ca fooL I atnoc to comply with all city and county«dlnarw and alae kw«Wnt m
buldint co cation,aM bertby authoriao Mpleaeouti.v of Nu city u mer upon tic
W abore-mcnd«cd prapcny foc inspeNm purp=&
(We)acne to aw,mdc r ntiy and keop harroA.a IAc City of Copertioo.phml
F'c,I lubili0a,jadtmcnu.coca and apcaa.Licb on,in any wy.cmc Malnat aid City
U incon to onccoftb.tanlintofthulannic
'-' AP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date y,•2' G"�
SO R RD
p
Y.._ _i3_n r2aH Z L/ 1? 0 6 Re-roofs
Siµaouc aAppliawaCana Dac
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W10 da"bunt or fotwc bulldint..Fant awe w haodlc hawdow nom ial
u dented by the Copenuu MU nal Code.CbaW,9.11 and the Health W S.fely
Conic.section 2350(07 i All roofs shall be inspected prior to any roofing material being installed.
❑Ya [}W
wikint—Pot aw'Ulpmmt wcoda,Mnob
If a roof is installed without first obtaining an inspection,I agree to remove
win the.Ppliantw f,,,n.
.mil hvw .11 cvmnLunu 'txrtncd by the Bay Amo Air Qtod ty M"Wooca all new materials for inspection.
imwz
D7
❑Ya Nu
I bare Icad the haandwa rorcrW r nequicmoaa under CbaM 6.95 or the ui for
o1a Halthh Safety Cock•Snavu 23505.25D3 aw125534.1 undervnd"9f huildiot
doe rot currowy hme•t than it is my mapmdbituy an notify the occupant a de
mgnimatent.rl on.,tbemapncoWmua a.cmmaNaacct;F.«y. Signature of Applicant Date
Dw«n or wOmri; d,00t Doc All roof coverings to be Class "B"or better
. . l
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 37539019 . 00
DATE ISSUED. . . . . . . : 04/25/2006
RECEIPT # . . . . . . . . . : 34135
REFERENCE ID # • . . : ,06040155
SITE ADDRESS . . . . . : 875 BROOKGROVE LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NELSON ALLEN M AND JOANN M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4633
RECEIVED FROM . . . . : ROBERT RUIZ
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
*EE 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
- ------ --
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
•
Community Development
10300 Torre Avenue
1 ! / Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
S 1Y n6 6 �?b
OWNER'S NAME: - ort PHONE #
GENERAL CONTRACTOR I ClAeov FAX #
IM /
I am not using any subcontractors: �2 ca , ( jt- 1
Signature Date
Please check applicable subcontractors and complete the followinginformation
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
" - X040155
CITY OF CUPERTINO
REPIPE/SE'vVERS/MAIN SERVICE
CUPEI�TINO PERMIT APPLICATION FORM
APN# i� I(� Date/
Buil ,i Addresses �bbK 1 � L� 6
j / (S u
Owner's Nan ,h Phone#:
V l csr72-70 2s'z 7Z79
Co actor: Phone: License#:
ez U6)8 --72-1- 9 $5-0 33s(01S
Contact. n Phone: Cupertino Business License #:
J ' vim ( - c..0 (039 - b� � Z
Building Permit Info: /
Bldg ❑ Elect ❑ Plumb
Job Desigtption:
ns7 zL d ce
Residential Commercial ❑
Cost of Project:
X01 lS. IO
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
BPREPlPE 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
•
MAY-OB-2006 14: 13 MARK THOMAS CUP 4082535173 P.01i02
O gens sqR�.
DISTRICT MANAGER-ENGINEER �� / BOARD OF DIRECTORS
MARK THOMAS&COMPANY.INC. ca WILLIAM A.BOSWORTH
DAVID E.ROSS U DR.JOSEPH F.BROWN
JOHN M.GAT1'O
DISTRICTCOUNSEL f ��
F
ATKINSON•FARASVN,LLP
r4B[I S H ES CURTIS S.HARRISON
HAROLD S.TOPPEL 20833 SVENS CREEK BOULEVARD,SUITE 104 W ENDELL H.KERB,JR.
T E
CUPERTINO,CALIFORNIA 950142154
(408)2637071 PHONE 0 (408)2535173 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 (Install 4" Clenout)
Name-.Allen
Address: 875 Brookgrove Lane
APN: 375-39-019
Permit No.: 06040155
• Videotape and Property Line Cleanout inspected.
No additional coni itions/requirements by the District.
Inspector: George Santos.........................................
Date: 5-08-2006......................
P/L Cleanout Location;
38' Long
31'.5"R/PL
5' Deep
cc: Home owner
SUPPLYING SANITARY SEWERAGE SEDIDH FOR; CITY OF CUPERTINO, PORTIONS Of THE CITIES OF SARATOGA, SUNNYVALE, Las ALTOS ANN SORROUNDING UNINCONFORAT[G At HS
ww w,cup e r fin o son i far y dis FNu.co Int