05030011 CITY OF CUPERTINO T��a,{��g. /vn }°"yy '.'
BUILDING DIVISION PERMIT cOrrRa B� l� k 1FA �
BUIEINGADDRFSS: INTERIOR ENTERPRISE INC PERMITN�SO30011
495 SCENIC ILVD
R'S NAME: PERMIT 6617E DATE
GREG RICHMOND 855 AZURE ST 5
PHONE: SANITARY NO. CONTROL NO.
(408) 245-5500
ARCHr1ECDENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMBUM Mtn
Sop
LICENSED CORI3RACTOR'SDECLARATION Job Description
a u� I bcmby afRrm that 1 am licensed under provision,of Chapter 9(commencing
with Section Vill of Division 3 of be Buainets and Profession Code.and my license Is
rull5"' ndenec
5'z uwnmC s Lk.g � r SFDWL-2 STORY (2350 . LIVING)
;8' Dam�comncmr I BASEMENT 1175 ' /GARAGE 520 '
ARCHITECTS DECLARATION
�S I undeeaond my plane shall W used M public reemils
J U
sad
Licensed Professions]
OWNER-BUILDER in DECLARATION
aF 1 hereby.(firm that 1 1. exempt from the Commiserates a License Law for IW
El O following mason.(Sudan 7031.5.Business and t dem li Code:My oily or county
$fLiwhich,its tnpermll requires te ,Wr,Wprow.deermitt rirepairany omens
tachine
his Wiulsssedpuruntto do prevision of for auehpermit70Eeaeignedwumem
£ < wommen uswitpurmanl7000)ofDivision
ivonoftheCmUmmsanicenelaw(Chodrer9 Sq.Ft.Floor Area �'1 000
elm that W is exempt
with Section 70nd the
ei for of al eu d excom d Ps,My vi Code)or
the W 4 nwnpl thrtfrom am Ve baso for Ue alleged exemPUan.My Noladm of
Section 70313 by any applicant for a permit subjects Die applicant 70•null penalty of APN Number Occupancy Type
am more than live hundred dollars(MI 35706015 . 00
❑Las owner of the property,m my employees with"pan t eirma compensdon,
will do the work,and the structure amt intended or Offered fowak(Sec.7044,Business Required Inspections
and Rof.W.As Code:TW Cenraeul License Law does not apply b an owner of q P
property who builds or Improv flemon,and who de ca wch week himself.through his
own employees.provided that such improvements Are notinsended aro@rod forsate.if.
however.the building Or improvement Is mid within oro year of compkdon.the owner.
builder will Mw the burden of proving that he did rot Wild or improve for purpose of
sale.).
❑1,as Owner of the property,am exclusively mntrseting with leaned eonmides 70
concoct the project(Sec.7044,Business and Professions Code:)The Conscience,Ll-
come law does not apply 70 an owner of property.who Wilds or improves iceman,and.
who mnlncu for such projects with a contras rl licensed punned 70 the Coastal
License Law.
❑1 em exempt under Sec. .B k P C for this rumn
Data
WORKERS COMPENSATION DECLARATION
1 hereby AM=under pewry,of perjury me of the following deelawiom: '
❑I haveand willmsinuina CerwriwuofCowent70self-imuminWoheYaCompen-
wide,as provided for by Section 3700 of the Labor Cade,for the performance of the
weals for which this Permit is issued.
❑1 have and will maintain WmkeJs Compensation Inguel As required by Sol
3700 of 070Labor Code,for the parformance of 070 work for which this par uissued.
My Workee.Compensation Insurance carrier and Policy number ace:
Carrier.S f 1'61 —14414 Policy NO.:OO 24 1) 900'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need n rMcmnpbled dine permit s fmone hundred dollen ISIM)
or last)
I call that in the performance of the work for which this perch is issued.l shall not
employ any person in my manner an As an become subject 70 Ute Workcn'Compenmtlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.arm,making this Omillcare of Ememption,you mould
became subject On the Worked Compensation provisions of the 1aWr Code,you mug
rJZ forthwith comply withsuch provision or this Permit mall W domed revoked. -
Z y CONSTRUCTION LENDING AGENCY
[+ I hil shim thal Vert 1..mnmuednn lending agenry,for the performane of
D4> the work for which this permit B Issued(Sec.3097.Civ.C.)
W0 lzrok s Name
� Lei Address
U O 1 cenlfy that 1 Mw read this application and w¢the tic above Information is
Ig, comet,I agrce 70 comply with all city and county mdinnws and sum laws relating 70
O Wilding construction.and hereby mthml Presentstivu of this city to rout upon 0e
above-mentirned property for Wpeni t
Ly,
(We)a Lou w,indemnify d P hamkss the City Cupertino ageined
faA liabilities, nu,coN and pe kh may in mY 0)Y agaWuaid City
U APPLI Mn an
nc UNDE a the STAN Sm 0 W NON-POINT Issued by: Dale
SOU ER
t Re-roofs
BI Applicant
ntrsemr s
H ARDOUSMATERIALSDISCLOSURE Type of Roof
W IWapplic t or fun
building Occupant am,or handle banNoes material
tle0n by the Cupertino Municlptl Code,Ch,prer 9.12,end the l asl and Safety
won 23332(.)7 All roofs shall be inspected prior to any roofing material being installed.
Ye, u
Will the applicant or tum Wilding nccupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
call hanNnus air eonuminanu as do ncd by the Bay Arca Air Qualhy M...gement all new materials for inspection.
District?
❑m
I n reed the anN a Ialsreyuimmc9ryV. a cr493 o(thc Glifor-
ma th Salmyc e,Scolio )i 3 diS534 rad buif0c Wilding
d t rtenti h .tan. R==ant of the
re Inc conk ted I ofawpancyo� Signature of Applicant Date
r acd egcnl f „e All roof coverings to be Class"B"or better v
JUN-12-2007 16:52 MARK THOMAS CUP 4082535173 P.01i01
• `+0 5M1fJOr�
DISTRICT MANAGER-ENGINEER .(pr BOARD OF DIRECTORS
MARK THOMAS B COMPANY,INC. B STEPHEN C ANDREWS
DAVID E.ROSS WILLIAM A.BOSWORTH
DISTRICT COUNSEL YEAii OF JOHN M,GATTO
9E VICE
ATgNSON+FARASYN,LLP. R�481126TLU WENDELL H.KERR.m.
HAROLD S.TOPPEI,
20833 STEVENS CREEK BOULEVARD.SURE 104
CUPERIINO,CALIFORNIA 55014-2154
(408)2597071 PHONE + (408)25 178 FAX
www.cupartinoaanitarydistrict.com
File: CuSD—MOP /�I I
Building Dept.—Cupertino
City of Cupertino
Attim Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: S)rD
• Name: Richmon Residence
Address: 10495 Scenic Blvd.,Lot 1
APN: 357-06-015
Permit No.05030011
■ Videotape and Property Line Cleanout inspected.
No additional condidons/requirements by the District
Inspector: George Santos/Tony Soares,Joe Sullivan t r S
Date:...06-1.2-2007................... Sanitary Sewer Location:
21' L/PL
cc: Property Owner 4' deep
18' long
• 1-Sewage Pump(for basement)verified.
2-Lateral is connected to MH#T-110(Drop connection).
SUPPLYING SANITARY SEwERAGESERNOEs FOR:CRY OF CUPNRTINO,PORTIONS OF THE CRIES OF SARATOGA,SUNNYVALE,LOS ALTos AND
SURROUNDING UNINcoRFORAnC-0 AREAS
TOTAL P.01
23 I w t�c,M sa- JE
2rj fol
05/11/2007 14: 10 FAX 408 777 3333 CITY CUPERTINO 16 001/001
community Development
10300 Tone Avenue
• j Cupertino)7 95014
T4 -3228
Fax(408)777-3333
CUPERTINO
BuildirDe artment
JOB ADDRESS:
PERMIT#
OWNER'S NAME: 6c Rtc-9mQoD.— PHONE#
GFNERA:LCONTRACTOR: N ftR GM . FAX�� Z70
6i•- Z�fo 1� Q P'-i
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following' ornmtion;
SUBCONTRACTOR BUSINIESS NAME BUSINEC6 LICENSE #
Cabinets &Millwork _
Cement Finishing /
Eleciriral
Gve+'l a4 C-'
Excavation 't — J J 6 Q�-�
Fencing
Flooring:Carpeting S _
Linoleum./ Wood
Glass/ Glazing 80r mkmz, S 12- ✓
Heating Al D, Al k- � Z 2'
Insulation _
Landscaping _
Lathing _
Masonry
Ornamental Sheet Metal D P 1✓
Painting/ Wallpaper _
Paving _
Plagering
Plumbing e4KmtftL CPA- fta a o1'8 70�
Roofing 1Z _
Septic Tank 'rDIJ E10 kof
Sheet Metal _
Sheet Rock _
Tile, _
Date
er/Contra or Signature