08090056CITY OF (,UPERTINO
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BUILDINF DIVISION PERMIT
CONTRACT.dORINFURMATION
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Bua�lyc43p1�Le5PERMIT
AYW00D DR
GOGO ROOTER
NO.
08090056
OWNER'S NAME:
PERMITISUEDATE
KOHLER DONALD
2530 BERRYESSA RD STE 509
09/11/2008
tNE:
SANITARY NO. CONTROL NO.
(408) 282-7026
ARCHTTECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION.
Cham,-9t(must...
Job Description
I hnmq affirm that 1 am likeemsedBu under provision Of e
is
with Secuon]OIrU)ofDiviuon Jof dee Business and Pra�rgyeuionCCotic, and mylirenmu
SEWER LINE CLEAN OUT
ur full name andnfr Lk-(2boTt g 11 O t_i 5 6
ll .0
.
License Clue
Dam Cantracuof
ARCHITECTS DECLARATION /
1 undersand my shat) W used sa recorW
plan Public
e q/
r/rr�V
Liconaed Pmfcasiond /
OWNER -BUILDER DECLARATION
I hereby allirm that 1 sum ex,mpt from the Contrumta License Law for the
following mann. (Section TLD 1.5, Business and Professions Calc: Any city at county
which mquirca a permit to contact, atser, improve, d,mulis i. ar repair my madam
prior to its issuvxe. atm requires the applicant foruch permit in file a signed statement
that W is licensed to the em,iaionof dm Convacmr's Lune Law(Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant
$8925
(Co..enting with Section]000)of DivisimnJnf Ne BuaiM.. and Pmf ion CaM)or
that he u exempt therefrom and Use basis for We alleged cacmPdm. My violation of
Section 7031.5 by aq applicant for a permit subjects the applicant in a civil Penalty of
31630003 Number
Occupancy Type
ret mart than five hundred dollars (5500).
.
P Y
❑ I.uowrer of dm pmpeny,mmY wployoes wiN waguudehuk compwxtion.
will Pr thewad4 Code:he Com aMlNanded Law rid ler Outapply. in an owner V
and Professions Cade: can0eneeu. Licrmm law does ret appy m an owner of
Required Inspections
lobo builds viirepratesch and who doessuch tank Ainsre3redthrough h'ts
m
mamimpr erenot )mendedmoBued sok,
mem
awnemployers,provided
prsuchimpmold wit
however, We building he improvement 4mld within arc year or me owner,
Wilder will haw We buedan of proving that k did tar hark m improv for puryose of
imprmeuan, Imaseof
ale.).
❑ 1, u owam of We property am uclusi m), contracting wide lieensed contractors ho
mNlmet We project (SCe 7W, BnNc9 and Professions Coda) The Cofactors U.
-
cenm Law does act apply to an owner of property who luitds or improwa Wermn, and,
who contacts for such projects with a contractor(+) licensed pursuant m dere Contr eem's
License Law.
❑tarn camvps under Sec ,Bl PCrm that mason
nOwner
Date
\ \V/ /WORKERS
SAN���I��
COMPENSATION DECLARATION
1 hereby a01no under penalty of perjury oro of the fallowing declaration:
IIIIIIJ'IIIL\J\e\\/UJJ1
law and of Consent m Corroon fm Wortrta fthe
bine tion ante
provided
urian, ide fourSection J]00 of the labor Cade. Ire the Performance of dm
ce o
r
work for which this permit is iumtl.
Pe mi
❑ 1 haw and will maintain Work s Compensation Insurance. u recurred by Section
3700 of the labor Code. for the prrformarme ofd, work for which this Permit Is issued.
'
My Warkeh Cmnpe.ationiuu.cccamierand Policy amour ate: ff��
SV•/Cal
Career. t71 n IC M 1i.00]�.Z,�poliq No.: &M \ L
LZ -
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
(Mil semim reml rot W completed'd the permit is forms, hundred dolian ($100)
or leu)
I certify dust in dee performance N the work for which this Permit u issued, l shall ler
employ any person in any maarer sou to become subject codec Wod¢a' CompenWm
Laws or Caufomia. Dam
Applicant
NOTICE TO APPLICANT. . If. after making this Certificate of Exemption, you shoum
become subject m dee Worker'. Campenaauort previsions of mo Lahor, Code, You muss
forthwith campy with such pmvivan m this Permit mail W doomed mmlecd.
CONSMUCf10N LENDING AGENCY
I hereby affirm dist them isa construction lending.,me, for do, performance of
the wude for which don permit k issued (Sec. 3(17[, Civ. C.)
Landets Name
Lcrt a aAddress
I mrafy deal I haw mad this application and sale dist We aouw h mmsatim is
.
mrrett I agme to comply wide all city and county ordinances it ram laws miming in
..
building construction, and hereby amharim repmsenmdws of this city to enter upon do
profor Wpemlan pur,pumawhichm.
above-menudpr
(We) agree m saw, indemnify and keep hnmlev dee City of Cupertino against
ms. cos ex pensnwhich may In any way attme agunsrsud City
incuiseemen uof thecosuand
in eonsmmrce of dee geanung of Nis permit
APPLICANT UNDE ANDS D WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATI Ng.
Issued by: Date/�GG1
�II
�`'IT'/1/p�
.
Re -roofs
Type of Roof
Smgnmum 01 AhcatWon�o,
HAZARDOUS MATERIALS DISCLOSURE
Will the apPlicant or future building occupantrim. m handle brurdou mameal
!
as Outlined by the Coperuon Muniripat Code. Chapter 9.12 and the Health and Safety
Code, Section 25532(x)]
❑ Yu �—
All roofs shall be inspected prior to any roofing material being installed.
lona the pelicans ler future holding occupmnt me equipment or drier which
If a roof is installed without first obtaining an inspection, I agree to remove
haraNnna air comaul is u defined by.she Bay Arta Air Qwlhy Management
all new materials for inspection.
❑Yet
unrkr ChaPmr 6.95oftou Glifm.
I hew mad the huaedms mmm05.
5533maew
nu Hc31de@ SarctyCodc.SatirIna25505.25537 arW ]553x.1 undersand IMtifdte hdlthng
rima ret curet t hate. q Nati y m ushl'Ry to notify We t of the
�m^e
O ! I 0
ummcnts which rent ler naanm ar. cemream ora p, ,�'"
0 T,
Signatur fApplieant Date
IY9p a� IP51
All roof coverings to be Class'R.a' or better
ownerarmthori: dagmt Date -
. 4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 31630003.00
DATE ISSUED.......: 09/11/2008
RECEIPT #.........: BS000006048
REFERENCE ID # ...: 08090056
SITE ADDRESS .....: 10481 BAYWOOD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER .............
KOHLER DONALD
0.90
ADDRESS ..........:
10481 BAYWOOD
DR
CITY/STATE/ZIP ...:
CUPERTINO, CA
95014
RECEIVED FROM ....:
MIGUEL COTA
40.79
CONTRACTOR .......:
DUARTE TADEU
LIC # 28801
COMPANY •
GOGO ROOTER
0.00
ADDRESS ..........:
2530 BERRYESSA
RD STE 509
CITY/STATE/ZIP ...:
SAN JOSE, CA
95132
TELEPHONE ........:
(408) 282-7026
0.00
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR VALUATION
8,925.00
0.90
0.00
0.90
0.00
1PPERMITFE FLAT RATE
1.00
40.79
0.00
40.79
0.00
1PRSEWER UNITS
1.00
20.40
0.00
20.40
0.00
ITRAVDOC FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
----------
----------
102.88
0.00
---------- ----------
102.88
0.00
METHOD OF PAYMENT
----------------- ---------------
AMOUNT
REFERENCE
NUMBER
CREDIT CARD
102.88
--------------------
VISA
'
---------------
TOTAL RECEIPT
102.88':.,
VOICE ID DESCRIPTION
-------- ----------------------------
VOICE ID
DESCRIPTION
106 SEWER & WATER
--------
202
----------------------------
UNDERFLOOR PLUMBING
301 ROUGH PLUMBING
507 FINAL PLUMBING
•
400 SEWER/LATERAL
"o
• CUPEkfINO
4
X
41
Ofo? 005
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
APN # & /)00 ,J, (�
ID
Date:
Fee
Group
Building Address:
1PCSEWER
OY luoo p eu QeThe
P
O,
Owner's Name:
1BPREPIPE
Phone #:
P
nu A,L o Le(Z
14W)9
-381
Contractor:
Phone #:
IBSEISMICOM
GFax#:
p
Contact:
Seismic Residential
Phone
abj Li( o:3 ki
COTI
Residential building
sewer/sanitary sewer —t
Fax #:
IRPSS
Contractor eicense
Cupertino Business License
Job Description:
L,, v..t 0-16 t, -,-r
Residential Commercial
❑
Valuation: o�
Project Size: Express ❑ Standard ❑ Large Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:
ID
Fee Description
Fee
Group
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
PntityFee
1BPREPIPE
Commercial re -pipe per fixture
P
1 CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
p
IBSEISMICOM
Seismic Commercial
p
IBSEISMICR
Seismic Residential
p
1PRSEWER
Residential building
sewer/sanitary sewer —t
P
I
IRPSS
CITY O
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
IBPWSVCS
Water Service
P
1CPWS or
1RPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
IBPWATER
Install/alter Water Pipe
P
1BPFIXTURE
Plumbing Fixture
P
1PGASRES
Residential Gas Piping System'
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
/
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
IPLMBINSP
Other Plumbing/gas Insp.
P
f
/
1TRAVDOC
Travel & Documentation Fee
B
1BUSLIC
Business License
B
Revised 6-16-08
0
0
r
•
•
Plan Review Protem Work Book Page -12-Revised 3/25/08
Green Building Plan Check
Index of Green Building
Points/Categories
A.
Category
Example of an Index or Table of Green
Plan Sheet or Page
Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B.
Site
9. Install H.E. Irrigation, (details/spec)'
L-1
2 points
11.
Permeable Paving, Note
L-1
2 Dints
C.
Foundation
1.
Use 15 °/, Flyash Concrete, (note)
S-1
5 paints
D.
Structural
3.
Uses Wood Woist, (See Spec.)
S-2
2 points
5:
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathing. detail
S-2
2 Dints
E.
Ext. Finish
1.
Composite Decking, (Nate/Spec.)
A-3
2 points
4.
B. Fiber Cement Siding, (Note/Spec-1
A-4
2 Dints
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
S.
Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Gal. Tank, (Note/Spec)
L-1
10 pints
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
3..
Energy Star Refri erator, Note/S ec.
AJ
1 point
1
P.
Other
1.
List Green Features on Plans
A-1
point
1 point
TOTAL POINTS1
40 points
•
•
Plan Review Protem Work Book Page -12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types, assigning a 'total points" value to a project to be considered environmentally friendly is
• not feasible. However, 25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for 'greening' your project.
71, Recycle Job Site Construction & Demolition Waste
65%=1 point; 75%= 2 points; BO%= 4 points
up to 4 Resource
i2. Salvage Reusable Building Materials
2 Resource pts
y=yes
_ _
4 Resource pts
y=
3. Remodel for Mixed Use, Adaptive Reuse, and
2 Resource pts
y=yes
Historic Preservation
4 Resource pts
y=
4. Protect Native Soil
2 Resource pts
y=
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=
7. Protect (Nater Quality with Landscape Design
2 Resource pts
y=
e. Design -A esource-NO—entLandscapes and Gardens
4 Resource pts
y=
9. Reuse Matedals/Use Recycled Content Materials
for Landscape Areas
2 Resource pts
y=
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=:
11. Provide for On -Site Water Catchment / Retention
2 Resource cis
v=
B. Foundation
1. Incorporate Recycled Flyash in Concrete
• 25% Recycled Flyash = 2 points; Add 1 point for every 10%
increase of flyash, up to 5 points
2. Use Recycled Content Aggregate
3. Insulate Foundation/Slab before backfill
C. Structural Frame
rSubstitute Solid Sawn Lumber with Engineered Lumber
2. Use FSC Certified Wood for framing _
(For every 10% of FSC lumber used = 2 points, up to 10)
3. Use Wood I -Joists for Floors and Ceilings
4. Use Web Floor Trusses
5. Design Energy Heels on Trusses 6' or more
6. Use Finger -Jointed Studs for Vertical Applications
7. Use Engineered Studs for Vertical Applications
6. Use Recycled Content Steel Studs for Interior Framing
9. Use Structural Insulated Panels (SIPS)
a. Floors
b. Wall
c. Roof
10. Apply Advanced Framing Techniques
11. Use Reclaimed Lumber for Non Structural Applications
12. Use Os8 -- - - - - - - -- - -
a. Subfloors
•
J. Sheathing
■
3 Resource pts
up to 10 Resource pts.
2 Resource pts
y=yes
2 Resource pts
y=yes
2 Energy pts
y=yes
2 Resource pts
y=yes
2 Resource pts
y=yes
2 Resource pts
y=yes
3 Energy pts
3 Energy pts
3 Energy pts
4 Resource pts
3 Resource pts
1 Resource pt y=yes
1 Resource pt y=yes
1. Use Sustainable Decking Materials
r
r
0
11. Install Water Heater Jacket -
a. Recycled content -
3 Resource pts
y=yes
b. FSC Certified Wood
3 Resource pts
y=yes
,2. Use Treated Wood That Does Not Contain Chromium/Arsenic
1 IAQ/Health pt
y --yes
13. Install House Wrap under Siding t
1 IAQ/Health pt
y=yes
14. Use Fiber -Cement Siding Materials
1 Resource pt
y=yes
E. Plumbing
r
r
0
11. Install Water Heater Jacket -
1 Energy pt y-y'es
2. Insulate Hol and Cold Water Pipes
2 Energy pts y=yes
r3. Retrofit all Faucets wnd 8howerheads with Flow Reducers
1 Energy pt y=yes
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
i
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
4. Replace Toilest with Ultra -Low Flush Toilets
4 Energy pts
I(1 point each, up to 3 points) _
Up to 3 Resource pts.
5. Install Chlorine Filler on Showerhead
1 IAO/Healih pt y --yes
6. Convert Gas to Tankless Water Heater
4 Energy pts Y_ -Yes
7. Install Water Filtration Units at Faucets
4. Use Advanced Infiltration Reduction Practices
(2 points each, up to 4 points)
Up to 4 IAQ/Health pts.
6. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yes
r, tiecmcar
a. Walls
i1. Instail Compact Fluorescent Light Bulbs (CFLs)
y=yes
�,(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
-(1
Up to 4 Energy pts.
2. Install IC -AT Recessed Fudures With CRs point each, up to
6. Alternative Insulation Products (Cotton, spray -foam)
5 points)
Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pts.
4. Install High Efficiency Ceiling Fans with CFLs
I). e;eemgs
(1 point each, up to 4 points)
Up to 4 Energy pts,
G. Appliances
r
r
0
r
r
0
1 Energy of y=yes
�2. Install Washing Machine with Water and Energy
Conservation Features
1 Energy pt y=yes
3.Install Energy Star Refrigerator
1 Energy of y=yes
4. Install Built -In Recycling Center
3 Resource pts y=yes
2. Install Floor Insulation over Crawl Space
G. Appliances
I . Fnstall Energy Star Dishwasher
1 Energy of y=yes
�2. Install Washing Machine with Water and Energy
Conservation Features
1 Energy pt y=yes
3.Install Energy Star Refrigerator
1 Energy of y=yes
4. Install Built -In Recycling Center
3 Resource pts y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pts
y=yes
b. Ceilings
2 Energy pts
y=yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
13. Insiall'Recycled-Content, Fiberglass Insulation with
iNo Added Formaldehyde
3 IAQMealth pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pis
y=yes
5. Use Cellulose Insulation
a. Walls
4 Resource pts
y=yes
b. Ceilings
4 Resource pis
y=yes
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yes
I). e;eemgs
4 Resource pts
y=ye:
•
1. Install Energy -Efficient Windows
• I a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. Conductivity Frames
2. Install Low Heat Transmissfon Glazing
J. Heating Ventilation and Air Conditioning
t. Use Dud Mastic on All Dud Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
6. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
1 Energy pt
2 Energy pts
2 Energy pts
1 Enerov of
2 Energy pts
y=yes
3 Energy pis
Y --yes
1 IAQ/Health pt
y=yes
21A0/Health pts
y --yes
2 Energy pts
y=yes
1 Energy pt
y=yes
4 Energy pts
y --yes
31A0/Health pts
31AQ/Health pts
9. Replace Wall -Mounted Electric and Gas Healers with
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
Up to 16 Energy
pts
• a. Install EPA certified wood stoves(nseds
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
41AQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health ots
v=ves
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2. Install Solar Vater Heating System
10 Energy pts
y=yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 16 points)_
Up to 16 Energy
pts
6. Select Safe and Durable Roofing Materials
t Resource pt
y=yes
7. Install Radiant BameF
3 Energy pts
y=yes
L. Natural Heating and Cooling
1, Incorporate Passive Solar Heating 5 Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
•
j1. Use LOW/No-VDC Paint2. _ - -
1 IAQ/Health pts
y=yas
Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
13. Use LowNo VOC Adhesives
3 IAO/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y --yes
i7. Seal all Exposed Particleboard or MDF
4 IAQ/Health. pts
y=yes
6. Use FSC Cartified Materials for Intedor Finish
4 Resource pts
y=yas
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
Y --yes
10. Install Whole House Vacuum System
3IA0/1-lealth pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Available:
Total Points Project Received:
1401 130 57
01 010
G:de'arprogs/greenb:rildngguiderines4emodelerslgreenpointsfine2.12.04pmleotedxls
•
CITY OF
�UPERTINO
0
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
JOB ADDRESS: Q , -
ujoo C.JA
PERMIT #
OCJl/<��s6
OWNER'S NAME: c
KL ty,
PHONE y o5 4 6 o391 --
GENERAL CONTR CTOR: oo
FAX #
I am not using any subcontractors: / O
00
/ Signature Date
Please check applicable subcontractors and complete the following' ormation:
Owner/Contractor Signature
Date
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
FROM :CUPERTINOSANITARYDISTRICT FAX NO. .:4082535173 Sep. 18 2008 02:47PM P1
L
0
Subject: Install Pr perty Line Cleanout
Name: Kohler Residence
Address: 10481 R ywood Drive
APN: 316-30-003
Permit
■ Videotape and Property Line Cleanout inspected.
No addi onal condidons/requirements by the District
Inspector: koger Santos,,,,,,,�-
Date:
...09-18-2008.......,., Samtary Sewer Location•
c:e: Property
39' R P/L 20' Long 5' Deep
SERVICES FOR: CITY OF CUPERTINO, PORTIONS OF THE CITIE9 OF SARATOGA, SUNNYVALE, LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS
n
6FNlfdsl
DISTRICT MANAGE
MARK THOMAS &C
ENGINEER
MPANV, INC.
p
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BOARD OF DIRECTORS
RICHARD K. TANAKWILLIAM
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A. BOSWORTH
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JOHN M. GATTO
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DISTRICTiB
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CURTIS B. HARRISON
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WENDELL H. KERR, JR.
HAROLD S. 70PPEL
CHRISTOPHER C. LEE
20898 STEVENS'CREEK BOULEVARD, SUITE 104
CUPERTINO, CALIFORNIA 950142154
(408)26$•7071 PHONE . (408) 2538173 FAX
www.Cupertinosanitaryrlistrict,COM
Pile: CUSD —
MOP
Building Dept.
— Cupertino
City of Cupertino
Attn.: Building DefIartment
10300 'Torre Ave.
Cupertino, CA 95014-3202
Subject: Install Pr perty Line Cleanout
Name: Kohler Residence
Address: 10481 R ywood Drive
APN: 316-30-003
Permit
■ Videotape and Property Line Cleanout inspected.
No addi onal condidons/requirements by the District
Inspector: koger Santos,,,,,,,�-
Date:
...09-18-2008.......,., Samtary Sewer Location•
c:e: Property
39' R P/L 20' Long 5' Deep
SERVICES FOR: CITY OF CUPERTINO, PORTIONS OF THE CITIE9 OF SARATOGA, SUNNYVALE, LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS
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