08030181 CITY OF CUPERTINO
BUILDING DIVIS104 PERMIT TRCUk RACT(3R INI±ORMAT ON
aulLglgG�4Dq 'AINETTE DR AMERICAN PLUMBING & .DRAIN 08030181
R'S bNA�MEE: M PERMITISSUBDATE
TARIY ARMED 4463 HOLLOW GATE LN 03/31/2008
NE (408) 205-0506 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERM TINFO
BLDG ELECT PLUMB MECH
�oLICENSED CONTRACTOR'S DECLARATION lob Description
rd 1 hereby M.
Nu 1 am licensed under provisions of Chapter 9(commencing I P
sz1 wiNS don7gMBafDivi4on3ofNeBanr dProfc�Qow CeAtuammylkcounia SEWER REPLCMNT, SEWER CLEAN-OUT. AMERICAN
H in roll force and e
Z License Ciro Lie.{ -.J ,V LUMBING
50'"A'oar \ A.
e ARCHITECTS DELLA TIoNRAIN RENEWED BUS LIC 3/31/8
g I understand my pl...hall W uud As public memo,
U
C licensed Pmreuional
or OWNER-BUIIDE0.DECLARATION
ConTION
i I hereby aRrm on 1 em uempl from WC Casmaaoes :Any c taw for the
p o which r{moon.Permit
t ID3 L3,Business and Preimprove.
aons Cade:Any dry or county . .
$ which requires•permit re cores do tltar.Improve,dcermitt erre a sig and euudum � l
thus W its tensed galsunL to the led appBcaof for Inch permit LiccutLneti statamcm
FFF< Wahe lsdnwlhSecUemtalbepmviYarudthe Bum n rS li¢ttml io Chaptar9 Sq.Ft. Floor Area 1128 Valuation
3a
Maine
ntln{with ScNon7andW basis n3 of WCnged euana Profrsyvi Code)un
3 Uut he 4 exempt Nertfmm and Us basis for Ue Winged uempUan.Any violation of
Section 70314 by any applicant far a permit subjccu We applicant to a civil penalty ofynI�T Number Occupancy e
tel mom Wan rive hundred dollars($5011).
37532035 C17' P YTYP
❑I.0 owns of Ne proputy,err my employm with wagesu thea role rompcnseUon,
waldathewark.andremuaurc hi Wa ntaMedoraRcmA fouak($u.7DN,BuUneu Required Inspections
and professldns Coat The Ces omat,are.Liccome Law donet apply W e ns An ow.of q P
property who Wild,crimproves Werner,and who doessuclt Annie transaction though his
Two employrra,provided that such lmpanwaRnu art not intended worteaed(frame If.
however,We building A,improvement is sold within ane year of completion,We owner.
builder will have We bu den of proving that he did not build or Improve for purpose of
Ask.).
C3 1,An anomer of Ute property am exclusively contracting with licensed contractors a
mwrma the project Apply
0 an,Business and property
waow Code:)The Cs therm e.Li• SAN
Y
wase tea circa not apply W re owns of propor(s)licensed
sed p or Mpmvea Norton,and, TAR
who contracts far such tV withaconuecmrts)Iicensed rwanlm We Contractors
Loewe aro.
lzam
,BAPCffrlMsmasonDaoWORKER'S COMPENSATION DECLARATION
I hereby a01m under penalty ofperjury aM of the following declaraROw:
w and will mama.a CeNOcate of Consent W self-Iwum far Wmlws Cmussm.
u provided for by Sutton 3700 of We Labor Code.for the performance of Ute
ar which this permit is issuedave and will maintain WortrY,Compewtion Insurance,u acquired by Section
f Ne labor Code.fu the performance ofUro work far which this permit is issuedrkee,Compenution Loon ca rend Politynum. "�t4.ek��LCu J Polity No.: lt�t_T) i0oa.
CERTIFlG7�IS OF EKHM IONFROMWORKERS'
COMPENSATION INSURANCE
must orlon need cot becAmphand UWe permit 4 furore,hundred da0u,(SIM)
or tons)
I certify that in the performance of We work far which this permit is Issued.I shall mat
employ any penin in any matrer an As W became subject in the Workers'Compenudon
Lave of California.Data
AppEont
NOTICE TO APPLICANT:It.after making this Ce tiOum of Exemption,you Would
became subject 0 the Workces Compensation provisions of We Lahr Code,You mune
O foMwilb comply with such provisions or W4 permit shall W domed mated.
y y CONSTRUCTION LENDING AGENCY
[-t IherehY affirm Wer tem is a construction lending agency for We performance of
CL 7tie wart(or which W4 permit 4 issued(Sec.3097,Civ,G
W Q tender's Name ,
a7.
. z Lundeen Address
U Q I CATHY Nat I have teed this application And sold thu the above Information is
III, r' cou ect.I agree W comply with all city sM county coin r cu and sued laws relating W
C) SCJ building construction,and hereby authortae mpmsemadves of W4 city u caw upon Ue
W NAC-mentioned property far inspection purpnre.
d (We)agree m ave,indemnify and keep harmless the City of Cupertino against
t„H liabilitiesjudgmenta.coats and expenses which may In ane my amus against as City
)7 in cWtuninertce aI We Starting of this permh. �t
•7 APPLICANT UND��RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUTON.S.A _ �l
Nuance Re-roofs
Si{wum of UCo RDO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or(Munn Wilding occupant dam or handle Health An material
fined Section
the Cupertino Munkipd d0.Chapter 9.12.and We Health anti Safety
sedan 255324)7
pees All roofs shall be inspected prior to any roofing material being installed.
o
Will WA applicant or future Wilding occupant ore equipment in dcHw which If a roof is installed without first obtaining an inspection,I agree to remove
huasdnw air contaminants As defined by We Bay Ams Air Quality Management all new materials for inspection.
wrlct7
DYw Nu
I have and!We haaaouus materials requirements underChainerti.95 ofthe Califon.
I W a
Itlrc sermons 25505.25533 and 25534.I undemand dadlie Wilding
wt currently he A emane INt it 4 my M.P. W notify ted oeevpsnt of the
immentawhk m be pdortaissuatux ofd Ccnifeata fOnvpaney. Signature'of Applicant Date
owner rc. a gent G Da a All roof coverings to be Class'j4"or better
• CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
• Sec: Twp: Rng: Sub: Blk: Lot:
APN 37532035 . 00
DATE ISSUED. . . . . . . : 03/31/2008
RECEIPT # . . . . . . . . . : BS000004313
REFERENCE ID # . . . : 08030181
SITE ADDRESS . . . . . : 10659 MINETTE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TARIY AHMED
ADDRESS . . . . . . . . . . : 10659 MINETTE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MARIO D FRANCISCO
CONTRACTOR . . . . . . . : MARIO D. FRANCISCO LIC # 27114
COMPANY . . . . . . . . . . : AMERICAN PLUMBING & DRAIN
ADDRESS . . . . . . . . . . : 4463 HOLLOW GATE LN
CITY/STATE/ZIP SAN JOSE, CA 95127
TELEPHONE : (408)205-0506
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 128. 00 0 .50 0. 00 0. 50 0. 00
• 1PPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40.79 0. 00
IPRSEWER UNITS 1. 00 20 .40 0 . 00 20.40 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 102 .48 VISA
---------------
TOTAL RECEIPT 102 .48
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106
------------- - -
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO Sd3 0 J v
REPIPE/SEWER/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN# 2-753
-75 O C� v Date:
Building Add ess:
06
Owner's Name: Phone#:
Contractor: Phone #:-4 g . vZDS S fl[�j
Fax #:
Contact: Phone#:
C)
Fax #:
Contractor License#: \ 1
Cupertino Business License#:
Job Description:
41
Residential Commercial ❑
Valuation:t
Green Building Check list must be completed and attached to this application.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
IBPREPIPE Commercial re-pipe,per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ 1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitarysewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
1BPWATER Instal Ualter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
/ IBUSLIC Business License B
•
Community Development
10300 Torre Avenue
i ` `'/• - Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
:UPER,TINO
Building De artment
. JOB ADDRESS: _ PERMIT #
1 ua r--\ Oma 30/ JL
OWNER'S NAME: T'Gr PHONE # z) tSC
GENERAL CONTRACTOR: * z FAX #
I am not using any subcontractors
/ Signature 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
Owner/Contractor Signature Date
FROM :CJPERTINOSANITARYDISTRICT FAX NO. :4082535173 Apr. 18 2008 07:27AM P2
ti�s's►xtra4�oi
DISTRICT MANAGER.0 GINEER .p
`t� BOARD OF DIRECTORS
MARK THOMAS&COM ANY,INC. tra ✓ WILLIAM A,BOSWORTH
RICHARD K,TANAKA C6 JOHN M.CATYO -
DISTRICT COUNSEL - YT:KiTA OF CURTIS B.HARRISON
ATKINSONiEFVECB WENDELL H.KERR,JR.
HAROLD
S FARABYN LLP. ��4d1(fB,NF.O ti�e�
HAROLD B,TOPPEL CHRISTOPHER C.LEE
208066TEVEN•CREEk BLVD.
CUPER nNO,CALIFORNIA 050142154
(408)263-7071 PHONE 1 (408)2636179 FAX
www.cup eriltiosaailarydislrict.com
April 18, 2008 File: CSD— MOP
Building Dept, —Cupertino
City of Cupertino
Building Department
10300 '1'orre Ave.
Cupertino, CA 9501 -3202
Subject: Residential Addition/Remodel/Roof
Name: Ahm d Residence
Address: 10659 Minette Drive
APN: 375-32-035
Permit No. 0803 181
The Cupertino San Itary District has reviewed the plans for the subject project:
• Sanitary sew r is not provided by the District to the subject location, please contact Eric
Tokutomi with the City of Sunnyvale at 408-730-7566.
Yours very truly,
MARK THOMAS COMPANY, INC.
District Manager-Fn rineer
Richard K Tanaka
CHB: ndb
If you have any questions or need additional information, please call Nichol Bowersox or
Carl Beckham at 408-253-7071.
cc: Eric Tokutorni, City of Sunnyvale
. Aluned Residence, Owner
SAW0 RDS\0)SU\LRl'I'F:Rti L11 LDIN(i UIJI 1'I.1!II'0CMNU'I`INTI IIS[AST'RICT1Nut in Di.vti id 2003\080.)0181 NTD 10659 Miacuc Dr_
NIII Oyc 1 - -2 I'd, —
SUPPLYING SANITARY SEWEF AGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS