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06030102
CITY OPCUPERTINO ^+ 11 BUILDING DIVISION PERMIT CONTRACTORINFORMATION . BUILDING ADDRESS: — PERMIT NO. 20580 SHADY OAK LA OWNER'S NAME: PERMIT ISSUE DATE MENDAL GEOFFREY O 2400 LINDBERGH ST 03/20/2006 lE; (408) 989-6005 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 j00 LICENSED CONTRACTOR'S DECLARATION u 1 hereby affirm that 1 am licensed under provisions of Chapter 9(Commencing ., lob Description W with Section]0(XI)of Division 3 of Nc Business and Professions Code and my licwc is n�o in mu fn aanderr«r. (�j REPLACE PROPERTY LINE C/O HOUSE C/O Liccnx ClNo �ic.N t-p Dole Cum aztor qq RCHI Cr$DEC A ION �'� ■ ps a� �® Sc d I undersand my plans shall M used a public mcvrds N�/6Aq'EL se,s o Licensed Professional 3 OWNER-BUILDER DECLARATION <I 1 hcmhy affirm that 1 am exempt form Inc COmractors License Law for the I1 0 O following recon.(Section 703 IS.Business and ProdtWons Code:Any city or county Mer/ L 200@ $4250 e 2� which requires a potmit to Construct,alter,improve,demolish.Or repair any structurt sin •h tI Oiy prior in its ismance.also requires the applicant for such permit to File a signed sla@menl EiC that he is licensed pursuant to the previsions ofOcConoacmr'sLicense Law(Chapter 9 Sq.Ft.FloorA Valuation 2F (commencing with Section]000)of Division 3 ofthe Business and Professions COde)or y Nat he u exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofUmb DCCU not mom than Five hundred della.($31)01. ane p y Type 0 I,u owns of theproperty,.my empl.'Os with wages u their sok compensation, will Or me work and Ne,Corium u,tot intended or offered fm We(Sm.7094.Business and Prefessiav Code:The Contracwr's License Law ducs not apply to an owner of Required Inspections property who bui Ids or improv thereon,and who does such work himself or tlu.ugh his awn employees,provided that such improvements am not intended oroffered for We.if. howeve,the building.,improvement is sold within one year of modpleuon.Ne owner. builder will have the burden of proving that he did no,Build or improve for purpose of vie.). 0 I,u owner of the prapeny,am exclusively Contracting with licensed mnmctors to conswet the pmjen(Sec.7094,Business and Profestiau Cade:)The Contractor's Li. emae Law doe not apply to an owner of no orty who Wilds or improves Ocomm.and. who eont.eta for such projects with a commator(s)licensed pursuant to the ConlractoYs LRense taw. 0 I am exempt under Sm. .B h P C for this mason wrier Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of the following declarations: a and will maintain a Cenifmao of Consent to self-insure for Wormercomper- tan,uprovided for by Section 7]00 of the LOW,Code,for Ne peRotmm anof me .,it for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued. My Worker'r Compensation triton mart and Policy n;m7 97 Gorier. / Policy No �I/ -L CERTIFICA OF UP MON FROM WORKERS' COMPENSATION INSURANCE . (Thu semiao need not he compleod if tW Permit u forone hundred dollars($101) of los) 1 artifv Nat in Ne perfunsom.of the work for which this permit u issued,I shall not ..ploy any person in any manner sou to become subjmt to tins Warkers'Compeuation Laws or California.Date SA qqt r{ Applicant f9+�'i a'± F;; Ry NODCE TO APPLICANT:If,after making this Goodman,ver Exemption,you should p�7 Ca «i '3 -„�r.'.d become Subject oPtott Worker's CompensationOJprovisions of WeLabor Cade.you most $ry +!k` .Jz forthwith comply with such pmvisinu or Nu permitalWl Wdmmcd revoked.ZED Bf�p s P: CONSTRUCTION LENDING AGENCY 5 1 hcmbyaffirm that there isacons dem umdingagcney forlW peromtarmc of 6i the work for which Nis Permit u issued(Sm.5097,Civ,C.) ELIQ Lender's Name a,z tonic,',Address V Q 1 certify ON 1 have mad Nis application and state that the above information u ty caned 1 agree to comply with all city and county ordinances and sum laws mlating to 0U building eonsuuction,and hereby authorim repwwroadwa of this City to enter upnnthe yabove-mentioned property for inspection purposes. (We)agree to save,indemnify and lump harmless the City or Cupertino against rq liabilities,judgments,costs and expenses which may in any way accrue against mid City t,)z in consequence of the granting of this permit. ^' APPLICANT UNDERSTAy9STANG ILL Cg1gPLY WITH ALL NON 01 Issued by: Date �-��HCl 7 SOURC E �, Re-roofs Stmt cop Apphc HOACZOAnRRDOUS MATER, LS DISCLOSURE Dam Type of Roof Will the applicant or forum building occupant nom or handle hoar lou material u defined by Ne Currents.Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 35572(.)? 0Y. V-N. All roofs shall be inspected prior to any roofing material being installed. win mea ncmt.r metre buildingam. If a roof is installed without first obtaining an inspection,ection,I agree to remove PP pure use equipments dcvims which avar hdouss air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. O Yes E Nu I haus read the haoseekos materials mqui...U..d,Chxpor 695 fthe Califm- maHealth hSafely Coale,sections 253(15.25533 and 25534.1 undersand ON i(the Wilding Ones not eurmndy have a anon,ON a u my respon l p'lity to ratify the.ecvpant of me mquiremcnts which muvb np�G��m 0'p fmato Of.O�cc / Signature of Applicant Date' Owner ormth.rivedag 7 �D.r” All roof coverings to be Class"B"or better MAR-24-2006 14:30 MARK THOMAS CUP 4082535173 P.01i01 DISTRICT MANAGER-ENGINEER = 9 BOARD OF DIRECTORS MARK THOMAS&COMPANY,INC. " � �' WILLIAM A.BOSWORTH DAVID E.ROSS DR.JOSEPH F.BROWN DISTRICT COUNSEL JOHN M.GA170 ATKINSON o FARASYN,LLP lgQt IS HED �� CURTIS B.HARRISON HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104 WENDELL H.KERR,JR. CUPERTINO,CALIFORNIA 950142154 (408)2537071 PHONE 9 (408)2535173 PAX Vo File: CuSD—MOP Building Dept. —Cupertino Community Development Department—Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Sanitary Sewer Repair Name: Mendal Geoffrey O • Address: 20590 Shady Oak Lane APN: 323-44-039 Permit No, 06030102 Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the District. Inspector: Tony Soares/George Santos......................... ...............A......... Date: 3-24-2006...................... Sanitary Sewer Location: • cc: Homeowner SUPPLYING SANITARY SEWEIAGE SEIYI(E5 FOR: 'CITY OF CUPERTINO, PORTIONS Of THE CITIES Of SARATOGA, SUNNYVALF, Los ALTOS AND SURROUNDING UNINCORPORATED AREAS WWW.CUQerrinosaGiYnr ydisrri N.eonl TOTAL P.01 .a1 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: / © � � PERMIT #O OWNER'S NAME: ml d PHONE # — GENERAL CONTRACTOR: FAX # I am not using any subcontractors: loor 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 Signa e Date CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kielsaw COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32344039.00 DATE ISSUED. . . . . . . : 03/20/2006 RECEIPT #. . . . . . . . . : 33637 REFERENCE ID # . . . : 06030102 ' SITE ADDRESS . . . . . : 20580 SHADY OAK LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MENDAL GEOFFREY O ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0454 RECEIVED FROM . . . . : DRAIN PATROL CONTRACTOR . . . . . . . : ECCLES, CHET LIC # 10745 COMPANY . . . . . . . . . . : AAAA-DRAIN PATROL ADDRESS 2400 LINDBERGH ST CITY/STATE/ZIP . . . : AUBURN, CA 95602 TELEPHONE . . . . . . . . : (408) 989-6005 ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ___ __________ __________ __________ __---_____ PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 __________ __________ ---------- TOTAL PERMIT 38.37 0.00 38.37 0.00 METHOD OF PAYMENT AMOUNT NUMBER ____________ __________________ CHECK 38.37 47984 ------------ ------------ TOTAL RECEIPT 38.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING r CITY OF CUPERTINO % ,«a`" REPIPE/SEWERS/MAIN SERVICE UPEkTINO PERMIT APPLICATION FORM APN# Date: 3a 3- 44 -�31 o 0 0 BniIaZOAaar O O G rName: Phone#: Contractoz: Phone: License#:. '41 2 6� — 017 Y 2 Contag,y. P one: Cupertino Business License #: ✓ ,r/ v &_0 - 7 o 2,1y uilding Permit Info: Bldg ❑ - Elect ❑ Plumb Ply Job Description: 1 Residential [ Commercial ❑ Cost of Project: . G O Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Pi in System Fee PLUMBING / PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFLXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING