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07090090CITE' OF CUPERTINO PERMIT c�arLTo IomrI�rt� BUILDING DIVISION BUILD N ESS: RUMFORD DR ABLE SE3TIC PERMrr NO. 07090090 OWNER'S NAME: PERMrr ISSUE DATE MARC MOL P 0 BOX 24819 09/14/2007 INE: SANITARY NO. CONTROL NO. � (408) 37'7-9990 :HITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3ofthe Business and Pr essions Code, and my license is INSTALL PROPERTY LINE CLEAN OUT in full force and effect. License CI Lt• k Dale Contractor ARCHITECT'S DECLARAT70N I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure iq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement Law 9 that he is licensed pursuant to the provisions of the Contractor's License (Chapter Code) $3329 (commencing with Section 7000) of Division 3 of the Business and Professions or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 32 64101 1 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber not more than five hundred dollars (5500). . V Q I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q p will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sat. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sat.). 1v [11. as owner of the property, am exclusively contracting with licensed contractors to ITAIm construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li - cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License law. ❑ 1 am exempt under Sec B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: (3 I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- •ation, as provided for by Section 3700 of the Labor Code, for the performance of the I for which this permit is issued. ,J I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Inst mncc a and Policy number are: 3t Ill G ]206H� Carrier licy No: CERTIFICATE OF EX PTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you mast forthwith comply with such provisions or this permit shall be deemed revoked. j CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 7 I certify that I have read this application and state that the above information is —� COrreeL I agree to comply with all city and county ordinances and state laws relating to " building construction. and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. y (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments. costs and expenses which may in any way accrue against said City in consequence of the granu g of this permit. APPLICANT UNDERST DS AND WILL COMPLY WITH ALL NON- Of Issued b y Date SOURCEG TIO 547 Re -roofs of Roof Sig atureofApplicant/Contractor 701116Type HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes KN. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? C3 Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth & S ty C ons 25505, 25533 and 25534.1 understand that if the building does not c Ely ha t, that it is my responsibility to ratify the occupant of the Date requirem 16ch el prior to issuance of a Certificate of Occu Signature of Applicant 7 t All roof coverings to be Class "B" or better 0wner r prized agent bak CITY OF C-1UPERTINO ('? 0 9 0 V u REPIPE/ US/MAIN SERVICE PERMIT APPLICATION FORM APN # P Bc`-;. 4.64 o Date1((, O Building Addre Z 1 �Ze ,�,Y c BPGAS Owne 's Name. Phone #: Con ctor: Ph e: . �3ct-- Qp�(L C- ��- Q a #: Licez;77/7S- Phone: ^l , (� O _( Cupertino�Business License #: Building Permit Info: Bldg N Elect ❑ Plumb ❑ PLUMBING Job sc ' tion: -41 �IKA- OVA. Pblg. Fixture PLUMBING Residential Commercial ❑ Main Water Service Cost of Project: 43) ZG1 BPSEWER Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE B'.dg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING ' PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE R,. -pipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 32641014.00 DATE ISSUED.......: 09/14/2007 RECEIPT #.........: BS000002643 REFERENCE ID # ...: 07000090 SITE ADDRESS 21356 RUMFORD DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER MARC MOL ADDRESS ..........: 21356 RUMFORD DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1334 RECEIVED FROM ....: ABLE UNDERGROUND CONTRACTOR .......: GILBERT, GLEN LIC # 21407 COMPANY ..........: ABLE SEPTIC ADDRESS ..........: P 0 BOX 24819 CITY/STATE/ZIP SAN JOSE, CA 95154 TELEPHONE ........: (408)377-9990 FEE 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 40.790.00 40.79 ---------- 0.00 ---------- TOTAL PERMIT ---------- 62.37 ---------- 0.00 62.37 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 62.37 --------------- 62.37 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER REFERENCE NUMBER -------------------- #6463 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING FROM :CUPERTINOSANITARYDISTRICT FAX NO. :4E82535173 Nov. 08 2007 Oe:34AM P1 DISTRICT MANAGER -ENGINEER MARK THOMAS & COMPANY, INC, E)"ID E. ROSS DISTRICT COUNSEL, AYKINSON • FARASYN, L.Lw, HAROLD S. TOPPEL City of Cupertino Attsi.: Building Department 10300 "Forre Ave. Cupertino, CA 05414-3202 YEA.5 Of 9ERfktvwF `rl'tsL/s aWo ~� 20833 STEVENS CREEK'30ULEVARD. SUITE 104 CUPERTINO. CALIF•;)RNIA 95014.2154 (408) 2537071 PHONE • (408) 2538173 FAX www.cLipertinosaritarydistrict.com Subject, Residential Addition/Remodel Name: Marc Residence Address: 21356 Rumford Dr APN : 326-41-014 Permit No. 07090090 BOARD OF DIRECTORS STEPHEN C. ANDR5WS WILOAM A. BoSWOWrH JOHN M. GATTO CURTIS B, HARRISON WFNDEL.L H. KF -RR, JR. Vile : CuSD - MOP Building Dept. -• Cupertino No additional conditions/req.wirements the is W. inspector: Joe Sullivan ........................�...4.� ... Date:... 11-08-2007 ............. ...... Sanitary Sewer Location: cc, Property Owner Ll SUPPLYING SANITARY SEWERAGE SERVICES FOR: CITY OF CUPERTi NO, PORTIONS OF THE CITIES OF SARATOGA, SUNNYVALE, Los ALTOS AND SURROUNDING L NINcORPORATED AREAS