00050096 CITY OF CUPERTINO
•
BUILDING Dlvr.SION stoty . PERMIT CONTRACTOR INFORMATION:
' BUILDING AD115ESS:
`- Cv9Grn�j/ SANITJ A
RY NO APPLICATION SUBMITTAL DAT
F
'%Op ot6 ^Oro
OWNER'S NAME J
;y, .5'a-y, NIC
CONTROLp
HONL. t t O
S F 6554
ARCHIT13CfIENGINEER „ BULDWO PERall I INFO
LICENSED CONrRACnder p DECLARATION ^
rO0_— Iherebyaffirm that I 3 fi eBdunderpdn fnsof Ch , 9(commencing ' HALF' Raa�f'O�t'�- lob Description '
rl rnr� w)f[if on]1100)ofDmnon3ofthe BuvrmsawdPmfevsiom Catle,uW my Lccnw is
�o.aju ufceelr.ciavaerce — Lm« ��J3/Ya /t ,y�1 71 .SIiC22 �,f -
vi'z,°� Des CO...-. - )'C.'/Ilolw-�}Q•$'Gl //�u J°1
s_u.0 ARCHITECTS DECLARATION
-I understand shal
my plans l be used u records
records
w y O
6 Licensed Professional Ln
OWNER-BURDER DECLARATION i ' - 1%/.G "—•""�` - -_•C�lYIS S(JLLF(�S . .
C Z G 1 hereby affirin Nei I am exempi from the Contractors License Law for the
it�❑ follovnng mews (Section 70315,Business aed Professmns Cude'Any city cr county -
i S which requires a permit On constrict alter,improve,demolish.or repro any structure S ' Ft. I'IOOr Area +
'prior to ns rsmmer.also regmus she applies for such paint m file a signed statement q f+f' Valuation
tent he is bcerucd purewnt to the provisions of du Contractors License Law(Chapter 9
(commencing with Section 7")ofDlvmsion 3 ofthe Bud.ma and Proreaaranac PN Number
that he is asimpa thererrom aW the basis for the alleged exemplum Any vrolu,mr of /// o Occupancy Type
• Secd.7031.5 by any applicant for a penult sub3.ts she applicant to a rind penalty of 3
wt more than five hundred dollars($500). J
I,As oworr,of the propcny,umY cmployecs wldi wages ulWmr role compel.wan.. Required Inspections
will do the work,And the smrcmm is mi numdW oro&red ROW,(See 7044,Bugnns 1' '
Add Profesusim Code.The Central Lt..law does nil apply to en owner of
property who builds ar Improves morels,and who does such work himself or through ,
his own employees,provided that such mmpmemmts art nea intended or offered for
We If,however,the budding orimprovemem is cold within sine yemof complelwn,tM
c wmur-0mMer will have the burden of proving that he did not build.mmpmve for pit- .
+ pose of ale). _
- ❑1,u owner of she property m cxcluatvely connwung with licensed contractors in
onstnuc the project(S. 7W,pontoon and Professions Coda:)The Condacme.Li- I
canes law dins not apply m w own.of property who Wilds or Improves thereon,end
w W Camrwrs fu sued polects wuh....brumn,)licensed punuwt in the Caronewm '
U.n.law.
❑Imexempeunder S.. ,B&PCfor this reason / / / / ILIA /
Own. ^.¢ W o�,(rte '. % ( � c
WORKER'S COMPENSATION DECLARATION
roAfhw p rshy of per jury one of the(ollmvng dlm'n ms
]nery nundacmlcneof Cowennoolf-insmfor Wokers Com
l-
solos,r pmvidW for by Section 3]00 of the tabor Cade,for the pedortwnce of the
work for which Nis perms a Lion 3
❑1 have And will maintain WcalsO6 Compcmuian Insurance,w required by S Ftum
I 37W ofthe Labor Code,f the pedonnarue ofthe work for which this permit is owed.
My Worker C Pe s won 1 wee d POhcy sum 'm' r '
Carrier, em Polmy Nos F�i� J� ,
CERTIFl�Pf10N PROM OR CP.RS'
m s t.
COMPENSATION INSURANCE
(This et road obecomleted Wife permit is br ow hundred dNlm(f 10) /n-/ O
or leas.) r D
coy any dm on to mynmicm..t beemnewinch his the mothCo.,.-Cofthe
( -
not employ any person i.any manner so n m biome rroject m the Workers'Coml-
• action laws of CUifomia.DU• s
NOTICE f0 APPLICANT IL after making Nu Certificate of Exempmon,you should
become subject to the Wortors Compensation provisions ofthe Lahr Code,you most - r
fonhwith.mply wroth.uch provisions or this permit shell be domed mvokW.
Z CONSTRUCTION LENDING AGENCY
O O t Iherebyalfirmrhatl heuu.con.uncuonl eMmgagencyfwthe'domunceof
Z the rout for which dill pemdt n issued(Sec.3097.Civ C.)
(� Lenders Nam- f
a, I<mee.Addr-•,
tcl 0 1 certify that I have read this application and stoic that the above information is ,
lY correct.I alma to comply With all City and county ordinances and mule laws relaung to s
Ca.) O bmiildmg comwcdon,and hereby amhoriu mpresentatives of thts city to enur upon she s _
above-menaoncd property for imitation purpose.
(We)slice ro save,mdemndy and kip harmless the City of Cupertino agamit ,
O U liabilities,judgments,costs and expenses which may in any way accrue Atlantic said City
} W Ia consequre.of the granting of dun period '
E. UG APPLICANT UNDERSTANDS AND WILLCOMPI Y WITH ALL NON-POINT
V SOURCEREGUTATIONS. . r f a I
9gwmm of AppluwUCOmr Due y
HAZARDOUS MATERIALS DISCLOSURE _
Willy teCupr bmM.n,buildmg.cupwtuamor hanNehuWoAdd fisate�al
Safety
Re-roots '
u defined io the Cupertino Muninpal Code.LTeprer 9.12,end the Health end Safety
' cue,semmnzss3z(.)+ Type of Roof
' ❑Yes ON.
' Will the Applicant or future buddingacc„ mtusewumpmentor devices which All roofs shall be-inspected prior to any roofing material being
m s .
cut herdous err Con lm %s defined by the Bay Area AB Qualny Management installed. If a roof is Installed without first obtaming'an inspection
"a7 I agree to remove”all new materials for inspection. Applicant
, ¢ Yes ENO . d
I have reedthe Istandms mauls(.uquimmenuund„ Chapter 695ofther Call. -un erstands and will comply with all non point source regulations.
forma Health&Safety Code,Sections 15505,25533 and 255M I understand that if the
building does not currently have a Amen,that it lsmy m,mrsibility in nui(y she occupant
,of the ngmremmta whmh rouged inn pnorm rssuence oh CenRcem of Occupancy _ /'i �- - /
Sign_ pplidan[ 1 Date
ta
Owner or euthonaedegem •Da p ,
All roof coverings to be,Class"B”or betier
OFFICE r
it
INVOICE INVOIt INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:36920040.00
INVOICE DATE...... : 05/15/2000 '
REFERENCE ID It ,,. : 00050096
SITE ADDRESS .....: 10804 ALDERBROOK LA
SUBDIVISION ..... .
CITY ............. : CUPERTINO
IMPACT AREA . . . ....
OWNER ............ : CHUNG
ADDRESS ..........:
CITY/STATE/ZIP .. . : CUPERTINO CA, 95014-4606
CONTRACTOR .. . . ...: LIC N
COMPANY ..........:
ADDRESS . .........:
CITY/STATE/ZIP ... .
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ __- --------- ------------ -----------
BPERMFEE P 107.00 0.00 107.00
BSEISMICRE P 0.50 0.00 0,50
BUSLIC P 90.00 0.00 90.00
_________ ____________ ___________
197.50 0.00 197.50
•.ID . - DESCRIPTION ...-i VOICE ID DESCRIPTION
............. ........ ....... ...............
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 6D4 ROOF IN-PROGRESS
l