00030123r
BUILDING D
BUILDINGADDRESS.
VISION � PERMIT CONTRACTOR INFORMATION: ('j s
-per 00 6 6
yG[/W/7 /r Q' //9LS SANITARY NO. APPLIC'ATIO UBMf
t G, VIE _ "Y,"Af. NIC "3SC•ON'IROL k.
b '
t - BULDINO JIMMIT INI'0
1 hereby amrm that 1 am exempt from the Comrmmfs License Law for the
Ofallowing mason, (Section 9031.5, Business and Profmior, Cads: Any city a runty
ou 3 m which requires a permit ro container, alter. improve, deamliah, or mama any swcture ,
prim m its ismance, else tecame, the applicant fd each pamdt in file a signed atatcmmt
that he is licensed Punuant to the provisions of But Contradone License law (Chalver9
(mormemm, with Section 1000)of Division 3 ofrhe Butimn and Professions Cods) or
' Ben he is exempt themfmm and the basis for the alleged uempsian. Any violation of 3
Section 1031.5 by any e,he., fora pemdt subjects the applicant to is civil per`Wry of s
rem mart than five hurdled dallan ($300). " ' -
❑I,uowvtt of me prapeny,mmy employees wins wag<au meinole compenmtidn. -
' } will domework, and teawisLt.. Us,clu snale(Sec.us 14, BUaincof
' and Profeuiom Code: The Co..,.?, Conm ?s Liana law dac not apply s lf owrcr gh
his own wed oyes, m improves hush improvements and who dose such work himself f through
hit own oweveras, provided that moo sold w ere um immrofc m offered for
WeIf, hmveve will building orimPrOVemens is soldwithinone yearofcomplesfor Ba
1w of ilder, will have the pWCn of provin8 than he did not Wild or improve f& po-
I. sown
r of the Droperty, am exclusively convecting with licensed cmtrumn to
consumer the project (Sm. 1040, Basins and Profession Code:) The Comrclofa U.
tense law does not apply to an owner of property wed Wilds or impmvn thereon, and
v .
who contracts for eachp Projects with a contractons) licensed Paternal to to Contrmia's
r 'License law, s '
9�der{� B k P C far this
ration
Owner a ^s--�w D.�
ORXER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury om of the following dcclantiau:
I have and will maintain aCe tificam of Commm uo self-insure for WodersCompen-
mtion, as provided for by Section 3100 of the Labor Codr, for the performance of the
work for which this Pemmilis issued.
0 1 have and will maintain Winner's Campcna urn Insurance, as termed by Section
3100af the Labor Code, la IW pcifomwmce of me work for which this Puri. is iuucd.
My Workers Comperaation Inurance carrier and Policy number art:
'Cunee' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This metim read era be compined iftW pmnit is foron humlred dollut (5100)
or Ices.) � "
I certify, that In the Performance of thewmk fn which this Permit is issued, )shall
not employ any Prancer u any manner sd ai to Tacoma subjec ro me Worker' Compete
moon laws of California. Date '
Applicant'
NOTICE TO APPLICANT: If, after meting this CamiBoti of Exemption, you should
beccrmn subject b me Worker. Compen union Provisions of the labor Code. you must.
f inhwim comply wit such provisions or this permit shall be deemed mvukol.
CONSTRUCTION LENDING AGENCY
I_ hereby affirm thu then is a construction leading agency for Performance of
the work fm which this permit is issued (Sec. 3091, Civ. C.)'
Lender's Name
ix > lender's Address "
W I certify that I have mad mu application and awe But the ibme infommion is
d 17 means. l agre to comply with ell city arm county otherness and sate laws relating to
U O building construction. and herchy authorize rcInctimstives of Has city a enter upon to
nbovememioned property for inspection Purposes.
ITT ; (3Ye) agrce to era, indemnify end keep humlcu tW City of Cupertino against
C C.) Iubiliti.judBments, costs and expenses which may in any way accre against said City
;;s Le: in consequence of me granting of this permit.
APPLICANT UNDERSI'ANIIS AND WILL COMPLY WITH ALL NON POINT
Z SOU CE g'C 11. 1Iv! ONS.
hr — _ -A,/>-/
A
unber' Oc pancyType
.Required Inspections
N
Willhe eaduart or future Wilding nccupam state or handle inconstant material Re -roofs
u defined by the Cupertino Municipal Cede, Chapter 9,12, W to Health and Safety '
sails. Sec am 21132(01 Typepf Roof •' ;
• ❑Yoe � .. ,
Will the .pDl;<.d er fdaab dine aanp,n, a,e e,n;p�e�; a,,e,.;c�t wh;rh All roofs shall be inspected prior to any roofing material being
em it broadens air connuninnu ay�flned by me Bay Aaa Air t]ualiry Mmatemem installed. If a roof is installed without first obtaining an.inspeetlon
District ✓ I a ree to.remove all new materials for inspection. Applicant
❑Yes
ON. �, g ,
understands and will -cote 1 with all non point source regulations.
1 Health & d the hevrdam tors; 2ls 5, n5menn miler 4,1 unce h.9] of to if the P Y P D
fora Healtlm @ Safety Code, Section 25501, 25533 end rro W, I utdttsand they if the n „
'
building ndc rely Mvee teaanLim coins rtspf Cariry m, f0c occupant -
' a ich mart be met Dnormism ce feCmifi ie of Occupemey,
X
L. % D� Signature of Applicant - Date
• �r ore xo z seem P•� Date
All roof coverings to be Class "B" or better
OFFICE
• n'U[J
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vii a �6i1
a
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O Z'= =
afrarm thu I am Bans under of Chapter 9 (commencing
1 hereby LICENSED CONTRACTOR ceder Provisions DECo of Cap
�.
- Job Description '
Cma,r
with Section TdeffecDivision3of Brc Business and Professions Cade. aced my license is
ion? o sis
Y
m full force and <Btts.
Clesa Lic.g
G
.
3 I—
Droc
Dne' CantacCL
ARC S DECLARATION
0
I— = O'�
adl be
1 undenand my Plans shell be used u PuMi<rtcarda
`• .
e
`` J� % (� �.--% e /Za%'✓l /7'
Llcenxd Profriamm)
OWNER-BUILDER DECLARATION
1 hereby amrm that 1 am exempt from the Comrmmfs License Law for the
Ofallowing mason, (Section 9031.5, Business and Profmior, Cads: Any city a runty
ou 3 m which requires a permit ro container, alter. improve, deamliah, or mama any swcture ,
prim m its ismance, else tecame, the applicant fd each pamdt in file a signed atatcmmt
that he is licensed Punuant to the provisions of But Contradone License law (Chalver9
(mormemm, with Section 1000)of Division 3 ofrhe Butimn and Professions Cods) or
' Ben he is exempt themfmm and the basis for the alleged uempsian. Any violation of 3
Section 1031.5 by any e,he., fora pemdt subjects the applicant to is civil per`Wry of s
rem mart than five hurdled dallan ($300). " ' -
❑I,uowvtt of me prapeny,mmy employees wins wag<au meinole compenmtidn. -
' } will domework, and teawisLt.. Us,clu snale(Sec.us 14, BUaincof
' and Profeuiom Code: The Co..,.?, Conm ?s Liana law dac not apply s lf owrcr gh
his own wed oyes, m improves hush improvements and who dose such work himself f through
hit own oweveras, provided that moo sold w ere um immrofc m offered for
WeIf, hmveve will building orimPrOVemens is soldwithinone yearofcomplesfor Ba
1w of ilder, will have the pWCn of provin8 than he did not Wild or improve f& po-
I. sown
r of the Droperty, am exclusively convecting with licensed cmtrumn to
consumer the project (Sm. 1040, Basins and Profession Code:) The Comrclofa U.
tense law does not apply to an owner of property wed Wilds or impmvn thereon, and
v .
who contracts for eachp Projects with a contractons) licensed Paternal to to Contrmia's
r 'License law, s '
9�der{� B k P C far this
ration
Owner a ^s--�w D.�
ORXER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury om of the following dcclantiau:
I have and will maintain aCe tificam of Commm uo self-insure for WodersCompen-
mtion, as provided for by Section 3100 of the Labor Codr, for the performance of the
work for which this Pemmilis issued.
0 1 have and will maintain Winner's Campcna urn Insurance, as termed by Section
3100af the Labor Code, la IW pcifomwmce of me work for which this Puri. is iuucd.
My Workers Comperaation Inurance carrier and Policy number art:
'Cunee' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This metim read era be compined iftW pmnit is foron humlred dollut (5100)
or Ices.) � "
I certify, that In the Performance of thewmk fn which this Permit is issued, )shall
not employ any Prancer u any manner sd ai to Tacoma subjec ro me Worker' Compete
moon laws of California. Date '
Applicant'
NOTICE TO APPLICANT: If, after meting this CamiBoti of Exemption, you should
beccrmn subject b me Worker. Compen union Provisions of the labor Code. you must.
f inhwim comply wit such provisions or this permit shall be deemed mvukol.
CONSTRUCTION LENDING AGENCY
I_ hereby affirm thu then is a construction leading agency for Performance of
the work fm which this permit is issued (Sec. 3091, Civ. C.)'
Lender's Name
ix > lender's Address "
W I certify that I have mad mu application and awe But the ibme infommion is
d 17 means. l agre to comply with ell city arm county otherness and sate laws relating to
U O building construction. and herchy authorize rcInctimstives of Has city a enter upon to
nbovememioned property for inspection Purposes.
ITT ; (3Ye) agrce to era, indemnify end keep humlcu tW City of Cupertino against
C C.) Iubiliti.judBments, costs and expenses which may in any way accre against said City
;;s Le: in consequence of me granting of this permit.
APPLICANT UNDERSI'ANIIS AND WILL COMPLY WITH ALL NON POINT
Z SOU CE g'C 11. 1Iv! ONS.
hr — _ -A,/>-/
A
unber' Oc pancyType
.Required Inspections
N
Willhe eaduart or future Wilding nccupam state or handle inconstant material Re -roofs
u defined by the Cupertino Municipal Cede, Chapter 9,12, W to Health and Safety '
sails. Sec am 21132(01 Typepf Roof •' ;
• ❑Yoe � .. ,
Will the .pDl;<.d er fdaab dine aanp,n, a,e e,n;p�e�; a,,e,.;c�t wh;rh All roofs shall be inspected prior to any roofing material being
em it broadens air connuninnu ay�flned by me Bay Aaa Air t]ualiry Mmatemem installed. If a roof is installed without first obtaining an.inspeetlon
District ✓ I a ree to.remove all new materials for inspection. Applicant
❑Yes
ON. �, g ,
understands and will -cote 1 with all non point source regulations.
1 Health & d the hevrdam tors; 2ls 5, n5menn miler 4,1 unce h.9] of to if the P Y P D
fora Healtlm @ Safety Code, Section 25501, 25533 end rro W, I utdttsand they if the n „
'
building ndc rely Mvee teaanLim coins rtspf Cariry m, f0c occupant -
' a ich mart be met Dnormism ce feCmifi ie of Occupemey,
X
L. % D� Signature of Applicant - Date
• �r ore xo z seem P•� Date
All roof coverings to be Class "B" or better
OFFICE
I.
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
i
BUILDING PERMIT INVOICE OPERATOR: kaaenb
Sec: Twp: Rng: Sub: Blk: Lot:35715022.00�
INVOICE DATE......: 03/21/2000
REFERENCE ID N ...: 00030123
SITE ADDRESS .....: 21925 ALMADEN AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ....... -
OWNER ............: LIN
ADDRESS ..........:
CITY /STATE /ZIP ...: CUPERTINO, CA 95014
CONTRACTOR ........ LIC # -OWNER*
COMPANY ..........: LIN
ADDRESS ..........:
CITY /STATE /ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........:
FEE DESCRIPTION
CHK
TOTAL FEE
PAID -TO -DATE
BALANCE DUE
BPERMFEE
P
157.00
0.00
157.00
BPLANCHK
A,
62.25
0.00
62.25
BSEISMICRE
P
1.00
0.00
1.00
��.
_________
220.25
____________
0.00
___________
/ 220.25
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