00030007 'CITY OF CUPERTINO ' > - PERMD,,NO.
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: / '7
'
BULDINGAD ESS: /� - - 9OD.3OW
pl iaC1 SANITARY NO. APPLICATION SUBMITTAL DATE
Z
O R'. N P i N ..
f' NIC CONTROL
And
BULDING 1117RMlT INFO
.a
F 7 i LICENSED CONTRACTOR'S DECLARATION �. r
ZO Z= I hereby am.Nu 1 licensed
censed;roar FroAsitew or Chapter 9(commend.; Job Description
Ir_ wrth Sotion]nn0)ofD' 3 fthe Business and Professions Cade,and my license _
y m full force ard effect.
Hip d Da.mcl.n sec«
Dem Contractor
ARCHbo usS DECLARATION
1 - -
unedntend mY Plant shell ll bo used u public rcmNs -
i to
Licensed Pridmai etaP '
OWNER.BNLDER DECLARATION' •� - .. . • .• ., ,
C 3 a I.hercby.mein that 1 am exempt from Ina Coaonmo License Law for the '
Fn following reason.(Semon]D315,B. i e, eM Rafmimu Coda:Any city a county
,� which its im m permit oc torso the he,icrippo,for such
demolish or repair any tatimme
�3— pniamita summer.also rcgairt.Ineappf<.m fa.acn permit la flearigad rl.amem Sq-'Fl. Floor Area Valuation
that he is licensed punurot to me pmvisiom of the Corms. r'e License faw(Chler9
fcer he I.monist SecVon]and!to basis for
.1 B ml esti said...A,o6 Imam oo-
But he is 31.3 b Nercfrom W Ne beers for the alleged exemption.Any violation of P In - Occupancy Type'
Section 7031.3by any applicant ra a m), subjecn the appli.nl to a civil penilry,of
nm nwie Nen f ve humlrcd dollen(SSOD).
❑I,ai owner of We propcnY•a mY empl�ycee with wag..Mlheirmlc compewtion, . .'..Required Inspections .
wnllelo Nework,std the structure is not intended or offered for onto(Sm.]Be4.Business
and Pmfemion Code:The Convamm'r License Lew does ata apply la au miner of ,.
property,who builds or improves thereon,and who does such work himself or through
his awn ernploye a,pmrided that such improvements see not intended or.Shared for
ho
aide.If, wever,the building or improvement is sold within one ye.of compluion,the `
owner Wilder will love the hardg N
en of proving he did vat Wild'ar improve fa Pur-
pose.f tile.).
I,u r of perry,am eadmvelycontrnued,with lianvd con.in -
conmve Ne project ec:]M4,esirose and professions CodeO TheCmvenor'c Li
-cense wd;iiiap yroroowes.of prnpeny who Wilda or improv.darrem,and - - - "
who. hamsfts uc rojmtew,N a concruch, al 'tented pun ammthe Contractor
Lice. w. m �u _
1 <aempt u
Owner -
RKER'S OMPE TIONDECLARATION �• i '
IMhe a rni undo pnWty o! jury ooe of Ne following dcdmtlon:
I Ihaors. ill imine Cenific it Consentto self-inmmfa Wakets Canpen- -
pion,u pro i for by;aGon 3] of the Labor Cade,for the performance of the
work(or whit s permit is issued ;, '
❑1 have and will maim,Workcr'.Compensation Insurance,is immoul by Section
3]W of the labor Code,for the perform s.of the work for which nn,permit I.,...m, '
My Worker's Compensation Inmate curia and Palley number art: all
Cartier: • policy No:
• CERTIFICATE OF EXEMPTION FROM WORKERS'
,. COMPENSATION INSURANCE
(This senion aedrrot hec.mple of ifthepemen is Pororchmakeddullan U110))
lanirylhatintha peAormerxeo(Ne wink rot wnian Ni.pemitisinued.lelW1
- not employ any person in any manner ro n m bemrme subject to N¢Warken'Conan-
moon Laws of Celifomie.Date
" Applicant '
NOTICE TO APPLICANT:If,after making Nis certificate of Exemption.yw.Iwuld - Ie "MAR„0'2 2000 ,
become mbjccno One Worker'.Compensation pmvisiom of the Labor Code,you must -
a forthwith comply wit such provision.Nis pemlit shall be domed revoked. _ '
CONSTRUCTION LENDING AGENCY ❑ `
0 Ihereby am=thatthereisaconswctionlending agencyfortepmfomunceof 'HV _
Ne work for which this permit is issued(Sec.3097,Civ.C.) - t -
j..i Lender's Name
C > lender's Addrew _
W 0 I certify due 1 have read this application and nine that the above infomution is -. .
Z correct.l all.to comply with ell city and c......Ni......and star laws mining m .,
zi Wddin nl
on,amlhcrebyauthenre representatives oflhis city to enterpo
un the
V .Wv otiose roperty far inspection purposes.
I:ti F, (w).gree ..ave.i.eemmry atd keep ndmle..the spy or capeni..awinn ,.
V Ii ilmes,judgment,omossudr.purtat whichmay in any waymcmeagsimtaaid City
�+ W i consoclueoee of granting of this permit.
. PPLICANTU ' HRSTANDSANI COM .YW 'H\I.I.N N-M NT
U, OURCR RF' T NS. ,
•_� ��ar /1/,
oemrt A cenVCn tr Dam
"FU7.A ;MATERIA D CLOSURE GC/�•7 a•� s V
Will sheepplicsnto um Wildingar ant teres handle hasardaaa matenal "Re-roofs. t'
as&fired by the Cupminb icipel Code. r 9.11,sed the Health and Safety '
67
Cod.,Smile.ViDzq)] .' - Type of Roof r
❑Yes .r
Will the applicant or fuuir Wilding occupant useequipmcnt or devices which All roofs shall'be inspected prior to any roofing material being
emit hazardous ab mmarnbuno to defined by Ne Bay Area Ah Quality Management instal d. If a roof is installed without first obtaining an inspection
”] tag e o removeall.new.materials for inspection. Applicant,
Yes
1
der hazardem;mannWnesulmmennunder chapter 6 SnftlrColi ' n erst ds and•wi�l omp with all non p int ource regulations.
" f.mie H a v Sefdy Cade.Sections ,33333 and 23334.1.0. d Net ft the
Wildin curve t itis yin biliry r'
of the ¢h t. e f a enif, c
Si re•of plicaAM
n - Date
rdym
All r04/coverings to be Class"B"or better
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rug: Sub: Blk: Lot:32617022.00
INVOICE DATE...... : 03/02/2000
REFERENCE ID # ... : 00030007
SITE ADDRESS ..... : 10151 AMELIA CT
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ... ......... : CLARK KENNETH A
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, 95019-1005
CONTRACTOR . .. . . . .: LIC 8 -OWNER-
COMPANY ..........: CLARK KENNETH A
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, 95019-1005
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ --------- ------------ ------_____
BTEMP P 57.50 0.00 57.50
EPERMITFEE P 35.52 0.00
93.02 0.00 93.02
VOICE ID - DESCRIPTION VOICE ID DESCRIPTION
...--- ----------------- ........ ..... ... ........
ROUGH ELECTRICAL 501 FINAL E ENERGY
505 FINAL ELECTRICAL
EA:RO 0000 M
•
Qty. if Applicable Fee ID Fee Description Fee Group
JBPERMFEE ISLOG PERMIT FE=S (BUILDING
.18CONSTAX CONSTRUCTION TAX BUILDING
• ISENERGY JENERGY IBUILOING
BENERGYADD - ENERGY ADD MULTI 1BUILDING
IBOVERTIME JINSPECTION OVERTIME IBUILDING
STENIPPERM TEMPORARY BLDG PERMIT JBUiLDING
BNIITIGAT 1HOU51NU MITIGATION FEE ISUILDING
BPLANCHK PLAN CHECK FEE IBUILDING
BPLANCKADD PLAN CHECK ADD MULTI ISUILDING
BPLANCKREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT REINSPECTION FEE BUILDING
BSCBLVD SCS SPECIFIC PLAN BUILDING
BSEISMICOM SEISMIC COMMERCIAL BUILDING
BSEISMICRE SEISMIC FEE RES BUILDING
ESPECIAL SPECIAL INSPECTION BUILDING.
BSWIM SWIMMING POOL BUILDING
ZAODCHG ADDRESS CHANGE BUILDING
EPERMITFEE JELEC PERMIT ISSUANCE JELECTRICAL
BELEC1000 ELEC 600V<=1000A ELECTRICAL
BELEC1001 ELEC 600V>1000A ELECTRICAL
BELEC200 ELECT SVCS 600V cr200A ELECTRICAL
BNEWMULT! MULTIFAMILY RES ELECTRICAL
BREMBUSWAY REMODELBUSWAYS ELECTRICAL
BREMFIXT LIGHTING FIXTURES ELECTRICAL
o BREMMISC MISC APPARATUS ELECTRICAL
BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL
BREMPOLE POLEIPLATFORM FIXTURE ELECTRICAL
BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL
BR RRECEPT RCPTL, SWITCH&OUTLETS ELECTRICAL
BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL
BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
BSF&2FAM SINGLE&2 FAMILY . ELECTRICAL
/ BTEMP TEMPORARY POWER ELECTRICAL
BTEMPSVCS TEMP DIST SVCS ELECTRICAL
MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL
BAPPLOTHER OTHER APPLIANCES MECHANICAL
BBOILERI BOI z 100,000 BTU MECHANICAL
BBOILER2 BOILER>100KTO500K BTU MECHANICAL
BBOILER3 BOILER>500KTO 1M BTU MECHANICAL
BBOILER4 BOILER>lM TO 1.75M BTU MECHANICAL
BBOILERS BOILER> 1.75M BTU MECHANICAL
BREMAPPU APPLIANCINSTALL MECHANICAL
BREMHEAT HEATER INSTALLATION MECHANICAL
BREMVFVFAN VENT FAN SINGLE DUCT MECHANICAL
BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL
BMNEWSF&2F NEW SF&2 RES SLOGS MECHANICAL
k oft
BREiMACOVER JACUNIT >IGG0GCFDI Ibl� nnVICnL
JBREMAIRHAN JA/C UNITS c= 10,OGCCri�1- IMECriANICAL
IBREMFURN IRELOCATION OF FURNACE (MECHANICAL
JBREMFURNOV IRELO FURNACE ,> ICK B i UMECHANICAL
BREMINHOOO JINSTALLATION OF HOOD IMECHANICAL
BREMRELOCA IRELOCATION OF HOOD. IMECHANiCALl
BREMREPALT REPAIR/ALTER HEATING IMECHANICAL
BREMVENSYS IVENTILATION SYSTEMS IMECHANICAL
IPPERMITFEE IPLUMBNG PERMIT ISSUE PLUMBING J
SNUMULTI NEW MULIFAMILY RES PLUMBING
BNUSFD NEW SINGLEFAMILY RES PLUMBING
BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING
1.BPCESSPOOL CESSPOOL PLUMBING
BPFIXTURE PBLG FIXTURE PLUMBING
BPGAS GAS PIPING SYSTEM FEE PLUMBING
BPINTERCEP IND WASTE INTERCEPTOR PLUMBING
BPREPIPE REPIPE OF FIXTURES PLUMBING
BPSEWAGE SEWAGE DISPOSAL MPLUMBINGBPS R SEWERS SPSPRINK LAWN SPRINKLER/BACKFLO SPSTORM STORM/RAIN WA ER BPTRAP KITCHEN TRAP BPVENT ALT OF DRAIN &VENT BPWATER INSTALLIALTER WATERPIP
BPWH TER WATER HEATERfVENT PLUMBING
BPWSVCS MAIN WATER SERVICE PLUMBING
ZDEVAGREE DEVELOPMENT AGREEMENT- PLANNING
ZDIRTM DIR TENT MAP PLANNING
ZFULLHR FULLAPPLBASE+HR PLANNING
ZFULLTM FULL APPL TENT MAP PLANNING
ULLUP FULL APPL USE PERMIT - PLANNING
ZFULLZONE FULLAPPLZONING PLANNING
ZGPAMEND GENERAL PLAN AMEND PLANNING
ZLIMAMENO LIMITED AM D PLANNING
ZLIMTM LIMITED TENT MAP PLANNING
ZLIMUP LIMITED APPL USE PERMI PLANNING
ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING
ZMINHILLEX MINOR APPL HILL EXC PLANNING
ZMINSIGNEX MISC SIGN EXCEPTION PLANNING
INTM MINORAPPTIRTMAP PLANNING
INUP MINOR APPLUSE PERMIT PLANNING
ISCASAMISC ARCH SITE PLANNING
ZMISCEXT miscTWX—No-075 EXT PLANNING
ZMISCFENCE MISC FENCE EXCEPTION PLANNING
ZMISCGEN MISCELLAPPLU NERAL PLANNING
MUPCIN • MISC PC INTWRETATION PLANNING
1 N SI N PERMI . PLANNING
PSI1TWAFORARYBIGN PLANNING
VARIANCE 101RECTOR VAKLANCt IFLANNINU
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