00020084 !-CITY OF CUPERTINO .PERMITNO.-
114LDlNcpmstoN ' PERMIT C►OO NTRAC OO R IIOO
BUILDING ADDRESS: •• �•1��1� ���,¢h �/�/��i¢��yf �l/r V `(
14122 • G V T L// cu G/ L' ,/(, .SANITARY NO, APPLICATION SUBMfITAL DATE
due•
_ N/C CONTROLp
_ y�ywDrcl,QCQA 9ysyS-1722 ❑
ARCHITECT/ENOINE'ER Sia_`��/ '�2z9l2 U71NNfJt:E12M1 N@O
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3 LICENSED CONTRACTOR'S DECLARATION _
oz=❑ Inertnr.rrrm NetIcan liccrud under Pmvisiene or Chapter9(c 'ng .. Job Description
vw C w I Ri Sation 7(00) for, Sof be Bu,mraand Polesimns Code,aMm i, -
si in full force end eR.at/'3 /t• sec.p
Amy license1J'7j��(.i {(
a Dau L Contractor
nl
ARCHITECTS DECLARATON
I udasuW my Plans eWaLbe
used M public rtcads
my QS
ti,q O' Ucanmd Pofeesioml • -
v'li w OWNER-BUILDER DECLARATION
1 bane .Rine that I w exempt from Ne contractors Lm<nse Lew fm led
O follewhich ne reason.rormit as contract,
Business and Profadons Cade:Any city st county
u.3$ whichmyomaapermitrteMnsthefiler,improve,hProto¢trieasigNY¢tNctw< Sq:Ft.Floor Area / lHa u
pdorto its amused pos o rectums led appvisionant foranch Contractors
mice uLnd aummant U
that he islicensedudquioant to the of DICursor the.fluarora License lww(Chaptm9 r ,
(cat he I,exempth5<doo and
for the
N alleged mamdProf..cur Anyons Code)or
d PN Number
Nat he Is exempt Ncmfmm and the per for bj ct%the exempnt to Any violation of 2 _O .Occupancy Type -
Eecfion7031.axe any aedd.11for a pemtil mbjau the applicant toacivil pemlry of ✓G l
pm mom Nen fixe hundmd tlollm
al,as rwmr er Ne pmpdry.army<mployea wiNw.gmmNeu W<canrpcnauier; Required Inspections "
willdo Na work.end Ne structure u not ironclad uaffnred for We(See7044,Buaimv ,
and Pofesaiom Code:The Conmclor's License Law does nm apply to an owner a
property who Wilde or improves Quarter,and who does such wort himself or through
his own employees,provided that such improvements am nor intended or off.m l for • „,
We.Ir,however,Ne Wilding orimprovcmenl is Bold within one jemofcamPlefion,the - r
wrer-builder will love the burden of proving that he did no Wild or improve for pm-
pmeof tee.).
I,u ver of Ne property am exclusively contracting win licensed conrremn to -
cemood IN projat(Sa,7064,Due..and Professions Code:)The C usarmore Li-
nse Law does not pply to an owner of property who Wilds or improve,demon.and
who contmctsfor such projects wirhecoronet.rya)licensed purer/to the Contactors -
Licanac Law. j ..
I am cxempturider Sce. - .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
l hemby.M m underpe ly of pe jury one of Ne following dalammet:
I haveand will nuinWa aCeniOcemof Comentn¢elf•inwmfor Worke.Comp<n- - • -
tion,as pm4iddl for by Saturn 3700 of the Labor Code,for the performance of the - .!
work v which Nis permit is issued.'
v=
and will mainum Washers Compensation Insurance.as required by Section
370(LaflW LAbrCode,fu the perfonrumo olds,work fee which Nispennir is iuud. c '
My Work Com'p�mratio�yInsuraae carr,and Policy n1µn - '
Carica /3-(rf'Yf]0 n
CERTIFICATE OF EKEMPDON FROM WORKERS'
COMPENSATION INSURANCE' Ir
(This tedien nadnd beermpl<led ifrte pallnir in faronehur,NM doll.(5100) t
or less.) s
employ
mythane,in my normceofne become
for which Nis the Worsent'Ca pen-
, rid or Gem sof Califon in any manor n as to become subject to the Warkere'Comptn- ,
salirn liwa of California.Deas „
Applicant ,
'NOTICE TO APPUCANT If,after sinking this Certificate of Ex<mpuon,you should
heroma
forthwith comply with
such
vCisoium un this ppemrmviil mail
Na Labor Code,you mart ' -
W dared revoked.' ,
CONSTRUCTION LENDING AGENCY
Q I busby CIE.had Nem iso construction lending agency for performance of
. the work for which this priori is issued/Sed.3097.Civ.C.)
� - - '
F., Lendre:Name
7 Landte Address ' -
ILI Q 1 cettifY Net t have rend Otis application end sum Nat rte aWve infomution is
.7 z carat.I agree to comply with ell city and county omimnces and mu hwe mining to - - _ --
V O building comtnal property
rofor<impreemisetepreurunivm pf Ibisairy toenur upon Ne
above-me e)., pto i.e far inspection purposes
(W<)agrees,¢ave,indemnify,.pri and kap hay i me ted City of Cupertino d City s
Q V inconseque consequence
it If apenseawhich may in any wry accme againn said City -
�., LiJ in consequence of Ne li B of this permit
0. APPLICANT UNDF- DS AND WII PLY WITH ALL NON-POINT
V Z SOURCEREGI AT -
Sigmtumaf Applican n see '
US MATERIALS DISCLOSURE
Will N,.,Iic or fumm building ucupeni¢mm orhandle hmerdrua memriel 'Re-roofs '
ns defied by the Cupenioo Mumdpal Cde.Clupter 9.12,end Nc HdN and Safety '
Coale,Section 25537(a)7 • _ / - Type of Roof
0 Yet
Will the applicant rr sure Wilding occupant use squipmcnl or devices which All roofs shall be inspected prior to any roofing material being
it havrdqus it,conuminants as defined by the Bay Ame Air Qunity Menaenmant installed. If a roof is Installed without first obtaining an inspection
""DYm, ` I agree-to remove all new materials for inspection. Applicant
Iheve Trod dr ,materW. nimmanls ender understands a will cons ly with all non points ur a regulations.
req Couper 6.93 of dr Cali-
fi.Health&Sarety C ,Sa-tions 73503,25533 and 25,5M.I understand sew if sere :r as �/ 4d
beildingdoas rmlcome aatcmnl.Nat it is mY rtapoa ibility to rmtify the uculant -
afdumqumossoute test be can Prior setae of a Certificate of 0",
Signature of App Date
Owner orauNoraod ale v
All roof coverings to be Class"B"or better
OFFICE c
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
r
CITY OF CUPERTINO
r�
• BUILDING PERMIT INVOICE OPERATOR: yvonnek
Sec: Twp: Rng: Sub: Blk: LOC:32634066.00
INVOICE DATE. .. . . . : 02/14/2000
REFERENCE ID q . . . : 00020084
SITE ADDRESS .....: 10118 BANDLEY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO'
IMPACT AREA . . . .. . .
OWNER ......... .. . : RAJKOVICH MARTIN TRUSTEE 6 ET
ADDRESS .. .. .... . . :
CITY/STATE/ZIP .. . : HOLLISTER CA, 95024-0189
CONTRACTOR .. .. .. . : GILROY, JOHN LIC k 15128
COMPANY ... .......; JUST WATER HEATERS INC
ADDRESS ..........: 1764 NATIONAL AVE
CITY/STATE/ZIP ... : HAYWARD, CA 94545
TELEPHONE ... .. . . . : (510)293-9901
NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
45.51 0.00 45.51
V CE ID DESCRIPTION VOICE ID DESCRIPTION
.......e.................... ........ ............................
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING