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00020152 'CITY OF CUPERTINO PERMITNCL BUILDING DIVISION PERMIT C►Og NTRACTOf R IiNF TOR+ ATIOg N': ��y_/�]��� UILDING ADDRESS: /sem SANITARY NO. APPLICATION SUBMITTAL DATE © . G c l ✓ p:. OWNER'S NAME: / � <� L f%...J '0—,—/f BOO NIC - CONTROLN , PNONLG O D "�L/ '/ "/ ' �Y f, G�'� �'YJ C/� ❑ RCHITECT/ENGINEER Ifal?DIN_G PERMITiI'NI;O 00 - r - LICENSED CONTRACTOR'S DECLARATION Z , ' r 0 O C_ I hereby aRrm Nat l w licensed uokm movision of CMpter 9(commcmiog Job Description m,_M in Nil OW)ofDivtaim3afthe Bu inauad RofessionC aokmyliaottis' v y Sec J In full face m L U /��e�•�-�-g' re0 Lirsa.a us. ` Lit.NSPG' t /r�y�/'/,k _ t- De¢ Conuctm W /D o, i mdantana car plana xhdl W a.dax pabha rcmrda ' .. ... a oaNf 0 Iacrosed Pmfeuimal OWNER-BUILDER DECLARATION f - c-Z a I hereby ME.Nal I am exempt from On Camvacme.Litems Law-far th. - - - ts-c following..(Section 7031.5,Business sok Pmfaafom Code:Any city ear caumy , 3 m wMch"of.•permit m cmuuum.her.improve,dcmoliN,m repair any earmare Sq. FL Floor Area Valuation 'prim m its issue.,dm ugaires Ne epplinnt for mch permit m file a s+8ned.ta4m me - thel he is lianud punuanuo Ne provision of Ne Contr¢mrs Licrnx Lew lChed0se t Oaths is exempt andl th basis or of a B�al exemption. Any ApN Number Occupant •Type Wt he is eumpt therefrom tad the baiia for Ne dkgd exemption.Any viotidon of Section 7031.5 by any applicant fa a pend.subjects Ne applicant t0 a civil penalty of /2 'Number _ nm mane than five hundred dollars(5500). v ❑Lasowark'and pestru or myrs intended with wgdae their ante 7W,Business egUlrerl Inspections , will a owneine rofftle nrty.co Mbere s ernplordd ooffered!wagesi .heirml7044,Bismans and Profession Cade:The Convector's License Lew does nm apply tO an an.,of , propariy who Wdra,or improves Nemo,end who does such work himself car through his own employee,provided Oat such improv.m uss am not intended or oRetd for sale If,however,Ne building m improvement is sold within one year of comitatio,die ower-builder will hem the burden of proving Net W did no Wild or improve for par,- .. / pose of weer, .• 6 ce s L w doe of the propep,un matter prop property who fig with licensed tormentors s nal mrtmci the Poysel(Sec.7064,Buainus and Pmfeationa Code:)The Contractors Li- . nose law cats far apply u an owner of tra tors act builds ra improves Comom es who cmi-c..for wch Woiata with it contractors)lkenad parsuant N the ConbmNrs BUSINESS . Lia uliw. . . ❑tem exempt under Sec. Date or thin rusan Owner � Date WORKMP WORKER'S COMPENSATION DECLARATION r I WxbY dfimn ander penalty of perjury One of the following declaration: ❑I have and will hs paries Csund,afConsrnuorelGivsurc fa WorkM Comprn- - ^ rs D Plums as proWdd for by Section 37M of the Labor Code,for the pedomta.of Ne r�t �.r6f{�YJIt✓' h(a which this permit is issud. - t t ❑1 hevc ed will maintain Workers Compensation Inmtmce,M mr.arm by Section 370Do(th.LOar Code,for the padcamrm..f Ne work(a,which this permit is issued. _ MYWofYMs noaJgyryK�ceniv-and policy Cam iv�-,LG"'V Polity No. ERT AIF TE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' (This comm,oed rant W emmpleud Visa permit is formahurded dollau(UW) or k.s.l - Icodifylhatinthe performance of the work for which Wiprrmit is issud,I shall not not employ Califon in any manner so n m become suhlam t the Workers'Compen- of enlaws of California.Delo Applicant should D D NOTICE TO ct 1.OnA Ninon, Coaftempen ati this Cenfftcate of the Later codn. .y most hecoa subject to Ne such ro Coons or is pmvit Thal of the labor Coke,you must �000 forthwith comply with wcM1 provisions or Nia permit shall W demand revoked. FEB � NS a CONSTRUCTION LENDINGAGENCY t p I hereby affirm that Nem iso commscbon lending agency faith.pe,fom sof ' ry the wok for which this permit is!.am(Sac.3097,Civ.C.) Undei s Name a y�y> lad.rs Acldmex - y W.Q 1 agran dm 1 h.ve reed that application ad cute Nat Ne above.reth 4. comet.l agree m comply with dl city ed county wdina.e ad Bute law rc4rimg m 7 :i: buildingcm.uactio,and M1ertbyancwnrertpesentuivn of this city to enter upon ale U,O about-mecaimd progeny for turnit tian keep ha. - LTr ice' (We).grse em cave,taciturnityand .,tome On City me.gnunoid City - 0 V N.bilincoi0es,judgmrn0,cnnin ofthisuewhich may in my wry acerae agtinsbeid City - )r Ci) in conse9ue.of the granting of this permit. •. - ' ► h APPLICANT UNDERSI'A NDS AND WILL COMPLY WITH ALI.NON-POINT SOURCER LATIONS. gf icor uacto - Data , HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding occupant state abmdle harsdous matdilRf e roofs as defied by the Cupcnino Municipal Coker.Chapter 9.12,and the Health ad Safety ' cola;sec am xss3z(.)i -- Type of Roof . ❑Yee ON. Will the applicant.,fumrc Wilding«au pant ase egaipmam,or davicea which All roofs shall be inspected prior to any roofing material being emit Intention eh conumi enu as defied by On,Bay Arca Ah Quality Management installed. If a roof is installed without first obtaining an inspection red ❑ho I agree to remove all new materials for inspection.. Applicant ❑Yes �. d _ Iheve the hazardous nationalsmyuimmenu under Chapter 6,95 of the Cali. un erstands and will comply with all non point source regulations. tomo Health&Safety Cade,Secdmsx 25505,25533 end 25534.I ma ei.ud that if the '• buildingdaa currently hevc a tenant Out it is my msporebilay to notify the compete - - aftheu I.whiay4 be cars p' - um.a.fa Cmi a = Delius, I . 5 Signature of'Applicant Dem Dale j. ' rw eallonzd ye➢ All roof coverings to be Class"B"or better OFFICE' . INVOICE INVOICE INVOICE- INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE .r.. r CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: chrietya Sec: Twp: Rng: Sub: Blk: Lot:35912024.00 INVOICE DATE.. ....: 02/17/2000 REFERENCE IO # ...: 00020152 SITE ADDRESS .....: 10166 BARBARA LA SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER PEEPLES, MARK ADDRESS . CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2902 li CONTRACTOR .......: LIC R COMPANY ....... ...: ADDRESS ..........: CITY/STATE/ZIP ... , TELEPHONE ........: .FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ ___ --------- ------------ _---------- BPREPIPE P 8.33 0.00 8.33 ' BPWATER P 8.33 0.00 8.33 BPWHEATER P 9.99 .0.00 9.99 BUSLIC P 90.00 0.00 90.00 PPERMITFEE, P 35.52 0.00 35.52 --------- ------------ ----------- 152.17 0.00 152.17 VV ID DESCRIPTION VOICE ID DESCRIPTION ........ ..-----..................e.. ........ ............................ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING' 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING •