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00020102 CITY OF CUPERTINO PERMITNO. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: (9002_0J02_ BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAT (W ER'6 NNA 2n �C WC CONTROL# 'HON(9-SS ❑ ..RCNITECfIENGINEER BALDING PERhrIT INFO pYJ w�00CC UU 6a H LICENSED CONTRACTOR'S DECLARATION 0 o v o thereby rRam that 1 an licensed under Provisions of Chapter 9(atmanrdvg Job Description 5M w with Section 7000)ofDivisim 3 of the Business am Pofessiom Cade,and my liansen QYf:JmNaM se llforac °E:on " o.¢nne ans ` Canraamror I1kQ e u.O g ARCHITECTS DEC 110th 1 T�� I understand my plans shall bo used in public rccordr i 6° Licensed PoreulorW X�,n OWNER.BIRLDER DECLARATION 1 hereby affirm shot 1 am exempt from me Contaectoes License law fm the 5 F O following re+en.(Section 703 1.3.Buximss and professions Cade:My city or county won 3 m which requires a permit In construct,atter,impmve,demolish,or repair stay structure Fiat 0 its ismance.dro mquires the applicant for such Permit in file signed summand Sq. FL Floor Area Valuation Nat he is licensed punuam athell of Division of da Contractors nal Prse law(Chapter r that he exempt tSection T10o1 or Basis for domeeudauamon.Anvi Cad.or APN Number Wt he is enema therefrom W the per far Ne alleged ficant to Any l and n or Occupancy Type Section then five my bed doll for a Pamir subjects dm applicant to a civil pcvlry of S SCo O CD O -o not more Nen Eve hundred dollen($500). ' ❑I,,xawnaarmepmpeny.armyemPlaya.wimwageamd,a;r,aleeamPenaetian, Required Inspections will do Ne work,am Ne W Core is tut,Ln ..Lan,d for sale,],in an B mer of em erlyprewhom Code:The Ces them i License law d«s rw apply ro an ownerof , properly who WilA.or improves thereon,po who don such wart intended or f through his own employhowever. es.the provided r i such Ment is sol ut wart nm iyeaMed a oRered for sale If,howesa:r,than Wilding or improvement is sold within one year of completion,the owncrboidcr will have the burden of proving mat W did Ion Wild a improve for pair- - 0 1 of taterte I, ias ownerof theproperty,amexclusively proeuun8 with licensed conuacmato pore La the project(Seeapply lora,Busowner rope property who onsbut Code)The ex thereem,I.J. apse law case not apply m tx owner of properly who build or impmve ommus mul wW contracts for such pojau with econaacmK,)licensed pursuem m me Contaecmrs / uan,e law. lemeaemptunder Sec. ,B&PCforthBmuon Owner Date WORKER'S COMPENSATION DECLARATION /// 1 hereby offs under pmWy of perjury one of the fallowing decla oms, ' 1 have am will mdnom a CcauOcate afcotsent to ulf-Insure fawooersCamper- tion.us provided for by Secuon 3100 of Ne Labor Code,for the pedomuae of the work for which mix permit is issued. ❑1 have soul will mountain Workers Cornpenution Imurana.u required by Saa'tion 3700ofthe labor Cate,for the performance afore work for wIt hmis rmltuiuued. C ym orkc�`es CoL �sm ar_r and Policy .�d R Policy b CERTIFICATEOF EXEMPTION FROM WO KERS' COMPENSATION INSURANCE ' (This sauon need not becompletedifNm pmmdt k.forams humaeddMlan($100) or Icss.) I unify that in the psrfanunce of me work for which this permit is ivand I shall not employ any person in any manner so as to became,noject to the Warton'Compen- xdiom laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cwiftcase of Exemption,you should become subject to the Workers Compenutica provisions of the Labor Code,you must - rorlhwith comply with such govisions to this penait shall be deemed revoked. - 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that mere is a construction lending agency for the performance of z the work ror,which this .it is issued(Sec.3097,Civ.C.) Laraine,Name �i > Lender's Actions, L1 certify Nm m 1 have read this application and state at Nwon e above inforOis -I.I a®ee in comply with all city and county ordinances and,tate laws relating to - V Obuilding construction.and hereby wthona rcpa,scnarivn of this city m eaderupon da, above-mentioned property for inspection purposes. Gtr Eon (We)agree in now,immunity and kap beronlee,to City of Cupertino against 0 f..l liahiliuc,.jmgments,costs am expenses which may in any wry acme against mid City iy WO in conma uence of Ne gmnung of this permit. F y APPLICANT UNDERSTANDS AND WI LL COMPLY WI Ill ALL NON-POINT f..l z SOURCE REGUI.Ar10NS. - t( Signorine of APplicam/Conwctor Date �_AS HAZARDOUSMATERIALSDISCLOSURE Will the applicant se Room Wilding Mcupant store or handle haamdous maaristl lfe-roofs as defined by the Cupcnino Municipal Cate,Chapter 9.12.nod than Health em Safety Cade,Section 15532(a)? /' Type of Roof [-]Ye, p No Will the applicant orfuture Wilding occupant use equipment or devices which All roofs shall be inspected prior to an roofing material being emit havarkas air comemara s as defined by the Bay Area Air Qudity Monogamous installed. If a roof is installed without first obtaining an inspection listr``t7 I a roe to remove all new materials for inspection. Applicant Yes f/I No g I love read do hoardodour nationals rtquiremmls tamer Cooper 6.95 of Cdi- understands and ill comply with all non point source regulations. lona Neelm&Safety Cade,S 'ons 23505.25531 end 2553x.I undersand that if the Wilo dastw it whichoavea vat,ctut is is mY of issi,onfito amity Ne acupant _/`S ©� menu watch mast ieeuana of a Cen�fieue Mtkcupaay. _ fon mmagn, -Date Applicant Date All roof coverings to be Class"B"or better OFFICE INVOICE INVOICE 'INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Elk: Lot:35606022.00 INVOICE DATE... . .. : 02/15/2000 REFERENCE ID # ...: 00020102 SITE ADDRESS .....: 22023 BAXLEY CT SUBDIVISION ....... CITY ......... ....: CUPERTINO IMPACT AREA ....... OWNER ............: MR. SABA ADDRESS ..........: CITY/STATE/ZIP . ..: CUPERTINO CA, CA 95014-4744 CONTRACTOR ....... : THOMAS, DAVID R LIC # 9331 COMPANY .......... : THOMAS PLUMBING INC ADDRESS .......... : 321 E WASHINGTON CITY/STATE/ZIP ...: SUNNYVALE, CA 94086 TELEPHONE . .......: (408)736-3050 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPGAS P 4.44 0.00 4.44 PPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 39.96 0.00 39.96 V^ ID DESCRIPTION VOICE ID -----'..DESCRIPTION ........ ......... ........ .............. SEWER I WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB S OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • • 9REMACOVER QAC UNI7 >1000GCF%l Jbl E cAN ICAL • 1BREMAIKHAN LAIC UNITS <- 10.0GCCFM jMECHANICAL JBRENIFURN IRELOCATION OF FURNACE I MECHANICAL JBREMFURNOV IP•ELO FURNACE > ICK STU jNIECHANICAL 8REMINH000 JINSTALLATION OF HOOD MECHANICAL BREMRELOCA IRELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS (VENTILATION SYSTEMS IMECHANICAL PPERMITFEE JPLUMBNG PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFO NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PSLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING SPSEWAGE SEWAGE DISPOSAL PLUMBING SPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALL/ALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZOEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE*HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULLAPPLZONING PLANNING ZGPAMENO GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING P LIMITED TENT MAP PLANNING LIMITED APPL USE PERM[ PLANNING MPUP MIN AMEND TEMP USEPERM PLANNING LLEX MINOR APPL HILL EXC PLANNING GNEX MISC SIGN EXCEPTION PLANNING M MINOR APP TENT MAP PLANNING P MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELLAPPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE IDIRECTORVARIANCE PLANNING 2 of 2 Resited WO/99