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00050001BUILDING DIVISION PERMIT �(CN %1•%r1 i0rGe a/•e+e ) ' LICENSED CONTRACT'OR'S DECLARATION 1 hereby affirm Nat 1 an lic.msed under mevisiom of Chapter 9 kormankiog with Section 7000) of Division 3 of the Business and Imitations Codes and my lianas is in full form and effect. License Class Li, Data Conant ARCHTIECr'S DECLARATION understood understomy plans shell he used as public rewrds . Licensed Professmnal OWNER -BUILDER DECLARATION 1 hereby aRrm Net I am exempt from Ne Contractor's License Lew for the Following reason. (Section 7031.5, Business and Profession, Code: Any city or county which requires a.Paoit m comwm, ober, improve, demolish, or repair any trommue prior m its issuance, also relphres lee applicant for such Nnom it, file a signed statement that he is licensed pursuant in Ne provisions of the Committees License Law (Chapter 9 (commencing with Section 7") of Division 3 of the Boston. and Profession, Code) or odth. rump, therefore red Ore basis (err Ole .Ileged exein a. Any violation of 3L5 by any applicant for a penult s-bjecp rhe applicant to a civil petWry of en five hundred dollarsner of tax, property, or my employee, with wages a their role comperuwon, work, and the mum. is not intended or offered for We (Sec. 7000, Bminess and Professions Cade: The Contractor', Liana Law does era apply to an owner a/ properly who builds or improves thereon. and who does such work himself err through' his own employees, provided that such improvemane ue not intended or offered for We . If, howevei, the building or improv<mont Is sold within one year, in cour lotion, the ownenbuildcr will have the burden of proving that he did not Wild or improve for per- poseofule.). ❑ I, as cwmm of Ne property, um exclusively connecting with lkensed coomcmrs in on,uum the pro . 7056, Bmimas and Profei,lons CedeO The Conuecmfa W- cenee law dm m Cpply m owns of property who Wilda or ireprovea Merton. and who h%oj. swith aronmcmrta)liceneed pursuantm Ne Conuectara Lice!.;�t rSm. B ItPCfr 's remain r Date %v WORKER'S COMPENSATION DECLARATION 1 hereby amen under penalty of perjury one of Oe, following daclass ion: 1 have AM will maintain a CerfiRmre of Consent to self -insure for Workers Compen. ation, as provided for by Section 37M of the Letter Cude, for the performance of the work for which this permit is issued. ❑ I have and will maintain wnrkin s Companatlon limen.., as oultured by Section 3700 ofdm L i Wr Cade, for the performsnce of Ne work for which this permit is isaved. My Worker's Compensation Insurance carter and FOR, nuobar are: Cartier: Policy No.: CERTIFICATE OF UEMnION FROM WORKERS' COMPENSATION INSURANCE or lees.) (This section need am be c-mplared ifthe permit is for.. hundred dollars (5100) I certify that in the performance of the wmk for which this permit is issued, ) shall not employ my person in any manna, m as to become subject in the Warken' Compes- vidunIawaofCalifxi ia. Data Appli., NOTICE TO APPLICANT: If, after mld melting this Certificate of Exemption, you shou become subjmL to the Wmixers compenadom invi,im, of the Lebor code. you most foMwith comply with such provisions or this permit shall be distorted revoked. CONSTRUCTION LENDING AGENCY 1 hereby oRrm that there is a mnnmedon lending agency for the pMomunce of Ne work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Landers Address 1 cenify thin 1 have read Nis epplicm i n and ..to Nat Ne above information is correccl agree to comply with dl city and county odiounces and sure laws odming m building construction, and hereby authorise ottemenutiver of this city to enter upon the above-mentioned property for inspection purposes. - (We) agree to save, imemarifLma ksep heroines the City of Copan. liabilitics,jndgmcnu, costs ends nuaw may in my way acme against said City in consequence of this%mut. APPLICANT IND' SPAN :A WILLCO PLYWI ALLNO��1 NT SOURCE. REGULAT S. � //V ( / n Y Signuure of ApplicanJConDun HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fmute bredingmce= exorhandlehazardousmaurid as defined by the Cupesuno Muni tl Code. Chapter it 2. and the Health and Safety CMe, Section 25532(.)? [I Yet N Will the applicant or (-tort itding acupant use equipmcm or devices which emit haundims it comaminunu defined by the he Arca Air Quality Mmag.mm, DimicR �Im�a'C No ons material, ualulremenuunder Cha%cr 6.93 of de, Cdi- forSections 2SM5, 25533 and 25530. I undermnd that if the �vvd NtG Job Description / G /3 &} Ira s Type of Roof All roofs shall be inspected prior to any roofing material being installed. 11,eiiroof is Installed without first obtaining an inspection 1 agree ove all new materials for inspection. Applicant untie s nd will comply with all non point source egulattons. Signature of Applicant Date OFFICE All roof coverings to be Class `Baa or better INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE . CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: nancyc mw Sec: Twp: Rug: Sub: Blk: Lot:32651023.00 INVOICE DATE......: 05/01/2000 REFERENCE ID # ...: 00050001 SITE ADDRESS .....: 22251 BITTER OAK ST SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ......: OWNER ............: PAUL DIAS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0103 CONTRACTOR .......: LIC 4 -OWNER- COMPANY ..........: PAUL DIAS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0103 TELEPHONE ........: FEE DESCRIPTION CHK TOTAL FEE --------------- ------------ BPERMFEE P 77.00 BSEISMICRE P 0.50 77.50 VOICE ID DESCRIPTION ONDERFLOOR MECHANICAL ROUGH MECHANICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL • PAID -TO -DATE BALANCE DUE ------------ ----------- 0.00 77.00 0.00 0.50 --------0.00 -----_77 50 VOICE ID DESCRIPTION 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL 507 FINAL PLUMBING 514 FINAL PUBLIC WORKS CITY OF CUPERTINO Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc - COPY # 1 Sec: TwP: Rn9: Sub: Elk: Lot;32651023.00 DATE ISSUED.......: 05/01/2000 RECEIPT N.........; 12124 REFERENCE ID N ...: 00050001 SITE ADDRESS .....; 22251 BITTER OAK ST SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER PAUL DIAS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0103 RECEIVED FROM .... : ALAN CONTRACTOR .......: LIC # •OWNER• COMPANY ..........: PAUL DIAS ADDRESS ..........: CITY/$TATE/ZIP ...: CUPERTINO CA, 95014-0103 TELEPHONE ........: FEE ID UNIT QUANTITY __________ _____________ __________ AMOUNT PD -TO -DT THIS REC NEW SAL BPERMFEE VALUATION 545.00 __________ 77.00 -_-__-0.00 ---_- _77 00 ------0.00 BSEISMICRE VALUATION 545.00 0.50 0.00 0.50 0.00 TOTAL, PERMIT ____________ 77.50 ___________ 0 00 7750 0.00 D OF PAYMENT AMOUNT NUMBER CHECK 77.50 1144 TOTAL RECEIPT .......']gv50 VOICE ID DESCRIPTION ........ ............................ VOICE ID DESCRIPTION 203 VNDERFLOOR MECHANICAL ... 301 ............................ ROUGH PLUMING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMING SOB FINAL MECHANICAL $14 FINAL PUBLIC WORKS 0 • • • Ory. i( Applicable Fee ID 'Fee Description Fee Group ISPERNIFEE JBILOG PERMIT FEES !BUILDING IBCONSTAX lCONSTRUCTION TAX JBUILOIyG IBENERGY JENERGY IBUILDING BENERGYADD JENERGY ADD MULTI 1BUILDING �BOVERTIME JINSPECTION OVERTIME 1BUILDING BTEMPPERM ITEMPORARY BLDG PERMIT BUILDING BNIITIGAT HOUSING MITIGATION FEE IBUILDING JBPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING SPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING EPERMITFEE JELEC PERMIT ISSUANCE JELECTRICAL BELEC1000 ELEC 600V <=1000A ELECTRICAL BELEC1001 ELEC 600V >1000A ELECTRICAL BELEC200 ELECT -SVCS 600V a=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL SREMBUSWAY REMODELBUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON -RES APPLIANCE ELECTRICAL BREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL BREMRECEPT . 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 STEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS , TEMP DIST SVCS ELECTRICAL MPERMITFEE IMECH PERMIT ISSUANCE IMECHANICALI BAPPLOTHER OTHERAPPLIANCES IMECHANICALl BBOILERI BOILER � 100,000 BTU MECHANICAL 8BOILER2 BOILER >100KTO500K BTU MECHANICAL BBOILER3 BOILER >500KT.O IM BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BROILERS BOILER > 1.75M BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI -FAMILY RES IMECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL 2 oft Raised vias .*