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00030059
CITY OF CUPERTINO - PERMITNO. .. BUILDING DIVISION PERMIT C0NTRAIQT0R INFgRMATIPN:_ B19N76%bg:bi V rl✓.e SANITARY NO. APPLICAMN SUBMITTAL DATE OW ER'SNAME _t P1: a NIC CONTROL# 40 ARCHITECUENGINEER ❑ BULDLNOPERMUINFQ X00 Chcir ies Ysuf y< f– '^ LICENSED CONTRACTOR'S DP.CIARATION ` z0 Z=?q 1 hmebY affirm that 1 sm licensed under Provisions of Chapter 9(commeneing Job Description F=�ry wit Scetion7")ofDivision3ofU Busimssaw0ofeam.nsCwe.0 mylimnseis /� __t[ intblafmtardeffect, cooVlCre•V7i" 266 e4 O i OO Limnae Caw Lic.# w 3µy Dete Contractor O< ARCHITECTS DECLARATION - ^ /� ^^ ),./' j, I undemmed my plans shall Seared u public rccmde r Q Sf� ah cL ex S�//0. a a e Licensed Professional u'vi:re OWNER-BUB.DER DECLARATION Z Q 1 hereby affirm Nat I wan exempt from the Combustors License Lew for the F G following reason.(Sation 7031.5,Buuneas and Profuriune Cede:My ciry ar Gooney 3 which mquimt a permit to cusbecl,our,improve,damnation,or repair any ammetme S Ft. Floor Area '' priortoinlsmanee,alm inquires the applicant for such pemut m rile a signed allotment f]• - VaIDau00 malheisliunrompursuart t.the larosionsofthe Conmacmre License Los(Chapter 9 (commencing with Sation 7000)of Division 3 of Ne Business and Professions Code)or Nat he is tempt therefrom and the basis for me alleged exemption.Any violation of � PN N tuber Occupancy Type Section 7031.5 by any applicant fan permit subjects the applicant toe civil not,of - mom than five hundred dollars(S5o0). 1,as owner of the property,se my employees with wages an their sole completed, Required Inspections will dome work,and the stmdure is nm intended orolf red forms.(Sm TOIL Business and Prefmsiom Code:The Cl nuactora Lima.law does trot apply to son amen of property who builds or improves thereon,and who does such work himself or through his own employees,Provided met such improvements an,no intended m offered for We.If,however,the building an improvement is sold wiNinone year.(completion,du owner-Wilder,will have the burden of proving that he did not build m improve for put- pnse.fai I,m owner of the property,sin exclusively contracting with licensed contractors to construct me project(Sm.7066,Business and Professions Code:)The Contractor's U. nee law does nm apply m in.wilt of progeny who builds m improves thereto:and whoc.ntracu for such Project withatntractogs)licensed Forms,w me Contractors License Law. ❑lam cae under Sec. _,B&PCfo Nis/M�/� Owner —/�0///EN!' Datc W (\� - WORKER'S COMPENSATION DECLARATION i hereby affirm underpenuly of Perjury one of the following dalanoom: (have and will maintain'Certificuenf Consent In aelNusure f e Workers Cou pen- setion,m provided fan by Secdon 3700 of me Labor Coda,for the performance of the work for which this Permit is issued ❑1 have and will maintain Workers Compeneati0a Inrurence,as required by Section 3700 ofine labor Cos .for the performance of Ne work for which this permit is iswed. " MY Workers Compensation Insurance carrier and Policy number are: - - Came' Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE (This secure need not be completed if Ne Front is for one hundred dollars($100) or less.) 1 certify that in the performance ofthe work for which this permit is issued,)shall not employ any person in any manner so ae to become subject tome Workers'Comtm- onion Loo".fCalifomia.No Applicant . NOTICE TO APPLICANT,If,after making this Certificate of Exemption,you should become subject to the Workers Compesuatio,provisions of Ne Lbur Code,you nun foMwith comply wit such provisions m this manit shut be deemed revised, CONSTRUCTION LENDING AGENCY •� Q I hereby affirm to mere is a unewctall lending agency for the perfomunce of hthe work for which this permit Is issued(SCC.3097,CIV.C,) Lewers Name [� finders Address , W Q I unify Out I have read this application and cute that me above information is z morcel.I agree to amply wine til city and county ordimn er and eine laws relating ro - C.) Qbuilding construction,and hereby authorize mprommin Ives ofthis city to enter upon the, above-mentioned pmpeny for inspection purposes. Ik (We)agree in save,indemnify and knee harmless the City of Cupertino against f..) Iiebilhies,judgments,costs and expenses which may in any wayammeagumt said City >i W in consequent of the grown,of this p.it. F d APPLICANT UNDERSTANDS AND WILL.COMPLY WITH ALI.NON.POINT V z SSOLW<�C�E/RIRt�GU//LATIONS. Smgn fA Icaaucant_*__ HAZARDOUS MATERIALS DISCLOSURE U� Will the applicant or future Wilding occupant store or handle haradous material R 'r Is as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Suety Cos .Sectionn532(a)^ Type of Roof C]Yet Will me applicants future Wilding occupant use equipment or devices which All roofs shall be inspected prior to any roofing material being ewtmh tscomous air comuminanu as defiled by the Bay Arca Ah Quality Management installed. If a roof is Installed without first obtaining an inspection ❑Yin I agree to remove all new materials for inspection. Applicant I have read me htiandm,materials requirement,under Chapter 695.ftle Call- understands and will comply with all non point source regulations. forms Health A,Suety Coda,Sections 25505,25533 sal 25536.I undmstaw that if the building does not currently have a temnt,that it is my responsibility in notify this occupant oldie mama wNch must 'ormissue a CenilicavyfrartoelI _ .nmmauthomedagem 'Z7/��,D.--�v�f/] Signature of Applicant Date All roof coverings to be Class"B"or better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO 1 BUILDING PERMIT INVOICE OPERATOR: nancyc Sec: Twp: Rng: Sub: Elk: Lot:36909050.00 INVOICE DATE......: 03/08/2000 REFERENCE ID k ...: 00030059 SITE ADDRESS .....: 19761 BIXBY DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER BORIS ABRAMZON ADDRESS .......... : CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3324 CONTRACTOR .......: LIC $ "OWNER" COMPANY BORIS ABRAMZON ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3324 TELEPHONE ........: FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE ___ _________ ___________ BPERMFEE P 77.00 0.00 77.00 BPLANCHK A 65.45 0.00 65.45 BREMRECEPT P 1.11 0.00 1.11 BSEISMICRE P 0.50 O.DO 0.50 EP�RMITFEE P 35.52 0.00 35.52 179.58 0.00 179.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ........ ............................ 101 FOUNDATION 102 PIERS 103 UPER 104 REHAB 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB E OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS tvi ?T WKvgll.{, '�'coll� SI,dP, W/ �ilrri►�� s� w�«„,� ►tea Cv�c mY �•M4'''''p'w �Pbc.) (^IIFG!'H69h zYr- - I I � � `moi- �• . 'N lu 24 11N><IG!t Cd1lG. �po'n11r� . w��¢ 6AR oN 8e'K�wf a�'�oP APPROVED IN ACCORL JJ4 HPO CUPERTIN eG� A OATS -45, S tifA } 260016. FK,f;�%4 k�Zp �5/iVpN This set of p.:-s be kept on tr; lawful to mat.. , w 'anSes or alterations on same igh), w :d n permission from The stamps �•-p- ''iY �I Cupertino. The stamping ci :Ls pyo!l and speeificeU0n5 ;HALL NO be lie d to permit or to be art 'pproval of the violation of any proyiaiona �510)79� —21Gi5 0 d,nv+ d or State tayl(. 7-1 ums ;P!d All JO 16.d T aq ';Ill JP VUfdu als I qjj -4, 1, uaal ols'j1w d �U!p ZZ i LIS UO lo ! "' I � Auj 'J�ja L,. --- ...L.. ��..__ - Irl, _. II- _ %- _ i. �. L��, U" puo UJI 01i IrN 2"1 04-0 10 49 Stu Mai's vo Sar 00 1.0 A- ) I,, N ... ...... 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