00020117 _ c. - . - PERMITNO. .. s
CITY OF CUPESICIN '� , n,T yI�♦.r�y. O *�a�sy ,,g T ON
BUILDING DIVISION `, PERM T + �M11T1\t1.l.TW�d{`i l`�I 13'II.�LIVl,I:` .,O QO 2L,. OI /
BUILDING ADDRESS " 5 -
`S Iv q SANITARYNO APPLICATION SOBM AI:DATE
D�qMe�1�=1 �- I NIC CONTR 1 N ,
ARCIIITF.Ci/F:NGINEER�R:
UL 1 c PRMIT INPO
ttz0 e
-Z a
3' LICENSED CONTRACTOR
O S DECLARATION'
_OO I hereby ti irm be I tin licensed under provisions of Chopper 9 4 , ;Job Description It.
wW withg r1000)ofD niofrne Bnnneesand Rofeesio Cade uM mY lift , Pb ° - - "P "-"' ' '1 .! ! x
QYSa� •in Poll ofrm and rR«i x • T -
oro U Line ClassLic.t
are _ �^ �
m 3 u D - Convacmr �
' V �/V v 1
u O Q' ARCHITECTS DECLARATION - - J J
y
liatfaroundi my plans shell be used as Public records `'J
i o O
Licanerad Professional
u ^ ' OWNEIUBUTLDER DECLARKION
s' YI h r<by affirm Chet I i m exempt from the Coac
ntrt Y L', u Law for the -
e.
rE m `foilowi g (S teas 1031 5.Bmsrrcss and PMnasans Cade Any city car..my
o,3F wh ch qm a perms w consuu0.alter improve,demolish pair any awcmre , $ Ft/Floor Area Valuation
r ypn tot mance,else requires the applicant for such pemn m file a signed stammant " q' ^ '
that he licensed purmantio dmprovinans of the Convacmrs License Low(Chapter 9
;(e gwirnswdon1000)ofot.ision3ofsbcBosinessudP fesssan.Catle)m .. A'P Number Occu an T e i
Sac he is ropy on,it h and Are burs(or Ue alleged exempt on.Any it Emery
of - - '�-ss s I �y yt i
S 'Section 103L5 by any applicant for a peanut eubjme the applicmd s...rud panalsy of `~s/N Cc '
t mom than five hundred dollars($506)
p Laanwirtrnrrnrpropei,y,armrempl<teen:imwag<aaarn<iraar«mcenaabon, •1 05
Required Inspectionswill d.the wank,andtheahumure is not intendedoroRered for see(Sm.1044,Business
and Professiam Code The Convectors Limme Law does not apply to an owner of. .!v` J' „. ••k ,
pmprrty who builds.,Improves thereon and who does such work himself ar Usough I _s
his own employee.,province than mro«
ch impmanRs enot mmndai or offered for'
side If,however.the building orimprovement is sold n within one year ofcompleu the
;.wl6i,Wilder odl have Uc burde of pro e that h did rim build or tmpm«f r P
fel 1 r .. . . ..
I as woer of the property am exclusively convscung with boosted contractors to }'
ct Ue project ac TOLL Business and Profenmon Code)The Conga roe s Li- F t
cense law Ams not ply m an owner of property who builds or improves thereon,and s '..'s• -
whoconveci Projects with a«nirutods)licensed Furswnt m the Contracmr's 4 - -
Licenu r F I!N A L E D
lam emP B&P o N rt ••
b Owner Date - e .❑ . '. 'I q •I ^
WORKER CO PENSATION DECLARATTON AUG O �a• 2001
I hereby affirm order penalty of Pa jury one of the following drelaravm s
..❑l have and will maintain a Canificare ofCorwanua self-inture for Worker.Comper.
sat n e provide)fn.by Sau n 3100 of Ue Labor Cade,for the pert rrheiuce of to
work Bch this perm[ sed, i ` , BUILDING
I have
arA will maintain Workers Compensation Insurance, -required by g tion
'31Wofthe Leben Code forrneprifannan«mthe workfm.h hth.Prrmlt is' eA. -
MyWorkersCompensationlou.Naim coma end Policy number eR
Kamer Policy.No.: '
6 - CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
• (Thi erten moment becompleci ifthe peanut is Poron hared dollars($1 00) i
or less)
`-'a I<conly than in the performance oftbe work for which this pemai is ismrd,leliill
not employ any person many manner,so as m become mbj«t to the Woeb rs'Cooper- - e
cat an Laws of Caltfomia.Dem'
-,d NOTICETO APP LIC ANT esagermesa BUra provisions
ofEsineption.dYoushould'
forth i subject y it Workds Compensation provi steal of the labor Code,you must
forthwith comply with such provisions or this pcsmn shell be deemed revokdi.. - � ,•
O.p` , d CONSTRUCTION LENDING AGENCY
,I hetebYufBrm tbmrn ' aonstmctiInd'_Bege rye th port moot f
'� r U ark for which rni peanut rs issued ISec 3091,Civ.CJ It •i' - - -
ey Le dens Name -
�( �C^ Is-d rsAddrt
W Q 1 carr f that 1 h e read tun and slue Uat Ue oho fwmeron is s
aw
W ca ctI B m mply tU e t d u ty ordinance and mu 1_ 'mlatlng to
O z: bwld goon wcu n and he b�yt1(f��` z tatives ofth city to ter upo ther
U,O 'ubove.memioned Property far inlpecli p lea :
firs F, -i, (We)agree m save,indemnify and k"ttp hi orris the Canty of Cupertino Against
O,V IiaELti .judgmeets ."oil expanses tech may to my way ac - limns,said City',
.,a.fra in queaceofdugrantingofthuspermt
'^ Qa APPLICANTUNOERSTANDS AND WILL COMPLY WITH ALL NON-POINT -
V SOURCEREGULATIONS.
� e •:/�i�T�wG�'�t/
+ "S8 t mofA hrant/Courictor i Dam
HAZARDOUSMATERIALS DISCLOSURE •` ro
Will the applicant or future building rampant store or handle hazardous material Re-roofs' t-.
n dcfirsce by the Cupertino Municipal Cod Ch pier 9.12,and be Return and safety •, -
coer srrr az5532401 t '. Type of Roof. .' -
0Y !, t
'
Will the applicant fu ddmgoccupant useeq ip t rdwmeawhich
'. All roofs shall be'inspected'prior to'anyy.roofing material being"
emit hocardous air conomsosnra as defined by the Bey Area Air Quality Management installed. If'a roof is tpstalled without first obtaining an inspection
District? I a ree,to remove all'new materials for inspection. Applicant''
❑Y o . '. gg
(have. a�terialarrgmrtmanuuMerChapmr6'43ofUeGel; �'under4ands`and'will comply with all'non point source regulations.'
forme Heal S e ode,Sccuons 25505,255JJ uM 255)4.1 undaatind that if tM -
,k ban)din snot it botait,n this mY responsubil notif U occuppgL ,is
to Ua re4 im be t u face sof Qan s
'Signature of Applicant Date
oor pr ori agent .Dam ! •:, 1 ..
r .. All roof coverings to be Class B"or better "
0OF16E
INVOICE INV02CE INVOICE INVOICE INVOICE . INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Elk: Lot:36903008.00
INVOICE DATE......: 02/23/2000
REFERENCE ID # ... : 00020117
SITE ADDRESS ..... : 10159 S BLANEY/GAR # U
SUBDIVISION ...... .
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ............: LAKE BILTMORE APARTMENTS
ADDRESS ..........:
CITY/STATE/ZIP ...: SAN MATEO CA, 94403
CONTRACTOR ....... : LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ... ,
TELEPHONE . . . . ....:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
__ --- --------- ------------ -----------
BPERMFEE P 287.00 0.00 287.00
BSEISMICRE P 2.30 0.00 2.30
BSF&2FAM P 63.42 0.00 63.42
'EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
388.24 0.00 388.24
E� ID DESCRIPTIONVOICE ID DESCRIPTION_.._ .. - O666vID_v'--v ...
.. ... ............... ........
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUE & 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 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS -