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00030063 CITY OF CUPERTINOPERAUTNO. BUILDING DIVISION PERMIT CONTRACTORINFORMATION: 0065 DUO BUILDING ADDRESS: F&hkt4 � eorgjar, jail QcSyy��,gJ (/'/�/VMr^�u �j�/��.��s�y�� 'SANITARY NO. APPLICATION SUBMITTAL DATE OWL��!^.g=r S�r�v�".p/,iaor '.d /2 0��0 7��3.��yyC'N _./�'_ ��jSQ. / N/C CONTROLp PHONC:�2_`IGIO � UAICGl.a.Am - CA �V "�/ ❑ ❑n:t zCHITEC"D/ENGINEER {{.� BULDING PERMIT INFO �v00 *Ir ZAs U ntU 6zY� Zo y LICENSED CONTRACTOR'S DECLARATION O Z_e 1 hereby alfom Nu I Am li"esed under pro.idons of CTuptcr 9 fcomrar-Ing Job Description s,,ntw with5-don]O0p)af Di`]'( Sof NeBudn-aWRofe�`Code.vd mY tianmis reply/g/l. nI A'�,C�ue ",{_ L` .g.gg/, �o � I. 4 o W Wfulttn�QeaM CRecL IC n - LieN /I��C�,Q1. C '��{(�•CJ\R•L .'F/�vI11TGi. g�7 OE De:.4-YYARCifI'IECTCSDEC M�/.l •+I ^e C�JT�"� 11ILW a!�N 1 understand my plana shall be used rs public rccadx i S o Licensed Rofeuiow OWNER-BUBAER DECLARATION , t Z r I brmby afBnn that I Am exempt from Ne C.nmactoes Licenae law for the M;p following reason.(Studio 7031.3,Business W Profecdom Cade:Any city a county ° which roquirm At p=mntt m construct,Allen,improve,demolish,or repair any non. Sq. Ft. Floor Area Valuation prim to its issuance,elan mq.ims the applicant for such Permit m file asigned statement Nat he a li-nand su purant to the Provisiom of the Contranrds Li-nse law(Chapen �/ysygo 9 �jeJa+ 1 Icommrncing with$-don]000)of Division]ordseBu-ineu Avd Profny vi C unit. AFN Number Dw Occupancy Type Nat he is exempt therofrom and Ne bssia for the Alleged exemption.Any violed.n oI �/�� O f� Section 7031.5 by any Applicant for•pemduubjeco Ne applicara m a civil pewry of ' pm nwro Nen five hundred dollen($300). I,Aa ow-r.fdepr.peny,mmy employ-s with wage ec their wl=compemulov, Required Inspections, will do the work andtbesuucm¢it trot lnmnded.roBend for We(See 7014,Be.. and Prefeuiom Code:The Conuactor's Liame law does nm APPLY in An ownen of property who Nilds or imp.vu Merton,and who does such..it himself nr through his own employ--,provided that inch improvemenu Are not intended or offered for ole.If,however.the Wilding of improvement is sold within.-yearof o.mpledon.the .Wild will havo the buNen of paving that he did was Wild or improve for pu- pm,.f cele.). Las ow-r of the property am exclusively conn-tang with licensed canoacmn An - comment Abe projecr(S-.7014,Buai.And Prof.W.Cade:)The Canmamors Li- cense Low dens nm apply ro An owner of popmy wW builds or improv-rhos on,And who contracts for such projects with a coninom s)licensed punuanuo the Contractor' License law. ❑T em rxempr undef 5-. .B I P C fcr Ibis mAAsm Owner Date WORKER'S COMPENSATION DECLARATION - at 1 hereby affirm under penally of perjury We of Ne following d Wr diom: I leve and will maintain.Certificate of C...11.self-im..for WmberaCompere- 'on.m Provided for by Section 3700 of Ne labor Cade,f-the ped. -e of the it far which this permit is issued, 1 have and will maintain Worme.Compensation Itax.A,As-qui ed by Smlon - 37W.f rhe LAbor Cade.for Neperfmmame of do wort fmwhich this permit is issued. My We&ch Comprmation too. a camcr and Policy r umbcr w: Cartier, Policy No.: CERTIFICATE OF EKE.MMON FROM WORKERS' COMPENSATION INSURANCE (This r-don neM rot be complexed if Ne prrmin is foo-hundred duH.($100) , or leu.) I restify dru in the perforrm-e ofthe wort fa which Nis permit is issued,l shag nm employ Any en n in enJv ma subj-t w Nr WORcri Counties. An fI11TO Appli CE - ' NOISE ct .IC f, ref mating Nir provisions o of Eacmpdo you Alwin. becomesubjectixcomp the re poo Compeor thi, pmvisiona.f tarelabor Code,. mon FaMwiN comply with sec provisions m Nis permit shall W d-mW rooted. CONMUCDON LEE DING AGENCY Q Q I beroby dfion Nm Nem is A emetrocdon larding agency for Ne perfomunce of Z she went for which Ihiv permit is issued(S-.MO.Co.Q Larders Num a > lander-AddrosA []] w^ 1 certify Nu i have road N{-application And some that the above intermissions is , d Q torr-a,l Agree to comply With ell city uta county ordinances and Awe laws mladng to 7 z. building construction,end hmeby amhorize representatives of this city to enter upon the U -above-mentioned property For impadan purpaua. 4s. Ew (We)agree m aave,indemnify and tarp Found m Ne City of copestino agaimt U liabiliriea,judgmcnts.-sen and npe=a which may in any wry Access,against mid City �a [� in con. uuroe 0f Ne granting of th' permit. h OF APPL A UNDERSI'AN S ]WILL COMPLY WITH All.NON-POINT U z SOU 'I 1 GUTAT �' . O �a r Si (App d monemm Dvm , �/pDd C[ RDOUS MATERIALS DISCLOSURE """""'g��J77 Will the applicant or future Wilding occupant store or handle harudous material Re-roofs m defaned by the Cuputino Muntclpl Code.Cbepw 9,12,end the 1k and sefny - Code,S-Oon255R(U7 Type of Roof ❑Yes 6s. Will the Applicant or future Wilding occupant use cquipmem or devices which All roofs shall be inspected prior to any roofing material being emit hmudous air c.nwninam As defined by the Bay Arca Air Quality Management installed. If a roof is installed,without first obtaining an inspection Dixtrkt7 OY- � I agree to remove all new materials for inspection. Applicant ' wwe e.dN=h.ud.ama WamairomommdrGh.p 693nrthe understands and will comply with all non point source regulations. fonds -IN sof .Satin 23503,M533 And 23334.I uMmund then if the Ni nL Nmit ismyrcaponsoinn 'fy Ne oapan ut r of mm�u whi pda w immrm of y�c �ppay U vt� Signature of Applicant Date uN z regent 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: karenb Sec: Twp: Rng: Sub: Blk: Lot:31623041.00 INVOICE DATE...... : 03/08/2000 REFERENCE ID N ... : 00030063 SITE ADDRESS .....: 10159 N BLANEY AV SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER MASON STUBDLEFIELD ADDRESS CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2329 CONTRACTOR .......: MILLER, JEFF LIC k 21019 COMPANY .......... : HIGHLAND CONSTRUCTION AND PLUM ADDRESS ..........: 20073 NORTHCREST SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: 4082411858 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPREPIPE P 8.33 0.00 8.33 BREMAIRHAN P 8.33 0.00 8.33 BREMFIXT P 1.11 0.00 1.11 EPERMITFEE P 35.52 0.00 35.52 MPERMITFEE - P 35.52 0.00 35.52 PPERMITFEE P 35.52 0.00 35.52 • 124.33 0.00 124.33 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING - Ory. if Applicable Fee ID Fee Description Fee Group �BPERMFEE JBLOG PERMIT FEES !BUILDING JBCONSTAX 1CONSTRUCTION TAX ISUILOING • ISENERGY JENERGY BUILDING SENERGYADD JENERGY AOL) MULTI ISUILDING 1BOVERTIME JINSPECTION OVERTIME BUILDING 8TEMPPERM ITEMPORARY BLDG PERMIT BUILDING SMITIGAT HOUSING MITIGATION FEE BUILDING 13PLANCHK PLAN CHECK FEE BUILDING SPLANCKAOD PLAN CHECK ADO MULTI BUILDING SPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSC8LVD SCS SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE IBUILDING EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V<=1000A ELECTRICAL BF-LF-C1001 ELEC 600V>1000A ELECTRICAL BE' EC200 ELECT SVCS 600V <=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMOOELBUSWAYS ' ELECTRICAL BREMF= LIGHTING FIXTURES. ELECTRICAL • N BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPO POLEIPLATFORM FIXTURE ELEC lCAL BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAO RMOL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS. MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE&2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS ELECTRICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL 5BOILER1 BOILER<= 100,000 BTU MECHANICAL -'PB .1 BOILER>100KTO500KBTU MECHANICAL 13130&EM BOILER>500K TO 1M BTU MECHANICAL BBOILER4 BOI 1.75M BTU MECHANICAL 13BOILERS BOILER:,, 1.75M BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL • BMNEWS &2F NEW SF&2 RES BLOGS MECHANICAL k o[2 Round VI(Y" BREiNIACOVER IAC UNIT>i000CCF`.1 INIECnANICALI IBREMAIRHAN IANC UNITS <= 10.000CFM IMECHANICAL I JBREMFURN RELOCATION OF FURNACE MECHANICAL I JBREMFURNOV IRELO FURNACE > 10K STU INIECHANICAL ljBREMINHOOD JINSTALLATION OF HOOD IMECHANICAL BREtuIRELOCA RELOCATION OF HOOD IMECHANICAL BREMREPALT IREPAIRALTERREATINGMECHANICAL BREMVENSYS IVENTILATION SYSTEMS IMECHANICAL PPERMITFEE PLUMBNG PER ISSUE IPLUMBING I BNUMULTI INEW MUUFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL . PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING SPINTERCEP iIND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING SPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING ' BPSTORM STORM/RAIN WATER PLUMBING gpTRgp KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN CV-ENT PLUMBING BPWATER INSTALL/ALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE DEVELOPMENT AGREEMENT PLJWNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR IFULLAPPLBASE+HR PLANNING ZFULLTM FULLAPPLTENTMAP PLANNING ZFULLUP FULLAPPL USE PERMI PLANNING ZFULLZONE FULLAPPLZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZuMTM UMITED TENT MAP PLANNING ZUMUP UMITED APPL USE PERM[ PLANNING ZMATEMPUp MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINORAPP MAP PLANNING ZMINUP MINOR APPL US PERMIT PLANNING ZMISCASA MISC ARCH S PLANNING ZMISC MISC Tm AN UP SXr PLANNIN ZMISCFENC MISC FENCE EXCEPTION PLANNING ZMISCG MISCELLAPPLGENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING PSIGN PORAR SIGN PLANNING ZVARIANC DIRECTOR VARIANC PLANNING 2 cf2 O Mbed 1110/"