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00050029 CITY OF CUPF.RTINO R1CTOIFORPERMTTNO. BUILDING DIVISION PERMIT @© O5-0d9 ( BUILDINGADDRESS: A - /Obo �llfH e �� 1-p1�M 2(P C SANITARY NO. APPLICATION SUBhTTALDATE OWNf:R'S NAASEr, I41 (ill-f✓fJ-(� �e �ZrV`-�^' V CI Bilks. [VYG C q— NIC CONTROLN HONC:� �� �� /It 111 ❑ ARCHITECIENGINEF-R - - `ruLDINCEERMIT INf;O Qu� LICENSED CONDIACIOR'S DECLARATION Re— Z " ., OZ=O 1 hereby affirm Net I can licensed under provisions of Chapter 9(cnmmeming Job Description - .. r�,y(_m wiN Smion7000)of0ivivion3afine Business ana Profmiom Cada.end my lied ire �yE infullforaandeRect. - -1 - - .License Ch _ Llc,g 9 9f i • Co ITnuamr ARCHECTS DECLARATION � /// // /D/� or v� I understand my plan&hell be used as public mcoda `^-� LCO f ` a o Wcrnscd Profenlonal OWNER-BUILDER DECLARATION Yo 1 hereby M.that 1 vin eacmpr from she Contractors Licanu Lew for IN, i F e following mamn(Saloon 7051.5.Emineas mad Prof..Cade:Any city a county O 6 C which require a permit m construct,alcor,impmve,aennachm,or repair anY avuctum a Sq.Ft.Floor Area Val ua�Ion pdmmslimuenaurmantMan uim deisiment for&mh pemNmEl .ia.(hmmem SaU dwrheivem,witpSame.mNepmvivision 3 of me, Bali la lianselsm(Chapter - (ommendngwiNs«tion7ol>D)ofDi.idrn3ofNeeu&invaandPmfeaaiomCoon)m Ap�i comb _ Occupancy e WI W is exempt Ncmfmm and Ne Buis la Ne ellegW exemption Any viopum of / 1 p y Typ Salim 7031.5 hY any applicant for a pcmuuubjects the epplicam to a civil pemlty of U SF 2 t more than five numbed dollen DWI. ❑I.wpwm<rarthepmperly,amyemployeawiNw.gwwNch.nlemmpcnwtian. 'Required Inspections - will do Ne work,end ale o Contractor's ont a rot inmndWe Law does and,appa.7Mn,B ser of y aro propPonerty w ora Cade:The over door.,mal w Law alms rot apply hi ro if owner gh properly who build+or improves t such i and who oras&such t work himself a through his own employers.provideor d Nis such mentis said within art nm intended o ofieaai for - owner-Wolder will hbuilt ie burimpmvemensu soldtornet ne ofmmpleafor she " Il} pose of owner-Wilder will have me Widen of provin8 that he did nm build a improve for put- - p9u of I.J.co - - ❑ h as nthe P of e, properly,an exclusively cmmmung Cwithod licensed conu lin.U.matron the projm(Sceapply o an ownBuser of end rte who builds Code:)The vet domor.and come Law does not apply to u owner of property who builds or improves Cormau and Lwho contracts ima" for such pmjom wiNecontneortsl licensed pursuanuo the Cantractore Licenm Lew.' 4 ❑lam exempt undergo. ,Bffi PCfor mice Owner - Dem !e► WORKER'S COMPENSATION DECLARATION r� 1 hereby effism under penalty of perjury,oro of me following cashoutiona ]IW ve eend will,uinWoaCenificate ofComrnno mlf-Nsum fa Workers Compen- .&tion,u provided for by Section 37(10 of on,Labor Code,for the petformuee of the wort fa which N is permit Ice owned. 13 have and will maintain Worker.Outmanned..Itnur .u required by Section 3700 of Nc Labor Cade,for dm perfonwmce fd.work for which Niapermit i&iuued. My Worker's nes 'anma_r e<a,; Psi cy Noy c"ta1_1ey3��6 f4 9 . CERTIRCATEOFEK FI'IONFROMWORKERS' , COMPENSATION INSURANCE(This stinks,need amt be comptevo if the permit is for one hnMroddol las 11100) or Isco.) - I candy Wt in the pertoweme of the work for which this permit is iumd.I shall am employ any person in any manner m as to We `vbyem roya% r is.Co.,.. - - miionLawvofCalihmiv m may/ L`— - Applicant Y I w s 0 y 4 7 _ - - • NOTICE TO APP ANT:If,otter peeking n this;Cisions of m Labor io d you shmM - ' become roomp y the Worker's compensation a,this provisions of Ne Lubin Coda,you mint fonhwiN comply with such provisions or this pcnnir shell W damW mvokW. CONSTRUCTION LENDING AGENCY IS 0 Q .I hereby affirm aw Nem 1.a mustrocom,lending agency for the performance of ythe..it for which this permit is issued(Ser.3097,Civ.C.) Bust lenders Name - SIM kl � - 1 certify Nst 1 hove rtW thu application and sane Nat Ne above infonmtim is �� d comsr.I egms ct comply with all city sex county ortliunas W mm lawn r up ng m - Z building conaweaooend faebspccfi immpmeennuvn of this minterupon tW V above-mWe)iti d propene for imparian krpoue res. F VT (We)arra m cove,indemnify and kap haranlas the City of Cupertino id City _ 0 C.) inco.,opmocof th,cmwend of parno,hmeYinmY way warm against said City } Gil inconmq NT UNae granting of duce permit. F � APPLICANT UNDF.HITAND DWILL COMPLY WITH ALLNON-POINT - V Z SO'HCIi HE 'IAflO ,lisIntumof Appeant/Conttot YDate ,�/ •—1 j �/• /'/ HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding occupiers arae or handle hazardous thermal Re-t0 s - efined by the Cupertino Municipal code,Chapter 9.12,coo the HeaIN and Sooty 1 UCode.Section 25532(.)7 Type of Roof t _El Y. - - Will the applicant or future Wilding mcupmt use equipment or devices which All roofs shall be inspeeted'prior to any'roofing material being . emit fmn ouv air communants as defines!by the Bay Arca AG Quality Management installed..If a roof is Installed without first obtaining an inspection Oltvino []Yes rrf<s- I agree to remove all new materials for inspection. Applicant I have read tW hnudmvmaterial.regorenentn ander Chapter 693 of the Calm' u erstands an ill comply with all non point source regulations. most Health ffi Safety Cade.Satiom 73505,25533 and 25534.1 uaoersmnd that if me I Wilding dam currently hove a teem.that it is my responsibility to Warily the occupant i 7 am Iro alms r a mmuw 'bmurtb vey'otu isswrce ofaCmihcate sf Qxupemy. Is VVV�✓✓� Dann& lnes ure of Applicant Date 6 Dam All roof coverings to be Class"B"or better OFFICE - _ INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE .j J CITY OF CUPERTINO '4 BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot:31602085:00 INVOICE DATE......: 05/04/2000 REFERENCE ID # ... : 00050029 SITE ADDRESS .....: 10601 N BLAN EY AV SUBDIVISION ....... CITY . ............: CUPERTINO - IMPACT AREA ....... OWNER ............: PENINSULA BIBLE CHURCH INC ADDRESS ..........: CITY/STATE/ZIP .. .: CUPERTINO CA, CA 95014 CONTRACTOR .......: SAGOR, JAMES LIC # 20510 COMPANY ..........: WESTERN REGION ROOFING `T- ADDRESS . 231 N 12TH ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)360-9111 � r FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 177.00 0.00 177.00 BSEISMICRE P 1.20 0.00 1.20 BUSLIC P 90.00 0.00 90.00 --------- ------------ ----------- 268.20 0.00 268.20 o ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ .___.... ............................ 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS