00050133 -crDGDICSONO
BUILDING � PERMIT CONTRACTOR INFORMATION: 00o
ND.
so / 3z> .
BUILDING ADDRESS:
SANITARY NO. APP ATION SUBMDTAL DATE
(/ j�oGr9�z� �S /Nc. . D 0
OWNE . NAME:
NIC CONTROL
2—
RCHITECf GINEER / BOLDING PERMIT INFO
moos D%'G�GJ 1�i�!
LICENSED CONTRACTOR'S DECLARATION
p i_ I herem w liw
by eRmslut 1 nsed urda provision of of Chapter 9(mmmc«ing Job Descriptio
F_Cu9 was Sfurnia00o)ofDivision3afthe Busiwsatrd Pmfessiom Catle,Wmylimmeis
e t5,Jy in full force I' �n ' - g� - ,
4 Lixu U..nn C c.M ",�1(/(�/ "'•'L„/
.2 LL F. Dante - f.'minel'br '
C okbz
LL o g ARCIfrrfi Dec
l u Ins ehanll be used
p
?•g Licrns fan i
u7 y Meton 00
I am exempt fr mDECLARATION
1 hereby.(Sere that I w exempt hsan the Cosmos rs s:Any c Lew fm pa
D following reason. (anti h'l031.3.Buainess and m.da ions Cade:Any city m county
which requirta n peal,ex cues the slur.imptorc,demolish.fi repair nY svucbue
Sq. Ft. Floor Area /' Valuation
primeito s licneneeslwm in Me thecars,fortieth me Conremetmicese Law(Chapter
summem _ 1 0 ^
Nat he is licensed punuamro Ne Provisions of Ne Conuamara License 4I.C ed.)or ( V
(cam eI,exempt
Semlmen And the basis
Jarpaeed exe naon.A violation of
APN Number Occu ant e
'
that he le 31.5 b aertfrom And the bier for the subjects
the gumption.Any it p edon of p y TYp
Section)OJ LS vaany nand idol rte a pemduubjau sm applicnuo s civil penalty of
tw more sen Bve hurdred dollars(53110).
❑Lu ow ns Dine pzapencto my"Intends withwe8erntle(Sec.mmpcnssnae, eCllon$
will do Me work and CoauwwRiand,License Law ffiensid
We(S«.1044,Buaiiuu -
and property
on Code:The Conbherem License law does IKK aplNy to n mwner or
p,..paha builds m impt di Th thereon,pr who noes wch work dad or of Wd fee
Ins own employee.Wilding tha such Improvements w nm iymof m offered for �13
ssle.R,hmveunpa Wildinbmimprov<mmtla wld withinmm Ylderimhysin iomrhe CCC
owe tof or Wm will have the burden of proving sat he d'W nal build m improve for pm-
poaa of 6010.).
1,an owesof ct property,Eeuess.and
constructing with:)The C mmune. ro
costarum d project(See.IDU,owner
of
rope Professions Codei The Conhereore Li- -
cane law don WE apply e ts owner of propmy who builds re improve Norton,ens
who .Law,for such prolan wiaerontr«ror(a)licensed pusuwtb the Contractors
Lt..Law.
❑[.exempt.sellerSa. .B A P C for Nis leavon T
Date
Owner
WORKER'S COMPENSATION DECLARATION
I hart will n m uMa pent care of jury Dee of dm insure hollievfor closlaWorker.Co
1 hove wa will maintaineCmifiem of the Labor
sada.for fm Workers Groff en-
Me '
tion,a provides for by Sectionsnewel
3'!00 of the LeborvCode,forme petfomanm of the
Fmk for which illxpeniallx ixore. �\
III
Fl 1 neva rape will oder Wahers Cores ofthe n Insuruta,u requited by S«bon
3300 Drat bar Code,i the pasta ofth0work far which
MYW a lis a anriaws Polley
Cameo Policy No.:
CERTIFICATEOFEICEMPTION
FROM WO
COMPENSATION
OMPE
COMPENSATIONINSURANCEp(f�j L
(ThissannnneWnor McompletW if tepemet is far ddlua(gl
m Iw.1
• Icertify parson themin Performany..uneem the a,so ec for wubjecch this tams ischo'Ci IshW
not employ any Panora in nY manner w n ro become subjat to dm Wooten'Compcn-
sstilicant of Cali/Nola.Dery
Applicant
NOnCE TO APPLICANT;If,Co making air provisions
o of Lifter
od You should
become subject to 0th Workers Compensation povision of the labra Code.. ..at -
foMwith comply rola such provisions m this permit a1Wl be deemrd revoked. '
CONSTRUCTION LENDING AGENCY
O Q I hereby affirm an tete isa conviction lending gency for the psrfumwce a '
rrrZ`1�� Vi
the work for which this permit is owned(Sa.J G'Cis.C.)
larders Name
;i- Lannert Address
k7 . I unify au i have read Nis applicniohantl awe sal the above infmmation is
CI z conl.I agree incomply with dl city county ordinances aand state laws miming to
Q Z abuilding conauuctim,and hereby ausaria represenwives of this city to enter upon de -
V Oabove-memimud property for inspection purposes.
fa•Fa (We)agree in eve,indemnify am keep harmless,the City of Cupe nim against -
O V lossaitie.judbmenu.cnuardnpe...which may In any way acemmiopeint said City .
Y W in conrequmce of the Bmnting of the,permit.
!� As APPLICANT UNDERSTANDS AND WILL COMPLY WITH All.NON-MINT '
F+ SOURCE REGULATIONS. \/ /s'•�
V r Signmrt of ApplicanVComectm Date
HAZARDOUS MATERIALS DISCLOSURE
Will Me applicant or future building occupier store or handle hazardous mmwiel Re-roofs
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the HOala and Safety Type Of Roof
Crde,Section V5532(A)7yp - "
' ❑Yes 0 N ., .
Will Me applicant or future building oecupam use equipment or devices which All roofs shall be inspected prior to an roofing material being
emit hazardous air contaminwu as defined by the Bay Area Air Quality Management installed. If a roof is installed without first obtaining an inspection,
strict' I agree to remove all new materials for inspection. Applicant
all O . ON.
I have read the hazardon muedds requirencnu urder Chapter 695 of th0 Cali- un erstands and will comply with all non point source regulations.
forma Health d Safety Cade,Satiate 25505,35533 and 25534.1 understand[has if the -
building does not chmentiy have a mount,that it is my responsibility to ramify the occupant '
of the mi,immenu wWh mum W ren prior m issuance ofe Cmificue M Occupancy. -
Signature of Applicant Date
Ownaor authorized agent - Dau
- All roof coverings to be Class`B"or better
OFFICE
CITY OF CUPERTINO
1� 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:37519018.00
DATE ISSUED. ......: 05/18/2000
RECEIPT #......... : 12282
REFERENCE ID # ...: 00050133
SITE ADDRESS .....: 10190 CALVERT
SUBDIVISION ..... . .
CITY C3PERTINO
IMPACT AREA .......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
RECEIVED FROM .... : TIM
CONTRACTOR ED HERNSTEDT LIC # 21640
COMPANY SPECTRUM LEAK LOCATORS INC
ADDRESS . .........: 17835 ELAINE CT
CITY/STATE/ZIP ... : MORGAN HILL, CA 95037
TELEPHONE ........: (800)532-5562
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- _ _____ _ _
BPSEWER SEWER SYSTEM 1.00 19.96 0.00 19.98 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
PERMIT
55.50 0.00 55.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 55.50 4535
TOTAL RECEIPT a= 55.50 -
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING