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00040146 ' CITY OF CUPERTINO +• ' • PERMIT NO. ' BUILDING DIVISION . PERMIT CONTRACTOR INFORMATION: �DO f BUILDING ADDRESS: • - - - - at s o�Wex'f' - f 4SANITARYNO. APPLICA 10 TTA UBMILDATE �.�,ec�'rVt, OWNER'S NAME: r . i NIC CONTROL# Z 53 O ARCHHhLUEN6(NEER, t. BtlLDINGP R ITINF OCZ I+�O U U n 6 0�y LICENSED CONTRACTOR'S DECLARATION - O =p I hereby affirm that 1 am IicctuN uwer provisions of Chapter 9(commencing ' Job Description - rmC5m with Section 7000)nfDHisiw3.fthe BmineeamdProfmsioiu Code,and MY lice:it - <YNJ in full fora and effect. o ' .• ^ �a3 Lgak� c ,^ g� m u Lianas Clan - Lin.M j.r„JO gQ M d .S t,�-v ee V H< Data water H uj O JARCHITECTS DECLARATION j, I understand my plm9 shall be ureal is public rccmds WOO n•g LcmaW Rofeesmnal ' m - OWNER-BUILDER DECLARATION 1 hereby Affirm Chet I am exempt from Ne ContrecroYs License Law for the O following moon.(Sectors 7031.3,Business ams Pcolesm v Cade:Any city or..my e i9 which requires a famish ish m coluWct,alter,improve,demolish,m.pair any income - S Pt.Floor Area poor to its issuance,also regain-The applicant fmvarh permit file a signed,calmo m ' q. s� Valuation that he is liansw punvmto Ne Provisions of theCmnactora Licence Lew fCTuger9 a.tmnendng with Secti.n]Iwo)rr Divial.n 3.rthe Brumae ams Pm.rmrmna cwe)ar, Ocaff t)y Type Ban he is exempt therde, efrom and basis for the alleged exmiptlm,Any violation of APN Number - tete Section]031.5 by any epphant for a prome mbjmts the epplkm,sea civil penalry of C•`t ^M _ ..i.e.Nsn five hundred tl.11ars(3300)., - fgwk L as owner of th<Frapeny,m my employee with wage as that Bole wldo Nework, nccomp,evusueiiins Required Inspections,'_ and Profession Code:'Th.Commences Liciase Ism does trot apply to m owner a property who builds m improvea thereon,and who does such work himself or through ' his own employees,provided that such impowamenu era not intended re offered for , We.If,however,the building or improvement is sold within one yesrofcomplwon,the - ' owner-Wilder will hale Ute burden of proving Net he did rot Wild or improve fm put, • , poae of.do.). ❑1;an owner of the property,sm eacluNvely convecting with licensed conganon to cmisnet the project(Bee.7014;Business and Profession Code:)The Contractor's U. canon Law data not apply m m owner of property who Wilds or imWoves thereon,and wW toners for such pro."with ictrumr(a)Iicenud u punmm t the Conuacbte License Law. -on 1 ❑ ams m under Seca / - W .B&PCfor this meson " OWMr ErasDa. NTORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury me,of the fallowing declermimn: 40 I have And will maivuin a Certificate ofocroent to self-im.fm Woken C.,.- nation,as provided for by Section 3700 of the Labor Cada,for Be performance of the - work for which this permit is issued. - ❑1 have and will maintain Waken Compensation Insurance.m taqui¢d by Section 370Uof the Labm Cade,for the performance of the wart for which this permit is issued. ` My Workers Compensation lmmento cancer and%lity number Cartier: ' Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' ` .COMPENSATION INSURANCE �• r � ' mle (This senior nerd not he completed if the pemdt in for on hundred dollare(I Hall - nd tete`,,• -I certify that in the ped"anceofthe work fim.hlch this permit isinuad.l shall - not employ-1 person in my tanner an as to become subject to Thr Woken'Co.,.- - - seibmo Laws of Cal if..ia.Data tete Applicant NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you almuld t _ become subjcd in the Workers Compensation pow!limr of the Labor Code,you must forthwith comply with such provisions or this.permit shall W deemed revoked. + , 'Z ° "'CONSTRUCTION LENDING AGENCY •- r "I 0 Ihembyaffirmihat Nemisacavtmcdmkndingagencyfoithepetfms cof - rh the work for which this permit is issued(Sate 3097,Co,.C.) _ lenders Name > Landes Address tete I Certify BIW I have road this application Wal Rate don Ne Ii tif.m.is waremittances, eeeq...... F•r rrea.I agree comply with d ty ord all city tons" snd w law laong to UO building orom etion,and hereby authonm.prcaenteuva of this city,.a....ponBar 4 ' ,�, ebovo-mentirned property for mapecoon purposes. - LTnr F•, (We)game m ernes.indemnify and keep hvmleas the City of Caprmna spemst ' U liabilities,judgments,cases and caper..which may in any wayacem a against Said City fro in consequence of the scanning ofNis parmt _ FEr• APPLICANTIINDERSTANDS AND WILL COMPLY WITH ALI,NON-VOINT SOU CE REGULATIONS Signamrtrf hcanJC.nvsctm � „ Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding occipmumre or handle harmdry material Re-roofs - ' as defned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section Section 25532(a)T - Type of Roof [I Yes YeaJu ' All roofs shall be inspected prior to an roofing material being Will the applicant or fuourt Wilding acupant use equipmem or devices which yy mivhnvdous air contsminmts as defined by the Bay Aire AG Quality Management installed. If a roof is Installed without first obtaining an inspection ia .Yea o la gree to remove all new materials for inspection. Applicant ;W.e a,Uchaanded„n„aa,rcga.mm r d �Inp.r695.ftheCall-., . understands and will comply with'all non point source regulations. forms Health @ Safety Cade,Savoy 75505,25533 and]5534.I understand thin if the f - - buileingdoesnacurrentlyhmeaWant.that it is my mponsibllirymnaify oy�jrry nts which may'�i e[pnormia vroom eCmificete of Odcup y - ol ,arar nowt_m(1�-� 'f� ��t SignatuieofApplicant Date Date 1 a' All roof coverings to be Class"B”or better OFFICE- tete � INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: nancyc Sec: Twp: Rng: Sub: Blk: Lot:37510012.00 INVOICE DATE......: 04/24/2000 " REFERENCE IO p ...: 00040146 SITE ADDRESS .....: 10340 CALVERT DRIVE SUBDIVISION ..... . . CITY .............: CUPERTINO IMPACT AREA ..... .. OWNER ............: WAYNE PINARD ADDRESS .......... : CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR ....... : LA RITA A WILKENS LIC N 214BB COMPANY ..........: SOUTHWEST ELECTRIC ADDRESS ..........: 14510 BIG BASIN WAY CITY/STATE/ZIP ... : SARATOGA, CA 95070 TELEPHONE ...... ..: (408)999-8721 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BELEC200 P 22.20 0.00 22.20 EPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 57.72 0.00 57.72 V IO . DESCRIPTION- .--..-- VOICE ID --_DESCRIPTION ...... ........ ............................ ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL Oty. if Applicable Fee ID Fee Description 'Fee Group �SPERMF—EE IBLOG PERMIT FEES !BUILDING I • IBCONSTAX 1CON5TRUCTION TAX IBUILOING ISENERGY ENERGY IaUILDING IBENERGYADD ENERGY AOD MULTI !BUILDING 1BOVERTIME INSPECTION OVERTIME BUILDING BTEtvIPPERM TEMPORARY BLDG PERiNIIT BUILDING BNIITIGAT HOUSING MITIGATION FEE BUILDING �BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING SSEISMICOM SEISMIC COMMERCIAL BUILDING SSEISMICRE cv, SEISMIC FEE RES BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG JAUORESS CHANGE BUILDING EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V —1000A ELECTRICAL Lp Iu�C/ BELEC1001 ELEC 600V>1000A ELECTRICAL BEI EC200 ELECT-SVCS 600V <=200A ELECTRICAL SNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODELBUSWAYS ELECTRICAL • MIJIBf REMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT . RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD 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 IMECH PERMIT ISSUANCE IMECHANICAL BAPPLOTHER OTHER APPLIANCESMECHANICAL BBOILERI BOILER < 100,000 BTU MECHANICAL BBOILER2BOILER>100KT0500KBTU MECHANICAL BBOILER3 BOILER >500K TO IM BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BROILERS IBOILER> 1.75M BTU MECHANICAL SR IAPPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES SLOGS MECHANICAL 10f2 asr6ca VIOM BRENIACOVER IAC UNIT >I0000CF`,I I'NI=C�ANICALI IBREMAIRHAN IA/C UNITS <= 10:OGCCFM IMECHANICAL I �BREMAI RN RELOCATION OF FURNACE MECHANICAL I jBREIvIFURNOV IP.ELO rURNACE > icK B l U INIcCH NIC L BREMINHOOD JINSTALLATION OF HOOD IMECHANICAL BRENIRELOCA lRELOCATION OF HOOD IMECHANICAL BREMREPALT REPAIR/ALTER HEATING IMECHANICALl BREMVENSYS IVENTILATION SYSTEMS INIECHANICAL IPPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOI CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING SPINTERCEP IND WASTE INTERCEPTOR PLUMBING 13PREPIPE REPIPE OF FIXTURES PLUMBING SPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORMSTORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT AL•T OF DRAIN &VENT PLUMBING BPWATER INSTAWALTER WATERPIP PLUMBING BPWHEATER WATER HEATERlVENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PIANNI NG ZFULLHR FULLAPPL BASE*HR PLANNING ZFULLTM FULLAPPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZF it 17 E FULLAPPLZONING PLANNING ZGPAMENO GENERAL PLAN AMEND PLANNING ZUMAMEND IUMITED AMEND PLANNING ZUMTM UMITEO TENT MAP PLANNING ZUMUP UMITEO APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING 'TJ LINHIL.LEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISC MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCEII APPLGENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERM[ PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING 7-VARIANCE DIRECTOR VARIANCE PLANNING 2 cf2 PAvind 311W"