00030100 CITY OF CUPERTINO PERMrr NO.
BUILDINGDIVISION, PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS.
I j�/�/�y� ��Jp((/ N/C SANUFARYNO APPLICAT NSS AL DATE
OWNER'
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CIONTROL#1
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ARCHITECT/ENGINEERt C.� /2� ❑ BOLDING PERMIT INFO
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C N LICENSED CONTRACrOR'S DECLARATION
Z S"3 I hereby effort Nn I ua licensed under provisions of Cluger 9(comauaing ��v _Job D SCrI tion / /
C Z=C ®/I�/ /k(1L -,,[gam/P glJ f l/./L
FXt J wife Satrce at flTvisi n)of Bno, WRofeuionr Code.uM mY lianrc is /G
SIL I- in full force end` Rnt r�I•—!�y!/y 6�TJ/l��- ^
O tau Llama Clau Lic.i
3 a F Da u Contractor
C g C a A .hall ECr'S DECLARATION s
I understand my plans.shaft be usW u Public rccmds 1 ,
6 0 C
Licensed Professional. •-
uyS'4_' OWNER-BUILDER DECLARATION
C G I hurtby eflirm that I am exempt from Ne Contracto's License Law fee the
G following reason.(Section 7031.5.Business and Pmlesafau Code:Any city ce county
which re9Jrts a Penia m cunspua.Jur,improve,dmolub.or rtpir any evurnue
a Sq. Ft. Floor Area � uation'
priormits licensed
Jaoro to the Neepplicmt fa sohpermit a Law(moment
eMthrislicensedpunuam to the Ne ,But . Lt..fmai (Clods).
chammes cagwi therefrom
road he baiiian3 ofNeegeiau.mon Anyamcade of N Number Occupancy Type
Nee he is comp Nagfrm and mu buffs ra Ne Jkaed gumption..ciAl omalty of n Q - P Y YP
Section]then five
applicam faapermit aublauthe aPPlicannoacivil penJtY of
wia mom Nan Rve h ro,a dollen try.,I'm.
Losite A.
and
the msc,or myw inloyaa wife ws'.asintercom for
e(Sm.compensation. Required Inspections
will do Nn work,endo: li.Conrouic an.intended aoRnedfaml apply Tan owneeof "
eM PicoIM whions Cade:The ows. eemi L1anu Law does nn apply m if owner of
gh
property who Wilde or minnows.du Merton,and who does such wotk Idem or of ered For '
his own employee,provided due wen impmamenu ti not m inumed r oRnM for
Wn.ILhowever.r will h Wil use burdenof ost iatold wiNinoa year ofemos for tlu
ow c.findder will neve Nc burden of proving Nat he dm not Wild or improve for par-
pauof�le.). .
L u ismer of Ne property,,H eulueivnd conmcein,wife limed common Li-
croon
a des.1 (SIL..nG,owner
and Profession,bus Code 011e Conuensm,Li-
come law dao nus apply eo an owner of property who builds or im in she
Norton,um
who commit for each PmPxu wit.cmtnctm(s)licrmcd pursuant m Ne CanmactoJe
Elisio Law.
❑lens exempt under Sm. .B&PCfor Nis reason -
Ower'
WORKER'S COMPENSATION DECLARATION '
1 hnrtby affirm under pnelty of pnlury oro of the fallowing declarations! -
IWveend will forbyneCeni37M ofCaaum to ulhirurthe Waken Comp she
cation.a provided for by Suction JTOo of the Labor Cade,for the peefamuna of she
work for which Nia permit is load. -
❑I love eM will ode,fon Worker's Cisms of
on Insurance,hi h rcs pme t I Section ✓1
My We du labor Code,for the performaaeof Newark for which Niapnemtit is issued. V '
My We a Campen}eiim)nsuu9¢rArrinend Policy tombet! / -
Cerrin'CUPS//17VAT .lN�a Policy
CERTIFICATE OF EXEMPTION FROMM WORKERS'
COMPENSATION INSURANCE
(miesection real tmt becompleted ifmu Perot isfa onehuedreddollm l5100)
or loss.) ,
Icy any Natio in a;,.. .iNe wok for which Nis cm Was ivad,n,.- '
rot employ any Person it any menae so u w hecame subjea w Ne Waetrn'Corhan-
utiaalawaofCJifomi�Dm' -
APPIL
E
NOTI - .
NOTICE TO APPLICANT:IL core melting Nia Canons,c or Labor code,
you enoeld -
bernme aubpce y the suchWousser's
Pro Cooper man im iisions cite tabor Code,. mmt -
i fanhwiN comply wife such govleiaa a this petmie a1Wl be domed revoked. '
O CONSTRUMON LENDING AGENCY
O I for w Jrmu pe Nert issued(Sm.30 lmdine egmry fa Ne peeformarcr of • 1 -
LLLFFFy���"^
CIO
the wok for which Nia permit is issued(8a.3097.Civ.CJ
Lender's Neme
Ieakr'I Address
Ia7 Q 1 agent Nee I have read this ayand cren and awe mut the above infuriation is
camce.l ogre tc cmPlyand wife y city end aunty ordNanaa and eine Gwt r upon
to
r7 C bulldingcansuucuro and for
rvthoriurepreunmivn of this city manor upon Ne
V � ebov< (We)agree,
property fa lmPation keep ha.
[ga [� (W4)agree ,ave,iadnmNfYarmhicDroyt any
City of Cupertinoid City
0'W incoiue,jnce of a cauand oxpmua which mayineny wry eccrcagainst said City _
W inPPLIC NT of be STAN of this permit. '
IY APPLICANT REGULATIONS. AND WILL COMPLY WITH ALL NON POINT
'SOURCE REGULATIONS.- i
67,
Sigrmrt
uof APPliranJContmcta m.. pl
HAZARDOUS MATERIALS DISCLOSURE -
WillNea,,licant or fumy Wilding acupmt smu car handle hnerdous meuried Re-r f as defined by she Cupertino Municipal Code,Chapter 9,12,arm rhe Hands and Safety a of Roof -
Cade,SwI.V55320O? Trp ,
Yes f3 No
Will Ne applicanaafmurt Wilding wcupIDt Use e9uipmwvt or devices which All roofs shall be inspected prior to any roofing material being•
not Focused!nuiair mitaminanott,deBnedbythe Bay Area AhQuality Mstagenon installed. If a roof is installed without first obtaining an inspection
yes L6 No
-p g
I have rewd the haurdoua contends rt�nir menta miner Chaser 6.95 of the GJi- unders ds and wcomply with all non point source regulations.
forme Health&Safety Code,smuts 25505.2553)and 25534,I understand that if On, /1-57
M
building don urrenmhav y cnut Nn It is my real onaibility m naify Un recupent 'DV
o"f aaM.A.0ueaeofe Catignua
'Sig re of Applicant Date
owns auNonzed agem -Oau
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: chrietya
Sec: Twp: Rng: Sub: Elk: Lot:37517023.00
INVOICE DATE......: 03/15/2000
REFERENCE ID # ... : 00030100
SITE ADDRESS .....: 10345 CALVERT DRIVE
SUBDIVISION .......
CITY UPERTINO
IMPACT AREA .......
OWNER PRAM, HONG
ADDRESS .......... :
CITY/STATE/ZIP ...: UPERTINO, CA 95014
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...
TELEPHONE ........ :
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ -__ --------- ------------ ---___---__
BPERMFEE P 77.00 0.00 77.00
BSEISMICRE P 0.50 0,00 0.50
BUSLIC P 90.00 0.00 90.00
--------- ------------ -----------
167.50 0.00 167.50
ID ............................DSCRIPTION VOICE ID .-._DESCRIPTION
........ ............................
FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS