00030097 'CITY OF CUPERTINO - �-a�•A3k� PERMIT NO.
-BUILDING DIVISION PERMIT CONTRACTOR'INFORMATIO.N:. . t'� O
BUILDINGADDRESS'. • • ,r• - _ v V V `/ ",
SANITARYNO. APPLICATION SUBMITTAL DATE
O '3 NAME:
NIC CON
TROL#
OYC
q�p+ RCHITECT/ENGINEER BULD PE ft FO
K t❑O Z� '
LICENSED CO CIOR DECLARATION
ZO Z.— 1 hereby arcmm Ina i em licensed sand.proviums of chapier 9(connowsm-9 Job Description '
a_g OWy with SaGon 9000)w(Divishm Sof tlrc Business aW Profeuons Code,and my Baena is
5 N a ,
y in full force and eR<m. -r'
6 rL.0
Wcwse Class - Lk. 4
Dem L'Onbmmr `' `
w O ARCHITECTS DECLARk�J ATION yy/. `
y � f underahnd my pions.hall be used es public rcemde 713a[J//s// ,
Licensed Professional
.OWNER-BU D,DERDECLARATION - s.
1 hereby aW.that 1 sm exempt from the Contra ane,License Law for that - -
.f G follwdng reason.(Satan 7031.5,Busumla and Profeuiom Cade:Any city or county, •"
which mr ulms a'psemit lecoesWLt.after.impow.demolish.or mmor my awcnvc S Ft. Floor Area • - - Valuation'
pdOrtoitsissuanto,9.requires Ne applicant for smh penrdtm Bleesigrmdaatemmt L]'
Nat he is licensed mummer to the provisions of tbe COnmac:r License Law(Chapter9 '
(commencing with Section 7()(K))of Division 3 of the Business aM Professions Codc)m - -
mat he is exempt nccrcfrom and the basis for she alleged exemption.Any violation of APN Number . :Occupancy Type
Section 7031.5 by any applicant For a permit subjects the,applimnt to a civil penalty of 11
not mom two five hundred dollars
-❑I,uowneeof de propeny,mmY cmployms with wagesu their bale compemetion, ' Required Inspections
wBl do fusions ands: he Cmeienm inwderor Law
time
apply
to as Business - '
and Professions Code:Thects.there Walla law des nm apply tom miner of
' property wnm based.of impmva t such i sed who improvements
a suchm m ante Montell or enrough -
ahisw,own employs,Providedlli,or t such improvements thin nm intender m oRertd for
mall hild,,will ea heaildingorimpnrvemmtisaoldth talent
fc,.for Law.
- poss of Sam).will hive dm burden of proving that be did not build err improve for pm- '
pose of sone.). i - - •. ,
❑T.as owner of the propinty am exclusively convecting with hemeed cmteracmn to '
construct the project(Sec,7(l Business and Profeaeions Code:)The Cwwmeors W-
cense Lsw does not apply to he owner of properly who builds or improver thereon,and -
whocontractsforsuchprojacts it. n.)licensed pmemou to the cantmcmea -
License Lew.
p [I MI xempt under Sm * A ,B&)P C f�.11Nts mass ` see
Owner ' / OR Dae
WORKER'.COMMSA NDECLARATIdN - - - -
he y affirm under pemlry o rju me of Na following tledthetiom: .s
Ih send will mainmin aComficate of Colleens m ulLinsnte foe Wcalow.Compem, -
ation.as provided for by Section 3700 of rhe Labor Code,for W performance of Ne '
avork for which this permit is issuer. • '
❑1 nave W will maintain Workers compensation Insurance,as required by Section " t, -
37Ww'dw labor Code,for de performance ofthe work for which this permit is issued. •1'• „
My Wof ea Compmaaion lnsumncecurier and Policy number arc:
Carrier i Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
- COMPENSATION INSURANCE
.(This semina need net be completed ifrheperaw isforone hundred dollars(SIW) .. _
:err leu.)
Icenifymnin0s rfo .'OfNewmkfurwhich Nispcmutisisme,,lshillnot employ any person In my manDer m a,to become subject to the Wmketa'Compen-
swim Laws of Califernia.Data ,
Applicant . .
NOTICE TO APPLICANT:.If,after making this Cenificam of Exemption,you should '
become subject to Ne Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions m this permit shell be deemed moked. '• '
CONSTRUCTION LENDING AGENCY' ` v
Q ) Ihereby M..iNat there isocamrmetion lending eSanty for the paromwce of
Ne week for which this permit is issued(SIL.3097,Civ.C.) -
y' Lenders Name .
be der Address
Lw: Q 1 n n fy Net I have read thtsailphos aon and stays that Ne above hf.ficn is - -
emrtet I agree to comply with all city and county osdi mm"and when few,meeting to
Obuldng conmucuon.dal herebymthonce mposensarves oftlus city m enter upon the
above mentioned property for Inspection purposes. s - -
pi Fu (We)egrea m save;indemnify and kmp hamless tbe City or Cupsnim agaimi - -
OU Imbilities,judgmenrs,costs and expenses which may in my way amme egainn said City
} W4 inconsequenceofshegrandngof Nispemm. • •.
F �+ APPLICANT UNDERSTANDS AND WILL COMPLYWITH ALL NON POINT '
V z SOURCEREGULATIONS. I -
3 02 S' !w f pplicenOConvnctm ... Dem Ov
HAZARDOUS ATERIALS DISCLOSURE _
Will sAe ejmliemt or future Idinpacupmtaort or handiehuWoua material _ ofs-
m defined by the Cupertino Mumcip I Vose.Ch tor 9.12,anal the Health and Safety,
,Code,section 255320) - _Type of Roof[I We
Will We applicant 0r furore occupant use Nupment or devices which .All roofs shall be inspected prior to any roofing,material-being
amt baomica*.ism tem h.anod bythBay Amm
a Air Management installed. If a roof is Installed without first obtaining an inspection
I a ree to remove.,all new materials for inspection. Applicant
❑Yes g
I h. read the haardea,maternal.re ummenis aMe,Gha;te.'6.95 of the Gall- understands,and will comply with all non point source regulations.
forme Health&Safety Cade,Sections 25505,25333 and 25534.I understand Na if the u A
buildirigdoesnacmentlyhaveamnant,toor ismY apomibility m notify the tampons - „1•u-,Y ,
uirenws which mast be met pram to sum a Certificate Occ y.
— r Signature of Applicant'" , - Date
Tramed age 7 Date - '
- All roof coverings,to be Class"B"or better •
:OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
1
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: TwP: Rng: Sub: Blk: Lot:34214064.00
INVOICE DATE......: 03/15/2000
REFERENCE ID R ...: 00030097
SITE ADDRESS .....: 10120 CAMINO VISTA DR
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA ...... .
OWNER YINN
ADDRESS ..........:
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2608
CONTRACTOR ....... : LIC #
COMPANY ..........:
ADDRESS . . ........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- _-- --------- ------------ ----___----
BTEMP P 57.50 0.00 57.50
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
93.02 0.00 93.02
VOICE ID DESCRIPTION VOICE ID DSCRIPTION
•.. .......- ....... ....... ............ S_-
......
lROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL