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00030095CITY OF CUPERTINO - PERMIT NO. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: � 0001300 9� BUILDING ADDRESS: V S (^' SANITARYNO. APPLICATION SUBMITTAL DATE I /^,fir-�f•IL (/��/�� A 9 OWNER'S AME: s 1 oar .SJ 1�V I NIC CONTROLN /� I - •c' Q' /l L" III ARCHITECl/ENGINEL•R-✓/ ��( C•'��3 BULLING PERMIT INFO Poi Z O H a LICENSED CONTRACTOR'S DECLARATION ' O Z;: G 1 hembY .firm that 1 am licrnsed uMer provision of Chepur 9 (commencioe , Job Description - FyFW with Sectiai'1000)ofDivision 3 ofthe BusinessadPro(eisioKr:ode, am my limns, is aYI� in full fol CRUO / �./1 w^ I \� u C W 6 Liceme Cle e Lic.N ?�1 > 3° a y' Deu Conuwmr'. t ty N a ARCHITECTS DECLARATI RWU 5 mv� y � I undmuM my pWu shall W used a wMk xcmds . aLicensed Professional . SuSn to OWNER -BUILDER DECLARATION C ? a 1 hereby aBirm that I sum exempt from the Contraction License Lew for the ' F O% following remain, (Section 7031.5. thio fi 5, Business ofesus, a oCode: Any city worryc.3F which x mares a Permit an construct, mer, Improve, deu101oh, or readar my structure S FL Floor Area Val tion prim 1.its itauanee.alx nquire,dmiapplicam for such pemdt m IIIeeapwdnism..t q' - mth he is licensed amen ant ti mrsismm add a GmvanOYe license Low (Clara - (tormenting with Section 70DDivision airMaedioKCodc)m thatheisaemPr thicom ed u basis for to alleged aemPrion.Anewn of - = r �Numb (JyOccupancy ccu ane Typ e Semo7031.3 by my alcant fast. Permitsubjects the eppliranna. civil penalty of Gu nm cothan five hundred doll. ($300). �'V ❑ t.. Required Inspections will do0xwons Only: Co. ren .Lt.. Lawd fmale(ply War,onme,a end artyProwhat Code: The ionuacrm's Limns, law does tamer, hi tom owner M .. his mor what build, or improve d+etmnm r who don such wok himself of memo r his own r due provided mi wch improvements thin na inuedee o offered far rale.If,however,the Wilding an improvement Issold within oneyouofromple for the r- builder will hove me burden of provint man he dM nm Wild or'improve for pm- VoaeMulvive / c i, ea owner of ct See co,704 am exclusively.it profession, with :) The Comment's m !If//Lgiy/ consuuct me protea (Ser. ,ran Bmioas end property fession,wW bur d. orO'ibe air thamm'e Li- cense e L dos mupply m w owner of properly who builds or improve thereon, and who contracts fo such Projects with aconuxu(s) hcemed pmwnt m me Cormacm/s IJ<mx Lew. / ❑lam eaemPr undine Sec. ,B@PCfor mis reason Owner Dau WORKER'S COMPENSATION DECLARATION ^ I hereby affirm undwpenalry of perjury one of the following wclantions: 0; C l have and will maintain aCenincau of Conarnt to xR-inwm fm Worker's Compen. e - ,anion. es Provided fee by Section 37M of the Labo Code, future peAOmunce of me F.wk fair m which this i nit is issued. C I have and will maintain Workeer Compematim Insurance, wr wituisnd by Section _ 3100 ofine L.ar Cow. fm me performance ofdu work for which this pomit is issued. M Wculm y�p aneecuria and Poll n Cvn'cr. A�iy Policy No T, f W s a l CERTIFICATE OF EKEMPIION FROM WORKERS' COMPENSATION INSURANCE , (This ration oed net be completed ditto permit is fmoahumboul"lshe(,1W) m las.) Isseiny perhatson in my armaeroast becomewhichthie shell ' m[ employ mf perwn in coy manner x u ro become xubject m dm Woken' Compen- , Applicator atwwf Glif(mie Luc Applicant NOTICE TO APPLICANT: If, ,fur melon, this Gammen, the Latbw Code, yen swuM become subject y it Wokele Compensationeprovisions of me Lebo Code, you most Forthwith comply with who provisions or mis pemiitshellWdecmed rooked ' CONMUCDON LENDING AGENCY O 0 I hereby aRmn Oam there is a construction lending agency for pafomtaae, of a wZ.i the wmk for which this permit is issued Sen. 3091, Civ. C.) ' �'. Lwarse, Nemo a Lenders Addra, .. ' . 1 certify mu I have ward this appliatio ,end state that the above infomution is 0e z correct. I epee to comply wit ell city and county ordinances am same hams retailing to Z) � - building construction. and hemby authorin, rtpraenamivp of this city m enter upon]", ebove•mentimed Property for inspection purposes. ' Ls, ri (We) ague an now. indemnify end kap haunlax to City of Cupertino ,punt O U Iiabilitm,judgmcnrs, cots said export. which may in coy war acme egumt Yid City } W in cm,"Sueoce Mme Beu^a 8 of this permit. ' �+.uG APPLI(yY1'C 11'EST'A't11DS AND WILL COMPLY W11711 ALL, NON -POINT ' I•% z SOUR(, it REGI & Si,..ufAppticwuCarstractor ATLS 'L+,W/—� HAZARDOUS MPAIADISCLOSURE , /, wnme.pPBant orfmare muam, rppap.numnmhwme nxwm, m.�id Re -roofs - as defined by the Cupmino MuvcigI Cane. chapter 9.12. w me Hada w Satiny Type of Roof Cade, Section 2553'(,)1 , - [I Yet 0. Will the applicant or Nmrt Wilding occultismtax equipmem or devices which All roofs shall be inspected prior to any roofing material being emit hareade sair conuminenu are wed by the Bay Axa Ah Gustily Mornmrnt installed. If a rojiea Installed without first obtaining an inspection °'°mi"' I a re ff t new materials for:'inspection. Applicant Yu o gunder tanI comply with all non point so rce ygulations. Gants HKI @ afa C Sebu 25503, 3553) atW 255Ja. I u ersund an if lire grll�i..� Wilding 'n pet LlMtit ismY tapomibiliry arty occupant " of dam xy c u st "amissnarcc ofe ay y�r VV Signature of Applicant Date Owner or uthoriz Ben[ Dax ' . All roof coverings to be Class "B•' or better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE 4NVOTCE "INVOICE CITY OF CUPERTINO . _ • BUILDING PERMIT INVOICE OPERATOR: Christya Sec: Twp: Rng: Sub: Blk: Lot:35627022.00 INVOICE DATE......: 03/15/2000 REFERENCE ID # ...: 00030095 SITE ADDRESS .....: 11395 CANYON VIEW CL SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: HOPKINS JOHN N AND CAROLYN S ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014 • CONTRACTOR .......: WARREN, HENRY LIC # 20719 COMPANY ..........: ABSOLUTELY WATER HEATERS ADDRESS ..........: 191 PADDON PL CITY/STATE/ZIP ...: MARINA, CA 93933 TELEPHONE ........: 18311384-5133 FEE DESCRIPTION CHK TOTAL FEE PAID -TO -DATE BALANCE DUE --------------- BPWHEATER ------------ P ------------ -__________ 9.99 0.00 9.99 PPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 45.51 0.00 45.51 VOICE ID DESCRIPTION_.-- VOICE ID DESCRIPTION .. ...... SEWER & WATER ---- ------- ........ ........� 202 VNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB 6 OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF CUPERTINO Item 5 of 5• BUILDING PERMIT RECEIPT OPERATOR: nancyc • �' COPY # 1 Sec: Twp: Rng: Sub: 131k: Lot:35627022.00 DATE ISSUED.......: 03/15/2000 RECEIPT #.........: 11714 REFERENCE ID # ...: 00030095 SITE ADDRESS .....: 11395 CANYON VIEW CL SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: HOPKINS JOHN N AND CAROLYN S ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014 ............ TOTAL RECEIPT 227.55 VOICE ID DESCRIPTION ........ ............................ 106 SEWER E WATER 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 302 TUB E OR SHOWER 506 GAS TEST RECEIVED FROM ....: JERRY CONTRACTOR .......: WARREN, HENRY LIC # 20719 COMPANY ..........: ABSOLUTELY WATER HEATERS ADDRESS ..........: 191 PADDON PL - CITY/STATE/ZIP ...: MARINA, CA 93933 TELEPHONE ........: (831)384-5133 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL __________ BPWHEATER _____________ __________ PER HEATER 1.00 __________ __________ 9.99 0.00 __________ 9.99 __________ 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 TOTAL PERMIT __________ __________ 45.51 0.00 __________ 45.51 ---------- 0.00 OF OD_ PAYMENT AMOUNT NUMBER ___________ ____ --_-_- CHECK 227.55 4537 ............ TOTAL RECEIPT 227.55 VOICE ID DESCRIPTION ........ ............................ 106 SEWER E WATER 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 302 TUB E OR SHOWER 506 GAS TEST