00030008 CITY OFCUPERTINO ', �' PERMrrblo.
BUILDING DIVISION PERMIT ',..�f R
BUILDINGADDRESS: IL�J�� f r�
O3l S �(I w/a[.�� ION SANITARY NO. APPLICASSUUBMITIALDATE
OW 'S NAME: 3ksyK� •-•vrl •Y.CTIf C�
ridy\ ?� 1-n NIC CONTROL#
-215-4L
NC: O S .- (�.v—'1 �(•L
ARCHITECr/ENGINEER ��v ❑ " B I.DIN.�PERA'11'I`JflF,D
ec�G
,�i,6o• ^
LICENSED CONTRACTOR'S DECLARATION
Z tithe Z 1 M1ertbY affirm No 1 w licensed under provisions of Chepmrn 9(commcain !
D z_� e Job Description
Swith Safion 1000)ofDivisionJof thin BuainensWPmfelaiam C.ade,.md mYliceaseis /'�� � �� �/
Go u Ufull fomeend effect. 3
Uueau Clan Uc.N
3 e 1- Das Coovacmr
II--FS O gARCHITECT'S DECLARATION
v�y 1 underuud my plans mail be used u public rccad.
ec
6 6�' UP
crnsd rofeuiarol _
bvi=H
OWNER-BUILDER DECLARATION e ZG J17
�
t Z< 1 hereby.faun that I son
m exemexempt from the Cuntiaemrs License law for the
f r❑ following roawn.(Saban 103 1.3,Business and Rafeuiom Code:Any,city or county
which responses a permit in cmammct,alter,improve,demolish;or repair any structure
prior to its issuance,dsortquimNeapplicant fwsuch permitbrteatiMum
gneuent Sq. Floor Area - Valuation
t Milia edp uutmo NeryovisionsofNe CmtiacrorsUmwUw(CWpmm9 /QU �.0
(comtmming with Section 1000)of DivislonJof rhe Buaiaes end Rolusi...Code). ppN Number - OTI
that be is attempt therefrom and ds basis for Ne alleged exemption.Any violation of ( Occupancy y `J Pe
Section
ti
noon ONen5 by onhood,amdollfee.permit subjects the applicant to a civil pemWry of
ber❑I,ae owner of the Properlyor mY employece wish wages ei their wile compevatim, Required Inspections,
will dotbe woh.end ds ativicene isna Winded ororterW for lale(Sec.1016.Busireas
and Pmfessim,Code:The Contractors Liarue law dean not apply to u owner of
properly who builds or improves to rena,and who does such wort himself or through
his own owa.mnploeu.the provided dart such improvements thin mm inunded a hart.,for
s war,hmwercr,the building is improvement is sold within me yeanofts".for the
owneroida will have the burden of proving Net he did nm bind ar improve for par-
poneof owner
❑1,u t No p of project
property,ern exclusively mere,amid comrmtine withCod lioensed stro e.U. `/
construct No project(Sec.loth,Bueirmass and Proleuims Cods)The Contiutora Li _VJ
cense law does rot apply a an owner of property who builds or imWovm dsemm.and
who contracts for num projects wish.cmtracm d'i rsemed pu..I a the Continuum. �,
U..law. ^
❑lemexemptunler Sm. ,B&PCferNismaon V
Owner Data
! WORKERS COMPENSATION DECLARATION
I hereby.ffirm under pantslmy of perlurY ms of the fallowing declarations: .
I Nxw and will mamtsina Cmrn
ifcataidCmut mialf.m.fm WorkersCompen-
mimn,ns provided for by Rome.3100 of Ne Labor Cade,for the performance of the
for which Nle permit IS Issued.
1 have and unit maintain Waters Compa ima Ie.as rtgmwN by Section
3 of Ne labor Code,fm Ne pefmmamse aide work for which this permit is isennd.
My Wo a orout romance carder and put,
s
Cani , en r Policy No:
CE RCATEOF El(EMPr10N FROM WORKERS' t
COMP L SATIONINSURANCE
ala..,
This section need rot be completed 9 mhepermim is for as hondmd dellen(SI00) 1�
it 0 2 2000 U
loy my parson
she any ofthe as
boxamewhije this themitisissoed,lmdl MAR
not employ any Cannon in uY manner an u m bttome subject a the Worker'Compam
mit laws of California.Dau
APPlicant
NOTICE TO APPLICANT:If,after mating mi.Cmificas of Exemption,yam mould
Ismme subject a the Waiter.Com,mom on provisions of Vs Taor Cade.you muss Cly
forthwith comply with such provisions or this permit JWI be demand revoked.
CONSTRUCTION LENDING AGENCY
O 0 I hartby affirm that Vert is consuuNon lulling spar,for the performance of -
Z ythe wont for which this permit is issued(Sfc.3091,Cl,C.) m
lammxra Nunn
a IenderaAmrtem
t� 1 cerify,Nat 1 have road this application and state that the above Information is
IY .1.1.groin to,comply with ell city and county ondimncu all sus law,rel.Vng to -
U O buildingcrmuuction,tad herebyind r.apratexam s.fdds city to ensr upon the
eovemnemimed properly,for inspection purposes.
LT+ F (We)agree to twin.Indemnify and keep harmlecs Ne City of Cupertino alpinist
O V IVabilitias,judgmcnts.eau end tape.which onY in any way accmeagaimt laid City
,�. in cone ueae of the granting of Nis permit.
F0- APPLICANT UNDERB ANUSANDWILLCOMPLYWITHALLNON-POINT ,
SOURCr R'GULATI(
J �Si$m,tAafA,Ihcsm1mtmcIor Culd �. r/��/t/(K�.az 1 /%l •'
HAZARDOUS MATERIALS DISCLOSURE
Will Ncapplicant or fuert building ormpmt.ereor handle hasedws maurid Re-roofs
as defined by the Cupertino Municipal Cads.Chapter 9.12,tad the Health and Safety
Cade.Section 255320)? Type of Roof
Ya
WiR robe.ppm;r.ntmr ma brBding aecmpa,,,rain egr;p,mRntaade�iu,watch All roofs shall be inspected prior to any roofing, material being
mit hal aa'u contato Qaasdefinedbythe Bay Ase Au Qudiry Mmagement installed. If a roof is installed without first obtaining an inspection
`tr"f I agree to remove all new materials for inspection. Applicant
❑Yeawr a
I marc mad ds hazardous nationals rtgmirtments render Chapter 6,95 of the Cali.
un stands a wi l comply with all non point source regulations.
rams Hatch&Safety Cade.Sec Me;MM.Z1533 and 255M.I undentaod Nu if the
buthen datan I.. hove to 1. itu my rtspondrymr!ot robe Mutton.
ofthe u' mandsw mus priortoismano,ofaCmificut of currency. •r
Signature of Applicant Date
Ownsircrinductionardli,nit Data
All roof coverings to be Class'B"or better
OFFICE
„
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
`M CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: LOC:31629O26.00
INVOICE DATE......: 03/02/2000
REFERENCE ID # ...: 00030008
SITE ADDRESS ..... : 10313 COLBY AV
SUBDIVISION .......
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ............: TUTTELMAN IRWIN AND VERNA TRUS
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2421
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ----"---"--- ___--------
BPERMFEE P 107.00 0.00 107.00
BSEISMICRE P 0.50 0.00 0.50
BUSLIC P 90.00 0.00 .00
197.50 0.00 197.50
ID DESCRIPTION -40 VOICE ID DESCRIPTION
........ ............................ ........ ......... ........... ...
305 PRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 6O4 ROOF IN-PROGRESS
D � �
MAR 0 2 2000 '
BY - --