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00050128 J�.ITY OF CUPERTINO • g RAC g R II ORI I g N: PERMIT NO. BUILDING DIVISION PERMIT ©�O j�� n Cd' BUILDINGADDRESS, SANITARY NOAPTION SUBMITTAL DATE O NEM AME: I V �� N/C CONTROLN HONL: CHITELT/ENGINEGR h .;R191171INGIPETRMI ;O foo LICENSED CONI'NACIORS DECLARATION _ 1 h,mby affnm that 1 w Returned uttler provitiam of Cluptu 9 fwmmencNB T ('_ C,f 2 u, .f S ;ob Descriptio '. _1• A,p•Ls ��\ F4=vO! wish Saban 9000)ofDiviaianlof NeBuainca.adp(s�oN((n'on�ad 'Tam=is 1�m�S'lla./`JCa 1 "l- 1tC.yICQkl- ��`'fu^ �f�+V 1e- ) fes in full force aor<Ren. 15 a T J J • i �� a Licenm - Li-.N F°��a us•5Date t - Cr •4!rG rl `t yX y. (' �+j t' l� IA.11 O ARCSDECATION IundenmypiwsialtWuseas I�.QC7N"/`g�A'�f•���•y�q—� t�p public ra,tda y o•y� O Licened professional - y7 OWNER-BUILDER DECLARATION C Z r I hcmby aRIN the I am mempr from the Comranmfs Licame Law for the 7: O following reason.ISM."'M13 I.S.Business,and PmfeWmu Curse:Any city or aunty - uerl which mfiuim a permit to cmaant,alar,tmproae,demolish,or repair any smnouc >3_ prior to its ivaanns,,also mlums the applicant fm such permit n rife a sigmd.macbmt Sq. FL FloorArea aluat100 that Its is Rcemed pursuant to the provision.of Ne Cantremor's Lhimse Law(Chapter9 (commencing with SecJon 7000)of Divislon 3afth.Boston..ad Pmrtasi...Coda). _ ..pA,p Nat he I.exempt therefrom and the basis for the dlegd exemption.My violation d AP%Number Occupancy �.JJ e Semon 1031.5 by any applicant fore permti mbi,cts the to Whitson e civil pemlty of nm trop than Evt hundred dolWs(1500). p I.uawmer of Jre propeny,mmy emplayrae wish wages..their anlecomPen.atian. Required Inspections will do the work,ad the abutter,is not mended oroBered for We(Sm.7014,Busters. and Psofessiom Cade:The Contractors License law does not apply to a owner of property wM builds or improves thereon.and who dare.tech work himself or through ( f his own employee, dal Jut such imps a N inanGil m oBend fm We.IL teNe Wil hmven Wilding or tmptovement 1.i.old within ons e Wild or momple(in the oxmer-butlder viii hero the Wdrn of proving Wo fe did not build or improve fm pury Pose of Wan. . I•u owner of the property,,H Cameras sly cwuuum,with:)The C retract r.U.construct the project(Sly.ION,Busimu ed ProfeW lbo Core)The Contractor's nd cert Law does rotapplywts with aofpmputy who Wil omimprove commucutd Liao.Lams fmanch projmu wish a conhuto.f.)Iicemd Wnuant to the Convxtots 01ann Lew. ❑lam cacmin unticrSa. .B&PCfa Nistwan Owner Data V > WORKER'S COMPENSATION DECLARATION 31/ I hereby alarm.der panalty of perjury oue of the follavioe dahomtmu: "b"a ad will m�a.C<niflcme WCmuentroself-Suers fm Wmkela Compare- ' O - b'"' as proYded cJon 1100 oftheLaborCodermNeenofthefowhichNitisiss"1andWilltainWo "Cree'rantouImurenceas req; by Sati7 Itof the Labor CmtM perfomm�ce of Ne work fm which Nispeemn is is.ud. My Woke Inmrymc curia and Pohcy, Cenier. 1 Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE (Thi..auou ted rept W cmnpletd if Ne permit is fortes hundred"I.(SIM) , or bass.) 1 cenify that in the performance of the work ra which this permit is issud,I shell not employ any Tenon in any matter an as to beams,tubject in the Wakers'Comprn-- action Laws of California,Data Applicant . NOTICE TO APPLICANT,IL afar making this C,dfscsse of E¢mpton,you should become,Subject to the Wotkds Compensation provision.of in,labor Core,you most forthwith comply with such provisious m this Permit shall d dre ed mckd. _ CONSTRUCTION LENDING AGENCY 0 Q Thereby afBthat at Nem is a com uction lending agency for the performance of z N Js,work frewhich this permit is issud(Sce.M0.Civ C.) EW LedeName CYi Lade/.e,Adtlrtu W ^0 1 unify than 1 have red this application and NIC that the above information to }et.1 ape,to comply comply with all city and county ordinances and some law.relating 1. U'O building construction,ad hereby suNorimreprc.enwives of this city to enter upon this BbaVellenitomd property for inspection purpose.. IzEW (We).,.n ma,NJcmtid 4rc fy and harmleu the City of Caputirm against . C (� liabilities,jdgroams,tmuad espena.which may to any Way a ante against aid City ;m f:7 in consequence of the granting of this permit. [r Q APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT ' V z SOURCHREGULATIONS: Sig acuteaf ApplicardConttamm DN —T HA RDOUS MATERIALS DISCLOSURE • Will the applicant or future building occupantnort or handle huadous material Re-roots as defined by he Cupertino Municipal Code,Chapter 9,12,ad the Heald ad Safciy Code,Sctian 25532(.)1 Typa Of ROOF . oym pNo Will Na applicant arfuture building nccupant use equipment or devices which All roofs shall be inspected prior to any roofing material being ,mut hmardoue air contaminant a a defined by the Bay Arca Air Quality Mnnagcmem installed. If a roof is installed without first obtaining an inspection " I a ree to remove all new materials for inspection. Applicant ❑Yoe ONO I-Mwaroad the hasndmnrmtm;alsm9ummtnnde,ChaPmb.95ort�cali- un erstands and will comply withal] non point source regulations. forme Health&Safety Code,Savant 25505,25533 and 25534.1 understand that if Ne I uilding does nm currently have a teranl that it is my responsibility to notify the occupant of the mqu remems which must W mot prim to issuance of a Certificate of Occupancy. Signature of Applicant Date Ownesm..csm.dagem Data All roof coverings to be Class"B"or better OFFICE CITY OF CUPERTINO Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek COPY # 1 • Sec: Twp: Rng: Sub: Elk: Lot:34217053.00 DATE ISSUED.......: 05/18/2000 RECEIPT #.........: 12274 REFERENCE ID # ...: 00050128 SITE ADDRESS .....: 10670 CORDOVA RD SUBDIVISION ......: CITY ............. : CUPERTINO IMPACT AREA ...... . OWNER ............: WEST DENNIS L AND BARBARA J ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3912 RECEIVED FROM .... : TIM CONTRACTOR .. ... . .: TROUT, ROBERT LIC # 21511 COMPANY ... .. . .. . .: SUNDANCE SKYLIGHTS ADDRESS .. ........ : 10565 FOOTHILL AVE CITY/STATE/ZIP ...: GILROY, CA 95020 TELEPHONE ........: (408)842-9540 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 101 FOUNDATION 102 PIERS 103 UFER 104 REHAB 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL • UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS