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00030166 CITY OF CUPERTINO PERMITNo. BUILDING DIVISION PERMIT CON RA TOO R INF O R+ A © BUILDINGADDRESS _ A �d 0 3 O SANITARVNO. APPLICATION S UBM� DATE _fl-7OTT-Ift .�nt_ OWNER-SPA — 3 - ^ `I NIC CONTROLp _ pC�'� -- ,Lm'L�1�uJ 4 O , P L: SAMA- CAt,, r CHITECT/ENGINEF.R _ HU DING;f!fiRM INF,p` ex Z 0�gLICENSED CONTRA.CfOR'S DECLARATION o z-0 1 hereby,(firm Nat I w Wormed awr prodame ar Quptcr 9(mmyrcdemg Job Description F:C;y wiNScxMm]000)ofDivi,.3.f NeBwinceaeM Rofeuimv Cade,era mYlu+cnais <y Ta in Nil force andeRmt. - oc Limn eta Lic,M` nY3 Deb ase+—�--I- Conriador Vg C V,0� 1 , ARCH=ES DECLARATION - o yep Iand nnM my place"I beuvd u public records ZZ m LicmrW Professional 5 z,� OWNEm exempt b DECLARATION �C) .Z 6 1 hereby.(Rrm Net 1 um exempt from the Contractors Cor Limrue Lew for Mae ❑ following wan.(Section to meamo Business mpsansova.da ow Cade:Any city 'merry w which ata a mut m cmnawc6 Jsu,improve.demali.h,..pair m etmcnuc - - da_ �mm'�tr"�twnaJm.sni.reds,pphcam'�wnpemlitNElee.ig�attemmt Sq.Ft. Floor Area (� Valuation Nal he iv licensed punwmmdm pmvirions of NeCmna.fe Liccn.Lew(CNptar9 1 I the,he is ingwit M Non]andM bassfr of Neegeal unod Rt.An, ihad.of APN Number - - Occupancy'type Nat he is campy any apps end Ne buys for Ne aleged osempt)to Any vinWion of YP Section]M. by ho y d loll for a pemut subjects the epPlicmt to a civil prulry,of A ` not mo.Nan five hooked dolor.,.,employ. ❑Lu eworofNd propartyNor.is empioyeu wimen isloodeadi .NWfae their'.].c.campematim. Required Inspections ' Will do rk,and the ew We 71114.Box.. end arty whow Code:lbs Cormex M.h License Lew dors nor apply to tf owns gh his o property who builds or'kande M Neon,arJ who dors such wet ded or of through aown employeese provided Nu such improvements a nw in.nded m offered for - owsale.r,however.Ne building ce are of Movie ta anode within m.Wild r ofor i prove,for Ne ownewbude' will have the buNm of Moving Net he did nM build or improve for par- ' pas or We.). - 'co L na owner of Ne Si�e.7 ,,R exclusively conhocdng C d:)Ifu Contractors tors LF I n.La Ne project apply o am w.uuv and Py aMen m Cade:)The Cornua em.LI- mea law dors not apply m ts owner of protons wce builds rs ent in improve.Mvaeon.and whocanLaw. osucM1 projmta with econwna(s)Izenad purtwntb Ne Contrec'tots `/�� uttnm ca" V ❑lam eve u .Bk PCf Nis ' w D.. W KER'S COMPENSA O DECLARATION • hereby affirm muter penalty of perjury oro a the follavw8 def I. . I hove and will maintain acedigcas,of Comex yoself home ewodeb Compen- atim,u provided For by Section 3]00 of Ne Labor Code,for aha pertamaee of Ne (t fm which this Mendel is)stand. 1 have and will s Compowui ounce,Is.quited by Sectimi 3]00 Code,f perfo of for which this permit uiuued. ped s o na In uranmc Polbynumbmare: Policy No.: CER CATE OF EX ON FROM WORKERS' COMPENSA ON INSURANCE �✓f .il 1 rinisnm b .aion need e complained if No pore, tome is hundred dollars(S 100) or Ru.) D �� Laoo ' Loy any Men asany. uenf,1.work become whichyhia Mm orimm'Consent, ll not employ any person i.my mm,wr m a.become nubjecr ro Ibc Worts.'Compen- pll onionli Lawn of Califamia.Dau 1,1 AOOCEtflat HOn ea subject.. APPLICANT:If,C.o metin8 i p certificate a at E,tor co. Y.World { haome a Wocy y it War4Ks Campenr this provisions of the labor Cod,Ya must (onhwiN romp:,with well provisions o Nis pennl,.hell de decreed revoked. CONSTRUMON LENDING AGENCY RuU Mm 0 Q i bereby am N .iso WeswNm:enditigegsncy for Ne peff.ceof Z y Ne wort for which Nis panni,is urued(Sac.309],Civ,C.) Lando.Naw a 7 Lanier'.Address - {� I certify Men)have seed sides eMlecation and w.Net Ne above information is G. Q correct 1 aince to comply with JI city and county,oxii ..weed..'I...ladng. U Z buldding consnucuon,caul hereby autheri..preunwiva a this city m enter upon ft V above-mentioned property for inspection purports. ' (We)agree in save,indemnity end keep hurdles Ne City of CupffMan against V Nobilities,judgmmu.tate and expenses which may in any way acme against said City - t W in comequcnce of the gaming of Wspermi P. APPLICANT UNDERSTAN ND WIL OMPLYWITH ALLNON.PoI U S RATIONS Sib of Applican nl.ctm ale R"on MATERI DISCLOSURE �Jl/t` wnn Ie(,r(fg(1�JT�j�C(tj}_. Will Ne Wool msWilding..pan,eta.or handle hrsrdms materia. yt Re-roofs tap�es, ` X l l as defined by that Cupenioo MuNcipal Code.Chapter 9.12,and the Heeled and!Seery Code,Section 25532(a)] / .Type of Roof _ ❑V<s o Will Ne applicant or future Wilding ecupart tau equipment or devices which All roofs shall be inspected prior to any roofing material being am emit hardous an cwJrunte as defined by the Bay Arm Air Quality Management installed. If a roof is installed without first obtaining an inspection, °i"nc° - I a ree to remove,all new materia for inspection. Applicant []Yes gg I Nave rad the haxudoua materials nyui.mmu unee 6.9fof Ne Cali. ugKWands an .ply w' ll non point source regulations. 'e HnIN&wety C 25505,25533 and X. understand Mut if ft ,s Willa tIyh. ttggpp1. u'mr.e mi ' to,toady Ne octu oN me mer men of enific9refC 1 c,\ Si Lure of Ap icant Date euMurizeda8e Data All roof coverings.to be Class"B"o better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO ' BUILDING PERMIT INVOICE OPERATOR: yvonnek Sec: Twp: Rng: Sub: Blk: Lot:35917019.00 INVOICE DATE... ...: 03/27/2000 REFERENCE ID b 00030166 SITE ADDRESS . . . . 10465 S DE ANZA BLVD SUBDIVISION . . . . . . : CITY . . . . . . .. .....: CUPERTINO IMPACT AREA — .. ... OWNER . . . . . . . . . . . . : CALI EDWARD S TRUSTEE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . .: CUPERTINO CA, CA 95015-1389 CONTRACTOR ..... .. : MILLER, ROD LIC # 20791 COMPANY ...... . ... : ALLIANES ROOFING ADDRESS .......... : 1250 CAMPBELL CITY/STATE/ZIP ... : SAN JOSE, CA 95126 TELEPHONE ... ..... : (408)261-2595 NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING FEE DESCRIPTION CHH TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ __- --------- ------------ _-_________ BPERMFEE P 127.00 0.00 127.00 EPLANCHK A 62.25 0.00 62.25 BSEISMICRE P 0.70 0,00 0.1O,� 189.95 0.00 189 95 VID DESCRIPTION VOICE ID DESCRIETION 10 � . .. asiOi .. ......... ... ........ ............._.............. 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS D MAR 2 7 2000 IL. By7 2000 - - -- ARz ;� i r •