00040188CITY OF CUPERTINO aabP UN
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BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: �_yL
BUILDING ADDR�:
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o° -o-{ Ibnwr.rE,m twl.m Gaea.ed node, p,o.iaiatu dfTuµe9(camrcxlns Job Description
ayi7 ndtSation ]0P0)MDin.im3dAeBoaiiva Rofgagu Cade Wmy tiaiueu.
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OWNER-BUILDER DECLARATION
H Z � I bertby M. t I .m ue,npt ham the Caeuanor. U,..a Law I. Ne
S p follmiep tam. (Seclbe ]031.3. B and P.ofeauma Cade Anr sty a minty
a�"'°K^'w""•°amhb`®°"`L.I", °ebalieb,a"P.i"°'''°'.`°"` Sq. Ft.FloorArea / Valuation v J
prlam0aiay.se,.lao rtquirta tbe.ppllsaf Chpennhwrde..Ipedau,a V
de,M6liaenaed pamam wde p.ovuiooa Mthc C«ur,ar.lxrnelav lCh.pur9J
«aaa,m.miwimsewa.]000)doi.i,.aaad,seBa.ia�.mePwe..im.caae)a
mSeuNbae is whPam .m de b.d. ue ekyal a.,eaa. Any ,;a.lm d � a—pN Number Occupancy Type
O31.5bmPEaf«.Ra, swbladb s,,].um.ciril m.ltyd
not vw.e Uw five EmdteO ddl.n I33fA1). V J
p Ltlawov dde pmpety.«my empbym ww w.se.tl tbcr.ok ,. Required.lnspections
smm me wan...d oe.a«aae i. ort intmeed«artemd ra the t0Y w ., Btlisa
Lod Ptdeaai«u Code: The Camrcwr'. L�— ' her dm na .PNY to .o a.aw d
poppy was Wiw. a intpwtl dertm, utd who d«a each wan hiimeHo ff o I t
hi. own emplgm, ptorided tlw vui� ivvm,e&lw vc oe iowoded a oRe,ed ra
..Ie. If,hover er,denn ft «im ap n,la wM withinarc Y�dnn, fm
owpu-0uildc win n,.e Iw w,den d po.;,K ibv h<aie na bade a intpime ra pw-.
pacdvinl.
❑ L tl o+mar M the p,c,cs m ucItnti dy emurues whh limmd conv.cus b
catvrvct the Pwlea IS«. ]IM6, Bu.ine..od Pwfeulpn. Cade:) I]e C«m.ebr. U-
B U S I N E S S '
ttue law d«. un.l�plY,o.n owm+d peope.y who build. a impmw IMem..nC
wlvcam,.na fa vab p.oja'tl Mtlt.abV.nar(.)lianmtl pvw.ntw Oe Cmarwr.
❑Imreu�. LICENSE
xemp uMeSs. ,BhPCf«,tda,ram
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WORKER'S COMPENSATION DECl.1RAT1ON
IMeby.If bide pmWy Mp MIlse me(fl cM deeWviom:
REQUIRED
I hive" will m.itwin. Cmif dConus my -iuve fa Wartera Cm -
cion, u povldM f« by Salim 3]00 d ft tk L.ba Coo, f« k pofmmvee M,be
wwk f« which W. pmdt u iwrd.
❑ 1 n..<.m win w.iawn warts. Caatpeuvkn Itla..aa. tl waaitm by senior
3](gof the la�baornpCconde�yla Jryppa.�(manpnrtc�nnM,hc w«k f« vkcb 1hi. psora � Taws.
Canty 4,TbTF IMrwtf� Polu'Y No. n
'�C . IFlCA .�' Elf -f ZION FROM
COMPENSATION INSURANCB
(ltila.ectim ne ]not be ra�leed rcme paxautufaone bw�ed ddlv.lS100) '
IcenifYl Ls a n,nn mNe pe,favuviceol tl,ewas(«whichnnpe,eitui>med,l WO
eat perw.nY w u man,er w bacavnc abject b Ne etrn' C ee- 1=0upon law M CahfomiA D.e
Appl
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NOTI
NOTICE TO" It. c. pekinS W. Ce,tlfk.,e MEaemp C . .IwuN '
b««m n cmp y it W b , is nss or i Thom M tk labor Cade, ym nbn
�fmhwiN comply with acb pmN.iam a thu permit thel be � mdM. •
CONMUC]ION LENDING AGENCY
O 0 Ib by.RumO deee is a camwc0an k itn apn, f« the perfmtuoaed
Z th wan I. whitlt tbis pmol, u i.ved (sac 3097, Civ. C.) .
F.. leder. Note
a > I<Mcr'. Addm.
W z I wtify @u I h.vc,od it 6.pplicv.n rod vee tbv tbe.bove m(ono.iun i.
Od nae g ape w comply wi y ritY .b emery oeA:.....d. city rtWinyw _
Z boiRlmy aomunlvt.m lceby..ltai:e wae.ee.i.e. dada ehywwRr apoo Brt
U,O .bore-e(W.). d 1.As Yfa i.ify pvrya.e.
fs U (Wjur[V w u Indemnity.nd 4apnny in Uy
Cle A,II vtit CTL,
O U Iihilititl,IndEmeo4 orae.' upeu.b Nu:h m.y in mY wY.caue a;alnv aid eny
} fs7 Ineonuq NTUNdepvwnsof ibis WILL .
(•+ �+ APPLICANI'U LA`LONANDS AND W111 COMPLY WfIH All NON-PoINf
SOURCI!Rf:GULAllUNS. '
Ip....... of AppliunUCoay.n r D.w
HAZARDOUS MATERIALS DISCLOSURE
vela the.pplic.xamwrtbnmiv rccapentR«ean,mle b,mam. m.,ew Re -roofs
tl dchoed by Is, Cupn Mad iPl Codc, Chip. 9.12.od ftHuhl, d Wny
Cade, senian 21532(0] , f Type of Roof
❑ Yea ¢N
All roofs shall be inspected prior to an yy roofing material being
c,oh h.n.Ean av aava®nuv d Ibythe Bay ud
MVAGQhy Mamseovn installed.. If a roof is Installed without first obtaining an inspection
vWY'DYn I agree to remove all new materials for inspection. Applicant
I Mwtodde b,,.,,ent.�;.B te��tta.. aide a.pt�b93d�e tel: understands and will comply with all non point source regulations.
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farm. Health S, y Code Satieu 255 , 25533.m 21536.1 mtlentmd Iw if the
buiMu�dw mc«mNy hex a th.his rt.pweibilitywmtify0 wcupw .
d0c pri«w' d.Cmifi p.rcy.
Signature of Applicant Date
«wdbvM.p D„e
i All roof coverings to be Class "B" or better
0) OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
' CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Elk: Lot:36217002.00
INVOICE DATE......: 04/28/2000
REFERENCE ID # ...: 00040188
SITE ADDRESS .....: 7816 FESTIVAL DRIVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............. RIDING/DAVISON CREEKLINE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE DESCRIPTION
CHK
TOTAL FEE
PAID -TO -DATE
BALANCE DUE
---------------
BENERGY
---
A
---------
62.10
------------
0.00
-_---------
62.10
BPERMF EE
P
207.00
0.00
207.00
SPLANCHK
A
175.95
0.00
175.95
13SEISMICRE
P
1.50
0.00
1,50
BUSLIC
P
90.00
0.00
/ 90.00
536.55
0.00
� 536.55 �
0