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00020041 CITY OF CUPERTINO „' V��]'/✓✓ PERMrr No. PERMIT TORBUILDING DIVISION NRT ©OOZ BUIIAINGAD � )) 00 / TARY NO. M AOATS 7mIA / SANI 'a � y[;0" Ekes N4ME /(fJ NN //ML 119N/C CONTROL P11 pNQyuia111r�t', �A s�fs-�72 � ARCHH'ECUENGINEER 0/IZq 3 -20 /2 - ' 'ffUl':DING PERMIT9NF0':,:!.ig"� Oc J�/ y LICENSED CONTRACTOR'S DECLARATION 1-11 Z O_- I hncby athnn div i am licensed under provisires of Chafer 9(<ommcMn Job DeNG IIOn O with Satiote7000)ofDivision3df the Buainsead Rofeuion Cah,ad my ice s /� ce Y,4 in full fora rod aaL „vis— O Us.Claus ,�Q� Lie.N aq Dne ConnectorAlex ARCHITDECLARATION on vU< 1 deoued my Plans shall W used ea public rccods ECT'S ' w 55 0 O Uor sd Rofeuiooel c (� OWNER BUILDER DEC TION - t Z 6 LMmby aRrm that 1 an exempt from the Contrasmfa Liam law for the E F G tollwring reason.(Section 7031.5.Business W Profeauooa Code:My city a county iC Lo Which user e t Io conswm,Nur,impostor..&.)to,of an,a enter, 3 m prim a its issua regtnires the applicant faach permit m rite a signed statement Sq. Ft. Floor Area Valuation that he is licensed footnote,to Ne provisions of the Generators Lienee Isw(chapter9 (comsnncing with Section 7080)of Division 3 of the photons.and Rofes.iom Cods)or that he is exempt thesafrom and re bait for Ne alleged!axeompAny vioatioof ,`+J ANNY`�he^r Q Occupancy TYP e Sectionby any applicant fm a permit subjects the applicant to a civil Penalty of not m mothen five hundred dollars(5500). Las ower or Ne papeny,m mY employees with were.u Nei..ole compo strums Required Inspections will Botha wmk ed the..num i,not inuldcd or offered for We(Sas 7044,Bminas and Profeselom Code:The Contractor's License raw dm not apply to an owner a popcny who builds,or improves thereon,and who div such wo It himself or drought his we employees,provit d the such impovements are nm inumted or offered for We If,howaur,this building or in, oversom Is sold withinon yearofnongldm,the ownt4Wilder will hexe the harden of proving that he did net build or impru•u(or puri- pose of We.). ❑I,as owns of the property,an exclusively conoricting with licensed nontncrora to j construct Ne project(Sec.704ons 4,Business and ProfessiCade:)The Connector'.U. cense Law dna on apply m an own,of Property who builds or immoves thereon,and �� who contracts for each pmjecu with a contmcmpursuant ma r(a)licensed pursuano the commotion. Unman Law. . . A I nm eeemp'soda Sec. .B&P Uor Nis rosin O Owner Dau WORKER'S COMPENSATION DEC TION • r hereby infirm under penalty of pedurY orae of the following dec Watim.: ❑Ihave end will msinwn•CedOcae ofConsatmself-insurtforWorkdaCompn- Wpmvidd fm by Salim 3700 of the labor Code,fm the p domunce of the We, which his permit is Wood, have ad will malnuin Wdhah compensation Imurance.u required by Section »'Xo a laborCode,o the races comeofata wmk(orwhich Nispandit ie ieeud. My WorkW c. p =tion In Amo-rse�a-sYp enter and Poltry99�� Cartier Wi X10E+/V L�Policy Nu.:A%nEpm1DlA - - CERTIFICATE OF EKEMKION FROM WORKRRS' COMPENSATION INSURANCE (This session need no becornplcud iftha pnmilix forme hundred dollars(1100) m leu.) I certify Out in the performance of the work for which this pence,is intend,l shall not employ any person in any manor u as to become wbjat to the WorloW Compete- attire laws of CNifomle.Dau Applicant NOTICE TO APPLICANT:If,after making Nie Onnifsate of Exemption,you should Mcome subject to the Worker's Compensation provisions of the tabor Code.you must forthwith comply with such provisions or this permit shall be deemed avokd. CONSTRUCTION LENDING AGENCY ' O p I hereby aRnn that them isacoeswNon kndingagencyfonhe perfomuocem' N the work for which Nparrot is part is issued ses.3097,Civ.Q ' F.. 4 Undoes Name ' Iander's Addre.cu Gil 0 1 certify ties I have roll she applialire old sou that the above information is V 0 corri l agres in comply with all city and county endurances and mu laws relining to building con tranim,anal hereby aulhaim representatives of Ods city to enter upon than abovecmemided property for inspection pur,su. La. F. (We)agree m save,indemnify aha kap harmless the City of Cupertino against O ,, Iiabili,ice,jdgments,costs ad apensa which may in any way sector,against said City >s S in consequence of du&NS. of this p, APKICANTUNDEDSA' II.LCOMPI.Y WITH All NON-POINT' SOURCEREGULAT Sigmturt of Applk tenor EEOae Ll 45 Route MATERULS DISCLOSURE WiseyteC fo�umwalogoccupant r9.12."tehaudousmmerial Re-roofs ' u dcfstd by OUC deo Municipal Cdr.Chafer 9.12,ad the Health ad Safety Cme.Senimus32fa)7 ` / Type of Roof (Dyes [JRO Will the appliant or future building acupent use equipment or devices which All roofs shall be inspected prior to any roofing material being "emit havdous air conuminan e0nd by the Bay Area Air Quality M=agement installed. If a roof is Installed without first obtaining an inspection . District? [3 yes, I a ree to remove all new materials for inspection. Applicant I have read the hanrdca.materials rwTuu unennmiler Chapter 69the 5 of Cali. un erstands and will,comply with all non point source regulations. farce Health d Safety Cade.Secums 25505,25533 and 25534.r unde,aund Nu if the � / Wilding does ted atremly haveetcmnt,thst it is my responsibility m nmify du consultant ' 0,he ration to vhich musstrmet p,ieruusuene oft Celli ceuM ceu Signature o li tet Date OWnrIX=Non • cm � am ' All roof coverings to be Class"B"or better OFFICE I w' RECEIVE]D September 22, 1997 OCT 0 6 1997 BY: City of Cupertino —�— Plan Check Division 10300 Torre Avenue n Cupertino CA 95014 Building Division: I am writing this letter in request of a permit extension for the SFDWL project located at 10070 Hillcrest Rd. in Cupertino. In January of this year plans were submitted and fees paid in the amount of$2,346.00, for permit# 30829, control # 8330. The fees broke down accordingly: $1,734.00 for Plan Check (428-010) and $612.00 for Energy (428 . Currently the project is being revised add altered to meet the city requirements. I am diligently working with the architect and engineers to expedite this project as quickly as possible, however I feel that we will need more time to finalize the plans, re-submit them to your department and begin construction of my new home. Your thoughtful consideration of this request is greatly appreciated as this has been a very frustrating process and I am anxious to complete this project as soon as possible. Tank ou, Christine Adzich cc: Bruce Bolinger Please respond to this address or phone number. Christine Adzich 10085 Carmen Rd. #4 Cupertino CA 95015 (408) 252-4787 •