00050011 CTTY OF CUPERTINO - - L „". + PERMIT NO,
BUILDING DIVISION PERMIT CONTRACiT 90R INEQR IATT�iQ-- 000 OO Ol� J•,
41,LOING ADD S: { �//vrn��� �1 g��
—'t" I 1 \r r� ,�t} SANITARY NO. APPLICATION SUBMITTAL DATE
1Ise +1�t Il//�/�iT�yr1 ��.- ,1 ""'t�J� NO CGNTRGL»
H ITF.CUENGINEER L •� {�L� ` 71 11ULDING PERMIT INFO
nwz
X58- 1233
Goa
t, `^ LICENSED CONTRACTOR'S DECLARATION
1 hereby aRw the 1 am licensed undo pm vision of Chapter 9(c.nmlercing Job Description
iniNgationadslif°ivi"onBusinu.W�P7ofeYinmCedfgpdmylicemeis �10 s_ 1_ _ e_ l-1
< in hll face W eHat.C3 ! Tek
u 3�U ucmue Cls acesN '
C u
0t; ARCHI'IECI'S DECLARATON
•.1 1 undentW my place alWl be vYd Y publicrerarde `.+YYY '�J JJJ vvvFFF-��+++`eee..iii
Licensed Professional ,
to, OWNER-BUILDER DECLARATION -
C Z< 1 hereby M.tMt 1 am exempt from me Contractor'•License Law for the -
following rum..(Section 9031.5.It.n Y W Profession.Code:MY city.monty
o w which acquire a pemdl m cowmct,der.improve,demotion.a reps'.any.wrnue
3- fialiYmquinUtheepplicimfa•ahPemdtmfle. ignedviskment $q. Ft. Floor Area Valu [ion
eiuuu¢e.d
met he is licensed ponoant some Provisions of Ne Contractor'.Licuse Law(Chsper9 I�
(c.mg with Section 7M)of Dividon 3 ofea Stainers W PmfeYlau Code).
that he is exempt thocfrom W me basis for the alleged exemption.Mr violation of 9r�N Nober Oce dncy Type
Section 7031.5 by any applicant for a pewit subjects the applicant to a civil Parody of /`� -�••,{J
.mac Dh
Dun Rve undred .rt do11 (g500).
p LY owver MNe pmpeny,amr emwoYere withw.earY Neo-.ole<ompew.dar. Required Inspections '
wiB domewons Cd Ne ay.tum is rams License Law
apply an
W artyProwho
Code:The Contractors,and w IAo doe.a apply ro f .Wm gh
Property wed held..improves North,pr who dos such words himself.0ed for
Ns own employee,provided r improvement soh improvementsw thin Ions inseraded Y oHertd for -
we.IL h.weven ea Wilding rle. f h cold did n.rc yurofc.mple far the
.r-Wilder will have the burden of proving Net he did tw Wild m improve for per- •
pose -
I,Y awn.of the Pee.704,Business
sines and Professions
ro e•cung Code:)
The Ccontranes i-
coamat dprojttt(Sec.70W,Bw of WPmwa Wi Caw:OThe C.n =, d
cense Law doex ont apply to Y.war of Property who sed a improves tlweon.W "
who contacts aaN Projttu withecontrector(O licensed punuYtmthe Cowecmrs -
0 1 wo corn
❑lam eumptuMer Sec. .B&PCfor Nia rteson
Owner • Data
WORKER'S COMPENSATION DECLARATION -
1hereby ill0wceder Pendry of perjury arae of ear fallmvior Workoc lou:
In..as aid will for by eCion 37DD of ConsentmCods,(rcbe Woormm�ceof m-
tion,m Provided f.by Section 3)00 of the Labor Code,fa the pMamarlce of da V O t -
k for which Ni.Permit is lamed. .•w _
I lave W will mdnain Woh<r.Compwation Insurance.Y required by Section .
3700 of the Leber Cole,fa me pfirformance.f d e wort for am
which this Permit is led.
My Wo e,CLl nwti I d Policy numbergb -
'C�rinr. olicy No:
CERTIFICATE OF EXEMPTION FRR S'
COMPENSATIONINSURANCE '1
-
(Thi.sardon roednohcompletedifNe pemtit ie forauhurchrcd dollae(5100)
ur kY.)
' Iccni(y Net in thepea rceofNewak(.which Ni.permit iviteue41Nd1 '
rot employ an in my a aubjeea to the Workers'Compen-
YtionLaw. 'f a
Applicut
NOTICE TO APPWC N': ,a nuking Nis nifcato of Exemption,you should -
hecome vobjart m the Vah Comported..Provisions of ftIahr Code,Y.most _
f.rthwidt comply with h vision.orNis pewit shill be domed rooked.
CONSTRUCTION LENDING AGENCY
Q 1hereby affirm this ft.uaco.wcdon lending UUy for the perfanunce of -
me wmk for which this pewit is oso ed(Sec.3097,Civ.CJ s
F. lender.Name .
(Yi > lenders Address ,
Til Q I caddy that 1 have rw red.appliwion W sure thac Ne above infomudon is ,_ -
wct.l agree m comply with all city W county aNlnuxu W sea laws relating to
i7 z building cora.uceon,W hereby suthoriY ri,manutives of this city to seem sm has
U 0 •have-mcommod propeayf.imyecdm pmpnrea. '
W ter (We)•grin•m Yve.indemnify and tarp harmless the,City of C.Pcm-againn
V Iiabililics.Oudgmrnta<.eWa sea which nuyinany way accme agdmt Yid Ciry
aFa IAPPLa
APPLICANT
UNNDEO RST "AN '111 ITH ALL NON-P01W
V AP
t
Si . , arc n D S —' 2.—DD
e Hk RDOUS MATE RIALS DISCLOSIIRC
Wel the liunt< forum Wilding.cupmt.lortor handle hezudaua malerid -COOS
as def W by the ani Municipal Code,Chapter 9.12,W ea Health W Safety
Coda stttion 25532(. Type of Roof
❑Yew a
Will ea applicant orfumrc Wilding acupmt use equipment or device which All roofs shall be inspected prior to any roofing material being
emit hazarons air contaminants Y rcd
diinants defiby the Bay Arca Air Quilty Management installed. If a roof is installed without first.obtaining an inspection
Dictim? I agree to remo ew materials for inspection. Applicant
E]yes NN.
IM.mad the hsvrdoua eeterid. un stands a ill ' h all non point source regulations.
rt.2533 rats seder Chapter h.95.f the Cali-
f.nu Health&S 'au 23505,2537)W 2553<.1 uedersfth ew if N r /p
Wilding down wont veer t. Yrtxpauibllirymnotify the p
.ccuant
hie '.lo uv .e of a Ceni cea '
Signature of Apple nt Date .
Date -All roof coverings to be Class`B"or better
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
�l
BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Tp: Rng: Sub: Elk: Lot:36202032.00
INVOICE DATE......: 05/02/2000
REFERENCE ID # ...: 00050011
SITE ADDRESS .....: 21446 HOLLY OAK DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: FLEER RICHARD P AND NAOMI H
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4928
CONTRACTOR .......: RADONICH, GARY LIC R 17814
COMPANY ..........: LOS GATOS ROOFING
ADDRESS ..........: 1771 SMITH AVE
CITY/STATE/ZIP ...: LOS GATOS, CA 95030
TELEPHONE ........: (408)358-1233
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 217.00 0.00 217.00
BSEISMICRE P 1.60 0.00 1.60
--------- ------------ -----------
218.60 0.00 218.60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FRAME 307 INSULATION
ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS