00060181 CITY OF CUPF,RTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: [117lZ 11N640 /
OWNER'S NAME: - AI'I'LI TION SUIT DA'I'S
c � - LZ00
'IIONIi: SANIq'ARY NO. COM Rol.NO.
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p s i ARCHITEC IENGINGER: BUILDING I'BRMI'I'INFO
BLDG F:LIiCT r1.UMB MECII
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z�y Z LICL'NSIBJ CONTRAC'p1R'S DIiCLANA'I ION
O Inemnr alrnn that Illicit B«sae ander nrn.nionsor cnapter9a'Exmmencing lob Description
OmFW with Sectinn]O((llet Divien 3 if he Broine"and pnsfc,sions Code,andmy license
G m y_I. I.in full force and effect. / �t
< I.laa,e Class —��_ ue.a_.2_ _3f y —2/at�E- �/1.9�/9 �� 2-s I m
x c e.u )rm.� �/E^ Cnmmctor%e .
ARCH]I'ECf'S DECfA 1�Y d
f-=0< larear,andmy plerdhrdl be eaJa.spublic records C ,I
5 ,
License)Pm(aaianal
Oat I am exempt treat
at the 12ATION
u 1 hereby shoe Inlll 1 1. exempt from the Contractor's Lima,c Law lin the
h z a following reason.l5wiian](]31s,Business and iso.da mlir C.Eli Any city m c iturc
PD wh'ct y p.ratio l t I 'II a. I link 1' y:vnc urc
ei
a..5 L poen t Iso y -th pp1a If rna its 11 Saw(Cha nem
(tall with
nus tt n p : as nn c I I r, - L IchaperY Sq. FL Floor Area Valuation
(c that he is a with Sorbet oto and
a Basi n 3 of the Nasonex aidtop Proion.Any
vi Cole)
of that he in exempt therefrom unJ the t imbofor the alleged exemption.t.Any violation
Ell andaSection than y any ured drift for IM),t wbjttp the:mPlinml fo a civil penalty
of nm marc man Bve(soars)JExIwr,IsswB. APN Number Occupancy Type
❑L ux owac.of me plop arty.m rtty atol,layecr welt wings,Ir,m.....ae eoa(pealroce
will Jo the work,and the structure is not intended or offered for are
(sec.eu4.
fit, ad Pr.ne, .Code:y he corttntamra t.iamu Law does a,,,apply m an Required Inspections'
ae,a son
r ugh hisow Who liglas or Improves thereon,and who encs m n work intended
or
or end let his own I v,,,I.t,a loodia that such improvements Eli
urc not iatenJcd or
cBwal Rn nate.IL nnwrilde ai building m improocmaos n(old within nne year of
completion,the roc of gilder rill have the burden nl'pmving that he did nm MtiIJ or
lo
iotpm,c for ptlrryne Exr xale.l. /
❑1 f be picapeA,..I cl.i,cly contracting with licensed contractors to 6�
est t da,p 1 't IS 71M4 B rvs I Proic,ions Cwt )ATE,Contractor s
Li cerise Law does not appIv to an of pim,gerty no Im Id r inaproves Ihercon
and who f
.on pormce, nn t t r(.)licensed poreent m he
Co CutLa..
01..1 exempt undsr
Svc. .B d I'C for his rear !'r
Owner Date O
WORKER'S COMPENSATION DECLARATION
I hereby affair under penalty of perjury one of the litllocr ng deelaatinns:
❑ I have and will n lintain a Ccrtifcate of Conseil u, selhlnwro fur W..Ler'x
Compensation, a provided lin by Section J]IXI of the Irlwsr Cale, for the
perfur Bance of the work for which this pennon is issued.
❑I base and will common.Worker's Compensation Insurance,a,required by Section
37141 of the Labor Code,or the portio:mer of the work for which(his lemon is
issued.My Worker's Cotnpenmtion Insurance currier and Policy mmnder are:
Carries policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COb1PILNSATION INSURANCE
(This.action need not he completed if the petmlt is for one hundred dollars '
($10)or tens.)
I sonify that in the performance of the work for which this permit is issued,1
shall not empiny any c,,E in any(moor ,,us to heconm sah'Ieaa m the Wndcrn'
Compcn,ain�a-�- of Californiai. )ate Qd
Applicant(�.f _
NO'1ICE'9;AI ICAN .u ac Ing�'em true "em.you should
Mmmac snhjcn at the W( is Compensation pmvisionso Ltber Code.You must
Z
Q hadesith untnply w,,h.nch Provisions,r this Pcnnl t shall be dccnred re,,Kill
F ry CONSTRUCTION LENDING AGENCY
as ' 1 hceby ulhich this peen iss anted(Sm. IonJing ngcncy Int the perforuwnm
of the work for which this permit is in,ucd(Sac.11(19].Civ.CJ I g
W Q Leader's N:ram 2-
= Z IsnJch AddressV 1 certify that I have tad this apilinctlo11.1111 state Ibat the Wove inl'nmeei se t,
carrel 1 agree ,comply with all city and county ordinances and ,are laws misting r
Q I, toh(ol)ing construction,and nembyathnrim m,maentmives ofmis city to enter.Mm
} (r] the uMwe-mentioned prnleny tor ins,see loo purposes. ,
E•r p, (We)agree mwve,indemnify and keep lannlc,the City of Capenlwa against
t7j liabilities,]ad,men...cots end ex,tasc,which miry in any way accrue.gni o,snid
V z City in consequence of the gaining of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINr Issued by: Date
SOURCE REGULATIONS. - y'
Signature of Applicant Contractor Date Re-roofs
HAZARDOUS MAI'ERIAIS DISCLOSURE
Will the applicant or future building Excellent same ear hal lmaatJom material Type of Roof
as of anal by the CIT1111l1111 nWoid prd coda.Chapter 9.12,sad the Health and Safety
Code.Section 25532(a)'l
❑Ye, ONE, All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fmumboaddlog(seapad aae,.ipamm.ndeviecrwhicn If a roof is installed without first obtaining an inspection, I agree to remove
emit i"i i,,ns air conauod'act as defined by the Buy Arca Air Qual'ny Mmagement
District^ all new materials for inspection. Applicant understands and will comply with
0Ycs 0N all non-point source regulations.
1 base mad the tel Moos ntmerials testimonials ander Chapter 695 of me
California health&Satiny Code.Sections 25585,25533 and 25534.1 understand that
if he huilmngEric,not aormaly have a enunCthal it is ltry rmP.....hili,sanity the
(wearied of the requirements which must be met prior of issuance of Certificate of
Occa.oteY.
Signatu of icant Date
owan is,aammvrd,,car 1� to All roof coverings to be Class "B" or better
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:
INVOICE DATE.... ..: 06/30/2000
REFERENCE ID # ...: 00060181
SITE ADDRESS . . . . . : 7813 LILAC CT
SUBDIVISION ... . ..:
CITY ..... . . . . . . . . : CUPERTINO
IMPACT AREA .......
OWNER ..... . .. . . . .: BRINKLUND
ADDRESS . . . . . .....: 7813 LILAC CT
CITY/STATE/ZIP . ..: CUPERTINO, CA 95014
CONTRACTOR .......: 'LIC #
COMPANY . . ........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ --------- ------------ ---------
BUSLIC P 90.00 0.00 90.00
EPERMITFEE P 70.42 0.00 70.42
PPERMITFEE P 70.42 0.00 70.42
_________ ____________ ___________
230.84 0.00 230.84
l� ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ --.........................
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL