00030014 CITY OF CUPERTINO PERMRNO.
BUILDING DIVISION PERMIT . CONTRACTOR INFORMATION:
00030014
OQ300 '
BUILDING ADDRESS' /'/f�0NSU T
a ^ I O /✓/A[/ /� �Jrf/A/!//l/..•./� SANITARY NO. APP / / 40V DATI
E AMI" 2^ /�J']G ///�� U/ NIC COKfROLN
G 257. 9 % /a (//�52, C'/� 95//2 ❑
ARCHI'IECT/ENGINEER HULDIN(1 PERMIT'INFO
=a z 94k-�29-'77
<¢y
LICENSED CONTRACTOR'S DECLARATION
z O z I hereby affirm that I am licensed under proviabm of Chapter 9(C.7=61
O ming Job Description
OZ-Q__w with Seetin>000)ofDrvision3 the Busiircea and%fevivw m
a m in full force and erteet. y. hrf((((M 2
s a I ansa I
�o i O Date � Contmmr
nom.O gARCHrrF,CCS DECLARATION
5 1 understand my plans shall W used as public records
a.
c E C O Umneod professional .
I[Si o o, OWNER-BUILDER DECIARAIION
1 hereby effort that 1 am exempt form the Contractor's License Law fm the
s O following reason.(Section 7031.5,Business and loot mom Code:My city a county
.t-m which mummer a permit m emutrom elan,improve,demolish,or repair any sausme
prior to itsi,ssuance.alsuoximiRstheapplicantfmsuchpemitWfileasignedsu4mrot Sq. Ft. Floor Area /vatlBalj�on
that W is licensed poruanuo the provisions of Ne ConO.Wea Licenu la-(Chapel 9
(comm<ndngwuh Section 7=).1 Division 3 of the Business and Perfeuiom Codc)a APNNum er' ane
Occu
that he is essmpt therefrom and the basis for the alleged exemption.Any violation of Type
Section 7031.5 by any applicant fee a permit vuby.ts the applicenno a civil penalty Of - 2
Occupancy
G/
nm muse In.live hundred dollen($500).
❑I,a.owner.rNepropang.mmyemployee.wiNw.gesuthci,wlerompemai.n. Required Inspections
will do the work,and the awcwee is not intended on offend for set,JS..7044.Bmiace,
and looresse".Code:'DIe Contractors License law does nor apply to an owner a
progeny who Wilda or improves thereon,and who does such work himself or through
his own employees,provided than such improvements are 1toI intended Or offered fm
WC,If,however,dm building or improvement is sold within one yearofcompledon,the
ownto-siker will have the handle.of proWng Nat W did oat build or improve fa pur-
true or owns
1,as ow of the PropenY,em exclusively convectin8 with licensed conuacmn to .v!
onset the pojmt(Sm.7th.Business and Profession Code:)The Contractor's Li.
,Coss Lew does rant apply to an.wner of property who bonds or improves Ideon.and
who contracts for such projects with a com acsuRs)licensed pursuant to the Contnctoes
Licenu taw.
I tan exempl under See. .B A P C fa Nis rcvon 10
Owner Dam O
WORKER'S COMPENSATION DEC RATION
1 hereby affirm under penalty of perjury one of the fallowing dmiansubma
I hove end will maintain a Cenifntc of COmC-I m self-insure forW-Ime-Compere
tion,as provided fee by Section 37W of the labor Cade,for the performame of the
V, forwhich this permit is issued,
have and will maintain Wahcia Compensation latmeace.as bol-Wed by Section
3700.(the Lebon Cade,for the perfonnmme of the work for which this permit is issued.
M: o ion 1 cs n.Po Potllocy nambmnte���,
CERTIMCATH ,EXEMPTION FROM WWO�/RICERS'„i f/J
COM NSATION INSURANCE
(This second need not W competed dthe,pemdt is fmone hunAed"'Its($100)
m less.)
I ronify tout in the pmfomneme of Ne work for which this permit is issued,)shell
mI employ any pc.in any mentor so m to become subjeel to the WOhcra'Compery
station laws of Calif xam.,Dau
Allwanl
NOTICE T7 APPLICANT:1f,after tanking this Certificate of exempdn,you should
become subject t.the Workers Compensation provisions of the Labor Code.yen must
forthwith Comply with such provisions or this permit shall W darned revoked.
ZO CONSIRUCDON LENDING AGENCY
O Iherebya n.tMl Nero 4.m.umedon lrndingapney for 1W performance of
Z 01e work for which this p Z is issued(Sec.3097.Civ.C.)
Im ake,Name
a >_ Lender's Address
Ism 1 oenify that I have read this application and stem than the above information is
L Co.,.I epee to comply with all city and county o shmamea and sues laws relating.
;; z Wildim,oaurrommn,end hemby.whoniu mpmarnalivea ofthis city In enter upon the
U O eicve-oun inned a.RnY for inspection purposes.
Lsx F.m (We)agree m save,indemnify and keep hamdesa the City of Cupertino against
O [) lubdises,judgments.voxes sed expenses which may in any way acme against said City _
�.n Wn consequem<of the ting of this
f"m y tAPP1.ICANT UND IS AND.' IWILLCOMI'LY WITII At,[,NUNAYy1NT
1..) z SOURCE RI:cut t 2 12 _— w
r
Signature oIApplicC m - ate D C, ti`7Jk�
DOUS MATERIALS DISCLOSURE
Will
ytapplicant
ftin forum Wilding e.Chu,tstnrt2,handle Heardousmemety Re-roofs
m defncd by the Cupertino Municipal Code,Chepur 9.12,ted the Health and Safety Type of Roof
Code.seers..n532(.)? / YP
Cl YC.
Will the applicant.,future Wilding mc.,anl use equipmem or devices which All roofs shall be inspected prior to any roofing material being
emit haurdom air contamimnu as defined by the Bay Area Air Qnlity,Management installed. If a roof is installed without first obtaining an inspection
"'i”? I a nee t remove w materials for inspection. Applicant
❑Yes
ha a e.ddRha,daamamrial no,ummems.'Chapm.b95.fthee.li- un snort ds a ill comply with all non point source regulations.
fano Health 8:Safety Code.S s 25505,25533 end 75534.1 understand thn if the
building does nor lyha uenw,malilismy respoosidlitytonotiry(Woccupant 2j
oftWtmrmtpfiawsssuaneeof.Ce�yfc Rf
LGh/( Signatu Applicant Date
tywne,.roam : m LL �m
All roof coverings to be Class"B"or better
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
I'
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: yvonnek
Sec: Twp: Rug: Sub: Blk: Lot:31602094.00
INVOICE DATE. . . . . . : 03/02/2000
REFERENCE ID N . . . : 00030014
SITE ADDRESS .... . : 20200 LUCILLE AV H 40
SUBDIVISION . . . . .. .
CITY .. . . . . . ...... : CUPERTINO
IMPACT AREA . .. ... .
OWNER .. . . . . .. . ...: STONESON DEVELOPMENT CORP THE
ADDRESS . . . . . . .... :
CITY/STATE/ZIP . ..: CHICAGO IL, 60661-3693
CONTRACTOR . . . . . . . : LIC 0 19625
COMPANY .. . .. . . . . . : ALMADEN ELECTRIC PLBG A HTO
ADDRESS .. . . . . . . . . : 1278 ALMA CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408)995-6411
NOTE:-THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- -__ --------- ------------ .----__-_--
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
_________ ____________
45.51 0.00 45.51
10 ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ -------- ..._...e..................
_.
502 FINAL PLUMBING ENERGY 506 GAS TEST
509 FINAL PLUMBING