00050124 CITY OF CUPERTINO - PERMIT No.
'iSIJILDING DIVISION PERMIT CONTRACTORINFORNiATION: O,
B DNC AI) RE njtiI( jard �,.a_1.` 0,,a�/�,/� I/ -;� SANITARY NO APKA^ION SSUBMITTAL DATE
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RCH11MCDENGINEER Vga a'INt P Iran`'•1 ✓ 1 JBOLDING PERMR INFO
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LICENSED CONTRACTOR'S DECLARATION
o Ihereby.jymthat l son licameedunderpmvisiauofChapter9(commencing Job Description
F,v._w�{ withgeclion 7000).(Division3afthc Bminesaand Pmfesa',IV�mY lisxnrc SIC,
1�^-{�-J1
d U in full force.vy<R a 1 C 2 +,^ c/ �� O. 1 ' -
0 6 a U Uma Cla L�(�Conwc� J Y 1 Il/b lT�
ARCHREC;DECLARATION
I undersand my plan shall W used u public s>mds
i O Lleansnd Professional
OWNER-BUILDER DECLARATION
C z G 1 hereby aRno that 1 am exempt from Ne Contractors License Law for the
damF
in follwnng i .(Section 703 I.S.BusiMss and Pmfmions Code:Any city or county
which uquimr a famdl In comma"that,improve.demaiah,or repair my nmcmm Sq. Ft. Floor Area
NIuatiOi]O
prior ae is isroence,also require.the applicant for such pemdt to file a signed suament 1�V /` )at he is licensed pursuant to Nthe e provisions of Consusors License Law(Chapter 9 6 l./
its,he is engwlNSCIfromtra and the
basis for of al aged ea and...Any
lm..0I C_ Number Occupancy Type
that he is 31.5 b therefrom and the bums for Ne alleged exemption.Any it Pmahn of 3 y
Section]W L5 by any applicant for a permit subjects Ne applicanno a civil pemlry of
rot more Nen five hundred dollars ISSOD).
❑I,.anwnernrNepmpertY.remyempinYa.wiNw,gn..dKir-le amnpam,dnn. Required Inspections
will do the workand theemicture is not itecialm or offered for We(Sec.]OC4,Business C A / 7 7 7 2-29 2, r/
and Pmfiandow Code:The Cmaractois License law does trot apply lis an owner of ( l— d
property who builds Or Improves therenm,and who does such woh himsdl m iluvugh
his own employees,provided Net such improvements an,am intended or Offered for
We.If,however,Ne bonding or improvement is rola whin one year.fcompletim,the
mimm.Wnd«win have the harden of proving that he did not Wild or improve for for-
pose Of sale).
C]I,ex owner of Ne property,or exclusively corseting with licrnsnd convectors to
construct the projm(See.7w,Business and Professions Cotler)"a Contractors V-
cense law does we apply to en owner of property wW Wilds or improves thereon,and
who comacts far such projects with a contnctor(s)licensed pursuant to Ne Communes ,
Limns law.
0 1 sm exempt under Sec. .B At P C for this mown
Owner._,1":2 Dem
WORKER'S COMPENSATION DECLARATION
I hcmbY affirm under penalty of perryry one.(the,fallowing decuntiom:
40 have and will for
by Section 3700
of Coventto sclf-imutohe arlhcnu Co of the
tion.r provided!or re Swoon 3]00 of the Labor Cade.for the peRomunee of the
work fon which this permit is issued. !'1
IN end will mu' vin Wm is Compensation Insurance, rtquired by Sation V
3700.( I. ormuu<of the woh(ter whichh Nis pylpy}{y{u
My worke' wvonl u ecarrierand Polic: 'IWg II
Carrier Policy No
CE 1FlCA1E OF E N FROM WORKERS'
COMPENSATd AnONSURANC'E
(This w<esinn need non h comcompletedifld I ifthe permit is forone hundred dollars($100)
or
I certify than in the of..of he work for which this permit is issued,)ah"
w employ any Person in any mourner an as no become vi to the wohars'Compen-
sation Iowa of Califamia Data
Applicant
NOTICE TO APPLICANT:if,after making Nis Car ificave of Exemption,you should
become mbject to the Workers Compensation Provisions of Ne Labor Cade,you most
farwith compl yw,m such previsions or his permit mill be demand revoked.
CONSTRUCTION LENDING AGENCY
O Q I hereby aRnn out there is a communion lending agency for the performance of
z the..,kOn which this permit is issued(Sec.303],Civ.C.)
=
CITY OF CUPERTINO
2 of 4 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY W 1
Sec: Twp: Rng: Sub: Elk: Loc:32644063.00
DATE ISSUED.. . . . . .: 05/18/2000
RECEIPT q... . . . . ..: 12272
REFERENCE ID # . . . : 00050124
SITE ADDRESS . . . . . : 21485 MIL LAR D LA
SUBDIVISION .. . . . . .
CITY . ......... .. . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ..... . . . . . . . : LINA MARTIN
ADDRESS ...... . .. .:
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1320
RECEIVED FROM ....: TIM
CONTRACTOR . . . . . . . : GENTILE, BILL LIC # 21328
COMPANY ... . . . . . . . : CONDITIONED AIR
ADDRESS ...... . . . .: 164B GIL44M AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE .. . . . . . .: (408)374-6311
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ---------- .
BREMACOVER NO UNITS 1.00 14.43 0.00 14.43 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
---------- ---------- ---------- ----------
`,•PERMIT 49.95 0.00 49.95 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
.....e.. ............................ -------- ............................
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL