00050126 ClBUOF
ILDINGUDIIVISIIONNO CONTRACTOR INFORMATION: PERMIT No.
PERMIT DDOO 0!
ILO NGADDRLSS: 1 i r APPLICATIONSU SANITARY NO. MF ff-fl
��15Z Ali►rl�v�lit I�v>° ncP -i�r►er9 Air S
Nnxr:O . V
NFC CONTROLg
17`btP-47 /� /vyf 15M /p� °
{ITECTENGINF,F.R �rn'�lj�ll LYa D a+' IULDI,A'G PERMUy INFO
D zO z • �.��1✓tea I
p^s
«U
mad
zo„? Inttebr,msimroa w�naeR• �nen vrtrsammne.Nmg Job Description
^w with Section]Iw0)ofDevivon3or Busim[e d of CmYlicmmis
y., in full force°sr�R< l 1
p, W U �Li ' O l
y 3 a N Demumc [sunned .ITV/\k 1T�,T 1—/' 1T
r u O gARCHITECT'S DECLARATION
1 understood my plans shall Mused ea public eeamat
w O z Licensed Peoft,ssionul '
c ou y OWNER-BUILDER DECLARATION
1 hcerby affirm that I am eaempr from Ne Cpmrarrors License Law for the
f F C following mason.(Section 70313.Bromems end Rofwiona Code:Any city or county
u. which respond a random codons,Who.innprove,demolio.or repair any mucturc S Ft. Floor Area FJ atigH�q'�
,nand iui,monme.WA."ones tMapplicmt for[wh peanut to fileeeigned autemmr q' ij (JV
thatheislicensed Wrsuanrmtheprovisionsof Ne Cmn 'LiummUw(C PW9 r
(enmmeoring wiN s«and]two)pr oiviaien3prtne Bpeine.a ma Prnredinn.caee)m APN umber Occupancy Type
that he is exempt Marfrom aM she Mai,for Ne Alleged exemption.Any violauon of ,�-s -S / _ ' ! nh P Y YP
Section 7031.5 by any applicant for a permit subject$the applicant too civil FWARY Of r J( L `/V_ r--� V
a mom Nen five hundred dors(5300).0
I,asownn Oftltcpruperty.mmyemPl ymwithwagdutlmirwlecompedafim. Required Inspections
win do Ne work.and the summum jaws intended conform for ssic(Sec.7(140.Buineu
.it professions Code:Thee.thadmi License w fad dm oder apply to lf Owner of / —Y (J
li
his and who builm,pr improvd theachn,end who does e a work himself ramal for /� (/ n L. �J
M,,cinowclat.deprodciedr improvement
each mentisoldw are not intended Orretiredfar 'mow
We.l-however.ted Wilding or im Of farming
ix sold within one year of completion,dr.
nerbuildtt will have the burden of,renin{that M did ata Wild err improve for pro-
pose of mile.).
❑I.a ownher of the popery,am caclu Ncly rim...'wit,liunssd crag.to
consumer be proj«t(S«.7004,Business nil Professions Code:)The Contractor,Li- A
ceme Law done WE apply to an owner of progeny who Wilda in improves ted mon,anal '`—
who cmLewsformula proj«u diNaconvecmr([)Remand Wnumtm me Contnmtor[ \V\
Eiceare Law. '7
❑1 em dempr order 5«. .B R P C far this moan
OwnerDam O
WORKER'S COMPENSATION DECLARATION O
1 hereby a?m under penalty of perjury We of the following declaration41 :
1 1 have red will maintain a Caniftcam of Cax«mt to self-inwm far Womel-Compen-
rim,u provided for by Section 37W of tW IaWr Code,for the perfomunce of the
work for which this permit is issued. ,
❑1 have and will mu)pis Worker',Compensation IOsprmce,u rtsuired by S.-MO
Mywak,es Cpa/rte wtwn'<of ds wok for whish this pcmu5 is iuyckk
My Workers u I e camtt and pro,
fee
which this
s t 11 N1
Cartier Policy No: '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This"«rim need.Mcornplct difrhe Irrom is(Dromic hundred dollars(SIM)
or Iess.)
I unity that in the peddemarre.fthe work for which Nis permit is wood.i shill
rwt employ my person in my menmr An as to Mcome cobj«t to the Wooten'Cr mpcn-
sation law[of Califomie Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,yw should
Wed.subject to Ne Woekasa Comiami.d n provisions of the labor code.you mutt
from.th comply with such provitirna or this permit shill M deemed mvok d.
CONSTRUCTION LENDING AGENCY
Q Q I thereby alarm than Vert is a conaucuon leMingegency for the peRomume of
Z Ne work for which this,moan isissued(Sec.3091.Ca.C.)
tandem Name
Tyr > i,moweA Acidic.”
W I unify Wt 1 have rum"a application and awe dol Ne above information is
d 0conew"I agree to comply with ell city and county Ordinances tad Aute laws misting to
Z building crostmetinn,and hereby Audience representatives of Nis city m ensu'upon ate
V Q above.maddened property for inspection progress,
s E„t (We)agree to uvea iMamnify and keep hamlda Ne City of Cupertino against
Q V liern)iud,judgment$.come and expenses which may in my way secret,against said City
�. W is conusucnce of the 8rantir,of this permit.
APPLICANT UNDERSTANDS AND WI I.I.COMPLY WITH ALL NON-POINT
VSOURCE REGUTATIONS.
Signamrt of ApplicmUConvactor Data
HAZARDOUS MATERIALS DISCLOSURE
Will ted epplicanr or future Wilding nacupant store or handle huaNOu[mamnial Re-roofs
ae defmcd by the Cupertino Municipal Code.Chapter 9.12.And Ne Health and Salary T e of Roof
Code,section 25532(q? YP
Ely. ❑N,
Will the applicant or foure Wilding«nulwnt use esuipment ofdcvivawbich All roofs shall be inspected prior to any roofing material being
emit harardmn air conomnnu a
iidefined ay by Ne BAres Air Quality Management installed. If a roof is installed without first obtaining an inspection
loon't] I agree to remove all new materials for inspection. Applicant
C]Yea FIN.-
understands and will comply with all non point source regulations.
Ihave eadthe hmard,p,mawil,m,piummrsmme,GMprer695oftMGa,i-
farmer HdIN&Safety Code,Savona 25505.25533 and 25536.1 undersand Lord ted
building does not currently have a tenant,Nar it is my mmunuhility in notify that occupied
of the"u'pement$which must M met prim to issuance Of•Certificate a Occupmry.
Signature of Applicant Date
Owner or aulhotired agent Date
All roof coverings to be Class"B"or better
OFFICE
CITY OF CUPERTINO
4 of 4 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
� COPY N 1
Sec: Twp: Rug: Sub: Blk: Lot:32624043.00
DATE ISSUED.......: 05/18/2000
RECEIPT q......... : 12272
REFERENCE ID # ...: 00050126
SITE ADDRESS .....: 10152 PENINSULA BLVD
SUBDIVISION . . . ....
CITY .... . . . ......: CUPERTINO
IMPACT AREA . ......
OWNER ..... . ......: MANOJ SRIVASTAVA
ADDRESS . . ........:
CITY/STATE/ZIP ...: SUNNYVALE CA, CA 94089
RECEIVED FROM .... : TIM
CONTRACTOR .......: GENTILE, BILL LIC N 21328 '
COMPANY .......... : CONDITIONED AIR
ADDRESS .......... : 164B GILMAN AVE
CITY/STATE/ZIP ... : CAMPBELL, CA 95008
TELEPHONE ........ : 14081374-6311
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ------ ___ ___-
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
---------- ---------- ---------- ----------
le PERMIT : 49.95 0.00 49.95 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 197.58 10759
TOTAL RECEIPT . 197.58
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL