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00030066 CITY OF CUPERTINO PERMITNO. BUILDING DIVISION PERI CONTRACTOR INFORM ' ON: Drs BbI U/ILDI]]NGADDRISS: j� a/�D D l:`✓ 1- ��`I I L�' Kp v L C;t L • .�,r /�. SANITARY N(l. APPLICATION BMITTAL DATE owN[i�5�IML� �t:,i I 1'. ✓1111 i /J J�IP SCt/T I r�LIC /tNf� N/C CONTROL# q �szy f-{OJ' �7 _ (o SOQ Sllvlaw;A.l'(� to `IYP,P6 El AHCHI'I ECT/ENGINEER 1 BOLDING,HRMIT INTO y TFy YfI goo (10g) 32-2 Z. y 7 i LICENSED CONTRACTOR'S DECLARATION 0 =n1 hall aRtm that 1 un keened under provisions of Chapher 9(co wing Job Description I_u with Sexual 170(00)of Division 3 addlre Busiar and Pmfevimts Cade,and my line—it x a a in nen force W aeeer "-b 1. /r Ddu Denise Clgss •1 LConwc^^• t�eil't sem• - rel �i islt '(lt-A.y ) L�.lf� .f N(.{a0•'.� fl..l.�D•� y I ARCHITECTS DECLARATION zeas Iud.rttud my Plans shJlhused upublic mc«ds L/3I J'�'s•4.y F�:Y�j .u•!�(�fi)�i_ `C_(BfCF CC�Ill�ru'C T �1:/sial u el o Licensed Professional // LL�lffs 4e, OWNER.BURDER DECLARATION j'te;M1O JLa, yyfyyp, iN-5'/ .)',I„J�si s � �laG•^w- i {i:Yi ,C.a'-e F 2 1 trial afEsm that 1 am exempt from she Centractola License law for the rr 7=m following teasau.(Section 7031.5,Business ad Profmimu Code:Any city a county 3 which ragaires.permit to construct,.ler,improve,demo :m Petrim any wwcture Sq. Ft. Floor Area Valuation prim torts i.a ce.also requires the applicam(area mdt mfk awi8nd aatemant � , ,` Nat he is licensed t w the pmv ons of ntrxrola license law(Cospsar9 U��` (mmtmenei.gwith I .7000)VIlDivisiou th.Butimua Profmio Cod)x _ APN Number Occupancy Type Nat he is exempt there f end Na bei mete atkgedeumpmimn.Any violation d Section 7031.5 by any apph t far a neat subjects the applicmno a civil penalty of 3 �,� am more Nen Bva hundred dol 500). ❑I,ssawm athemplieny.a mplayee,withw,gaash.umktmmpeuuion. Required Inspections will do On woh,Wthe sou re is 'neodedmaflcralfm We(Sx.]Of1,Busfneu and Profaaiomw Coda:'Ih anuutor. 'eme law docs m apply m N Vara!M property who builderc s or proves shnn, who does such wok himselfor through his own employees, iced the such impro cots are not ineded m offend for We.If.howeve,the ildingmimprovemrnt is within one yurofcompletion,she ownn.Wildx will a the butdu or proving that k not build or improve for pal pore of wale.). ”I,a owner of a p ly to or um allusively convecting with licensed wntracmrs al constrttm ea pr act(See.7061.Business and Professions CVC.:)The Contractor'.Li. came law doe t apply b u owner of property who builds m improve raceme,ed who tantrums Mail Mi..wish a e mtrumr(w)licensed pariah m the Central BUSINESS Litoma law. ❑n em exempt under See. Data or this moon �� Owner Date WORKER'S COMPENSATION DE TION 1 hereby 171111 r pcntlsy of perjury oro o allowing dmlmtiotu: ,have hichdo.peleine '¢etc VECon arelbinsurc far Winkel.Compete ��RED scum,as provided fa by SaOon a Labor Cede,for the performance of the work for which Nix pemN is issued 1 have end will tuiman I is Is Camp�-'a aumince,es equircd by Salam 3700.fthe Ll Chile eperfortnmtt of rhe work for which Nis permit is ismed. My Work<Is Canpcn en Insurance terrier end Polic number art: C. o IFlCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This action need not becompleted ifdc permit is formic hudrad dollar($ ) m Il I cenify Ort th the p.Rormaacof the work for which the permit is issued,l s not employ my person in any manner to a to become subject to the Wasi m'Coup, ,anon laws of Ci lifomia.Data Aicmr aw` NOTICE TO APPLICANT, f.a tin making Nis Qnifiae of E.can -ptuaterf.should subjeet m the Wolf s Compenution Mvisions of Code.you mum El deemed evoked. CONSTRUCTION LENDING AGENCY O 0 Ih dhmi NUNare is a comtroctim lending agency for the pc ,ormance of Z the wink fm wh Nis permit is ixwd(See.3099,Civ.C. 4 Landers Name a > Icndci r Addeo R7 I certify Na 1 neve this applice/ and arrow thin Ne above infontul og is 4. crowd.l m=m comply with city my andimaes ad sum laws elating m 7 Z building construction.and hereby a nee rcprcunwivu of thisciy to a..upon Ore U 0 abovcmcmimxcl proper for i no ex. fes .e,r (We)eget m save. cmnify and kee east City of Cupertino egeimt O U liehilitiesjudgmants,co ed c- Lt my wayucrueegaimt said City in consequcae W the rating of Nis permit. [•+ IS. APPLICANTUNI .RSI'ANDSANI)WILI.COMPI.VWI'rHAI.I.NON-POINT SOURCtiHE.r.ATI y" I U Z Sigmtaa of ApplicVm0CVVVxcmr Dare � / /'''')� 2. -7 -a-al HAZARDOUS MATERIALS DISCLOSURE Will theapplicmt or fumm building occupam line rehandle haudmu.matend Re-roofs not derind by the Cupertino Municipd Code,Chapter 9A2,and the Health and Safety Type of Roof Cade.Sectimt 255320)? YP ❑Yes 14 No Will the applicant or future building octal use equipment or devices which All roofs shall be inspected prior to any roofing material being mit heaardmuw au contaminmu as de0nd by Ne Bay Arcs Av Quality Mmegctr¢m installed. If a roof is Installed without first obtaining an inspection trkt' I a ree to remove all new materials for inspection. Applicant ❑Y.w 56 No Itsoaredthelot it tenstsrcymrxnmV derChapel6g5oftheCali- U❑ erstands and will comply with all non point source regulations. rmda Health h SNety Code, 25505,25533 and 25536.I understand that if the - beildingdaasrnacurentlyhea rush dm it is my responsibility in nal Ota receptor ofthe"mic." hi arwivma.afa Canrfieveof OccupaaY. ��m Signature of Applicant Date Owner ar authrul agent Data All roof coverings to be Class"B"or better OFFICE CITY OF CUPERTINO •T 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc COPY 0 1 Sec: Twp: Rn9: SVb: Blk: Lot:37542022.00 DATE ISSUED... .... : 04/27/2000 RECEIPT q... .. .. ..: 12104 REFERENCE ID 9 .. . : 00030066 SITE ADDRESS ... ..: 632 PHIL CT SUBDIVISION ...... . CITY . ... ......... : CUPERTINO IMPACT AREA .. . ...: OWNER ..... ... .. .. : PHILLIPS JOHN S AND MARILYN S ADDRESS ..... I. .. . : CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4654 RECEIVED FROM .... : ALAN CONTRACTOR .......: BARR, ROBERT C LIC U 21133 COMPANY . ......... : ROBERT C BARR CO ADDRESS ..........: 056 SAN PABLO AVE CITY/STATE/ZIP . ..: SUNNYVALE, CA 94086 TELEPHONE ........ ; 4087499929 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- SPERMFEE VALUATION 25,000.00 307.00 260.95 46.05 0.00 BPGAS OULETS 1.00 4.44 0.00 4.44 0.00 BPLANCHK PERMIT FEE 307.00 260.95 0.00 260.95 0.00 WW BY PERMIT FEE 307.00 9'2.30 92.1.0 0.00 0.00 IXT NO. FIXTURES 1.00 1.11 0.00 1.11 0.00 P ..ABITFEE FLAT RATE 1..00 35.52 0.00 35.52 0.00 BREMRECEPT NO. OUTLETS 20:00 22.20 0.00 22.20 0.00 SSEISMICRE VALUATION 25.000.00 2.50 0.00 2.50 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 --------- ---------- ---------- ---------- TOTAL PERMIT 761.34 353.05 408.29 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ -"------------____ OTHER 408.25 VISA s_¢'9v TOTAL RECEIPT 408.29 • INVOICE INVOICE INVOICE INVOICE INVOICIPINVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: nancyc Sec: Twp: Rng: Sub: Blk: Lot:37542022.00 INVOICE DATE.... . . : 04/27/2000 REFERENCE ID # ... : 00030066 SITE ADDRESS . ....: 632 PHIL CT SUBDIVISION .... ... CITY ........... . .: CUPERTINO IMPACT AREA .... . .. OWNER ............ : PHILLIPS JOHN S AND MARILYN S ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4654 CONTRACTOR ....... : BARR, ROBERT C LIC 0 21133 COMPANY .. ........ : ROBERT C BARR CO ADDRESS .... ...... : 856 SAN PABLO AVE CITY/STATE/ZIP ...: SUNNYVALE, CA 94086 TELEPHONE .. . .....: 4087499929 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ ___ _________ ____________ ___________ BENERGY A 92.10 92.10 0.00 SPERMFEE P 307.00 260.95 46.05 BPGAS P 4.44 0.00 4.44 WLANCHK A 260.95 0.00 260.95 BREMPIXT P 1.11 0.00 1.11 BAMECEPT P 22.20 0.00 22.20 IICRE P 2.50 0.00 2.50 E ITFEE P 35.52 0.00 35.52 PPERMITFEE P 35.52 0.00 35.52 761 34 353.05 408.29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER 4 WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUG14 PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 S14EETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS • Y INVOICE INVOICE INVOICE INVOICE INVOICE-INVOICE INVOICE INVOICE INVOICE • CITY OF CUPERTINO • BUILDING PCRMIT INVOICE OPERATOR: nancyc Sec: Twp: Rng: Sub: Blk: LoC:37542022.00 INVOICE DATE...... : 03/09/2000 REFERENCE ID # ... : 00030066 SITE ADDRESS .....: 632 PHIL CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: PHILLIPS JOHN S AND MARILYN S ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4654 CONTRACTOR .......: BARR, ROBERT C LIC # 21133 COMPANY ..........: ROBERT C HARR CO ADDRESS .......... : 856 SAN PABLO AVE CITY/STATE/ZIP ...: SUNNYVALE, CA 94086 TELEPHONE ........ : 4087499929 NOTE: THE FEES LISTED ARE ONLY THOSE DUE AT PERMIT APPLICATION FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BENERGY A 92.10 0.00 92.10 BPERMFEE P 307.00 0.00 0.00 BPGAS P 4.44 0.00 0.00 HK A 260.95 0.00 260.95 XT P 1.11 0.00 0.00 S ECEPT P 22.20 0.00 0.00 BSEISMICRE P 2.50 0.00 0.00 EPERMITFEE P 35.52 0.00 0.00 PPERMITFEE P 35.52 0.00 0.00 --------- ------------ ----------- 761.34 0.00 353.05 '