02070110 OF
CITu DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT
21265 STEVENS CREEK BLVD VISIBLE GRAPHICS N`62070110
56 12N INVESTMENT MANAGEMEN 15216 BURBANK BLV, SUITEf1T'AT]81Irf§72002
HONE:
(818) 787-0477 SANITARY NO, CONTROL NO,
G D OZ ARCHITEC(ENGINEER: BUILDING PERMIT INFO
\ he Z
rBLL-
DG ELECT PLUMB MECH
C.I L:7 l.J
Z LICENSED CONTRACTOR'S DECLARATION I
ltInqy Iherebyoffirm that l am licensed under provisions of Chapler9(commencing INSTALL 2 AWNII37r1`Cri�tiWANNER
-1:
with Secti 7 )af Division Sof the Business rad Professions Cade.end mylitensc
3 is in full! ,
z6 Liccnu CI n
O Lic.•/ r ,]I
�' m Conwao
u ,
t' ARCHITECT'S DEIRAT1
-to 1 undenlond my plans shall be used as public rcc t
E p O Licensed Professional
OWNER-BUILDER DECLARA N
�-'y I hereby eRrm that 1 am exempt from the Can e w th $7800
t? following recon.(Section 7031.3.Business and Pmfeui i.y u i EDj,
which requires a permit m construct,alter,improve,demolish,or repair arty auvew
prior ro its m.ranate,ah{ reggi.es the applicant for such permit to rile a sigrwd statemem - - - _.__------------
t _. -
e' -t - -- Valuation
the'he is icenseE pbrsuant m the pibnstosi of the the Busmfs License law(Chapter 9 3 �'fJ BId�F��.• l,' a
(rommenaing wiNSectfmnomand the bason is
theallgedexess erMion.Any
Codel , �l'a!;ti tri.vx.' l`,13a.a s•.
oe that Fe is 31.5 bf thereffom and.he basis for the cas alleged 1p ion.Any vioutan
-of notSecmo]03 than
a dred one fore permit subj¢s the applis�nno a civil penNry'
:of no.mare than five hundred do0.rs(ssoo). 10APN FZWGN5T= ;E!;\:•'y N•.l Occupancy Type
OLesowmroftheproperty..,my employees with wogcsas tock,.lecompensaiion, 103 - UFER
"will-do the work.and the'sfrbnure'id'not intended ar alreied'for gale(Sec.7O4a',' lnSpeCt10H5'' 'I't'"
tRa in.. ad'Professions Code:The Convectors License law does not apply to an yptP.(tDtr�,gy
ow.urof property Who builds or improves thereon,and who does such work himself 105 - ANCHOR IIU1..r1J
or thane h his own employees,provided Nat such improvements are rad intended or
offered for i6 le:If.however.the building or improvement is sold within one year of-- '-"--- - 3O4'-'-' 'ROUGH "EI]ECTRICALT--'-' '----'-' --""-'---"-'- ---
qY.'.11 , I.;;ll •.(.
improve fortheownenb.k.).will have the burden of proving that he did not build or 505 - FINAL ELECTRICAL
improve for purpose of sale.).
_. _..__ - _...-----514 ---FINAL—-PUBLIC—WORKS -- --
O 1-as owner of the property am exclusively contracting with licensed contactors to _;f•! ,r{• _- -
construct the pmjecr(Sea 7044,Businers and Professions Code,)The Comeacmr s
- _ - License Law does not apply to an owner of property who builds or improves thereon,
_
and.who.conrmm.for-such.Miecu.with.e.contacmr(g Ikensed.purauanl m.the. ._._...___._Contractor's License License La „
:. ❑taro exemP.under Se c' ' -� " BAPCfonhis rteaon - l 1' IV't
Owner`• Dam'.` '• " -.
"'WORUR-SCOMPENSATIONDECLARATION
1 hereby aRrm under penally of perjury one of the following declaration:
0 1 have and will maintain a Certificate of Garment to self-insure for Worker's '
Compenn0on;no provided for by Section 3700 of the Labor Col,. for the
performance of the work.for which this permit is issued.
❑1 have mallwill mainuih Worl:er'eCompertie.ianrins....u required by Seminal
ante bf the work for which thu rMt g
3]00 of the Lvbor Cade for the perfomt
i4rterad'M Se%c Compen Mn lnPo reser :
CERTBR AT10 OF
EX ON
.O.M...WORK"rs' -----------_ _COMPENSATION INSURANCE:
'M a aet.iodneed not be completed if the permit is fm ane hundred dollen
(S.10.0)or.IessJ
shoe I Bendy(halm the In any mann the work for me this ct to t seiuutd 1 It sf t t t j,,.'/E "- - —' -•__.."-....._,.._
Comnot employ dny'peraon I y manner so as to become subject to the Workers' t.
ComQcnsetton laws bf Cehforine Dem'
Applicant
INOnCETOAto the orkees Compensate this Cisions of tof he Labor y should •\ .,.>il
0 b howl subject m the auceN Compensr tion provisions of the Leber Cade,you rriusl
forthwith cam 1-w th ouch No visitors or this pertniuhall be domed retained.
'V� I,f � i.t `'CONSTRUCTION LENDING AGENCY ' "I 'o :if
� y (hereby 6Rmi that Ute Isa2on'tuueton'lendingg aj;enry for the pedorm6nx �. e
o(she work for whikh Oen permit is ilsSieg(gee.J09];Civ.Cd ' "; " ' �
Londe sAddrtsn.'...' - .
I andy that 1 have reed thio epplicatitn end stem that Cho-above mformnt..is
law[r cbireaangrce m pomply.with,ell city'entl coumy ordinencen end one lawn rclning
�:. ro building ronstmnion:end hereby euthoriie rcprcsemarives of thiuity to enlerupro
As the Bove mentioned property for nspec.i nP rPosea
Py (WbFf{r«ides a ndemmfy and k ep herndcu the Cny of Cupemno egging.
.rA liamhues.3ud{menta,coati and a pensees beth may in any way accrue eyginsr gaitl
V � City.m ddnsequenoe of th atone ng of this permh �y
APPL9CANT UND 7Mb�5 AND W L COMPLY kTTH A L NOMPOINT' C_Js✓.
souRteREo nq 7�Igl Issued by: Date
3 mmreofAppauvNCoa tc 7 og7e- Re-roofs
tl .HAZARDOUS MATERIALS DISCLOSURE
.- work epplmantmfuture balding occupgnl nae M1gndle huanbas rwentl
safety Type of Roof _ ._.---.
4 definW by rhe Cupemno Muntn el Code Chapter 9 @end the Health alto a, -
tddd ❑Yes 1S5J2(q)ne r Notl IP vp11'',tI All ev �,�
All.roofs shall.be Inspected prior.to.any_roofing material being.installed."
vett the gpphcent or umn Idmg oecupam use egmprnem or dewlctswhtch If a roof is irisialledwithout first obtaining 17 g an ins ectlon,-Ta ree.tolremove
rut M1vudous tai eonuminenu u defined by the Bry Arta Mr Qudpy Mweement
Di
amm _ all
new materials for inspection. Applicant understands and will corn lyall'non-point soureregulanons'
..
4-� :Ia 1 have . ..
�feed'rAe M1g;krdaus materiels requ <mems arida Chapter.d Ste df,the
Cnf fbmL Neelth k SBery Cade,Sections 25303 1553)and 73374.I tinders mil that
if the budtlm{doas nm curien0y havcamnmt mnnrsrm rtFWnnof mndt(ythe
oitupen.o!the req nu which man be mei poor io usuente of Cenifi" of
oesm Z3 Signature of Applicant Date . .
t �� _. . - -
owner er athe :.p ag rat Dal. t All roof coverings to be Class,"B"or better
t
• 1 elleb.�' rt -- - : . . �, - .. . � . __. .-OFFICE-. _ . . . .. ... _..._ .. -. .. . _ - - —
CITY OF CUPER'1'INO ''' `
BUILDINGC DIVISION ERFI PERMIT '�'GONTRACTOR INFORMATION: .
R-
BUILDINGADDRESS: VISIBLE GRAPHICS PERM �gig as MW
21265 STEVENS CREEK BLVD 02070110
WNER'S NAMI7: 14732 CALVERT STREET APPLICATION SUB DATE
WESTERN INVESTMENT MANAGEMEN 07/18/2002
PHONE: (818) 787-0477 SANITARY NO. CONTROL NO,
ARCHITEC MINGINFER: BUILDING PERMIT INTO
BLOC ELECT PLUMB MECII
l= 0 l�
000 LICENSED CONTRACTOR'S DECLARATION I Job Description
au I hereby affirm that I am licensed under previsions of Chapter 9(commencing p
with S.clinn 7000)of Division J of the Bueincm and Professions Cock,and my license is
t'ad in dictmeand cffcet. INSTALL 2 AWNINGS & 1 BANNER
T'n_ License Cl ss Lic.N
F?Fp DaleContractor
ARC]IITECTS DECLARATION
1 understood any plans shall be used as public records
apwdU
.B:e Gse
Licend Professional
1.1Z:0 OWNER BUILDER DECLARATION
<5 I hereby affirm that 1 am exempt from Ne Contractor's License Law lar the
m a
no following reason.(Section 7031.5,Business and Poressions Cork:Any city or county
e x$ which requires a p.rrou to vtm oo cf.offer,improve,demolish,or repair any structure
prior to i6 issuance,also myuifes the applicant leo such Permit In file a signed statement
that he is licensed pursuant to the provisions ofthe Contmcbak License Law(Chapter 9 Sq. Ft. Floor Area $7VAMition
c�p monoccncing with Section7lksp of Division 3 of the Business and Professions Code)or
a 3$
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 1831.5 by any applicant for a pormil subjects the applicant to acivil penalty of Occupancy Type
not mom than five hundred dollars(SSDB).
Las owner of the property,or my employees with wages as their sole compensation.
will do be work,and the suuctme is not intended or offered for sale(See.704L Business
and Professions Code:The Comae License Law der not apply to an owner of 103 — UFER egmred Inspections
po,eTty who builds or improves thereon,and who Jtessuch work himself or through his
n employees,provided that such improvements arc not intended or offered for sola If. 104 — REBAR
however.the building or improvement is cold within one year of completion.the owner 105 — ANCHOR BOLTS
hoi]&,will have the burden of proving Nat he did not build or improve for purpose of
sale.). 304 — ROUGH ELECTRICAL
❑ I.as owner of Ne properly am exclusively contracting with licensed contractors m 505 — FINAL ELECTRICAL
consumer the project(Sec 711,1J,Business and Professions Cock:)no Cunraclm's Li-
nseLaw does not apply toanowner ofpropert,who Wilds orimproasdaemon,and. 514 — FINAL PUBLIC WORKS
who contracts for such projects with a msmrat or(s)licensed pursuant to Ne Contractoh
License law.
I am exempt under See ,B&PC for this reason
wncr Dat
WORKER'S COMPENSATION DECLARATION VVV
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I hsaand will maintain a Certificate of Consent to Glf.insum for Worker's Compere
cation,a provided for by Section 3700 of the Labor Code,for the performance of the
work for which this Permit is issued.
D I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the IaMn Code,for the petformanee of the work for which this permit is issued
My Workers Compensation Insurance carrier and Polity number are:
Carrier; Policy No.:
CERTIFICATE OF F.%EM"ION FROM WORKERS'
COMPENSATION INSURANCE
(obis Section reed not becamPla.d if dre permit is ter one hundred dollars(SH)(H
G,less.)
1 certify that in the perfnrmantt of the work for which this permil is issued.I shall not
employ any person in any manner ns m to b.cnme subjen to the WorkersCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:11,after making this Ccnificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Ctde,you must
O Z forthwith comply with such provisions or this perm it shall he deemed revoked.
zO CONSTRUCTION LENDING AGENCY
F-r I herehy affirm Nm there is a corfor,tum lending agency lnr the pedormanceof
a 7 the work for which this permil is issued(Sec.NN7,Civ.C.)
W Q 1<ro!Z:Nam.
Z 1<ader.e Address
U Q 1 comity that I have read this application and note that the above information is
LL — correct.I agree to comply with all city and county ordinances and sore laws relating ,,
O V building constmeaon,and heae
thereby uthorim reprenulives of this city to enter upon the
above-mentioned property for inspection purposes.
fd (We)agree to save,indemnily and keep harmless the City of CuNrlino against
h fiabilitics,judgments,costs and expenses which may in any way accrue against said City
U Z in conscquencc of the granting of this pcond.
r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
SignalumodApplicamV mroacm, DateHAZA
IIAZARDODOUSMATERIALS DISCLOSURE Type of Roof
Will do.applicant mforum buildi........mmor handle No
aMmaterial
as ddincJ by the Cupcmino Municipal Cede Chapter He
r 4.11,and the Health and Safety
Cede.&chnn155311a)'! All rooks shall be inspected prior to any roofing material being installed.
❑Yes El No
wiR th.a secant or future Wildingant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit batardous air contaminants as defineb occupant
Ba ArerQualit Management r r r s all new materials for inspection.
Di.,tden
Cl Vic., 0N
1 have mail the hasallous materials requirements under Chapter 6.95 of the Celifor
nix l lealth&Safety Cock,Simon.25515,35533 and 2554.1 undmnand that if th.Wilding
does not currently have a enem,dor it is my respornibilily in notify the tccupant of the
requirement.which huslhemet Kim iniauanceof.CemneareofOccupancy. Signature of Applicant Date
Owner or authorind agent Date All roof coverings to be Class"B" or better
CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACLQRINFORMATION:
BUILDING ADDRESS: DIM WATF
W NER'S NAME: APPLICATION SUB DATE
TPRN
TNVR"qTMPNT
MANAC
CALVP.RT
q T7 07/IB/2002
TRF,
PHONE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: PHONE#: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ow, INSTALL 2 AWNINGS & 1 BANN R 0 D O O
TO ARRANGE INSPECTION JOB DESCRIPTION
t;�y •NISPECTIONSw' ° DATE ,IN$FEC., CALL 777-3226 MONDAY-FRIDAY 24 HOURS RESIDENTIAL:
zogz BEFORE REQUIRED INSPECDON.JOB ADDRESS ❑SFDwL C3 KITCHEN REMODEL
FZ� FOUNDATION/PIERS/H.D.S. AND PERMTTAARE NEEDEDWHEN PHONING. E]ADDITION ❑ PLUMBING RE-PIPE
UFER GROUND O MULTI-UNIT ❑STRUCTURAL
p� u MODIFICATION
FLLgwO PAD/SETBACK-CERT RESIDENTIAL_COMMERCIAL—OTIIER El INTERIOR [:1 CHIMNEY REPAIR
GARAGE SLABS/PREGUNITE IMPROVEMENT ❑ SWIMMING POOLS
le�Ga POURNO,CONCRETEUNTILABOVEHASBEEN.SIGNED " HAZARDOUS FIRE AREA ❑ BATH RF:MODT:IJRF.PAIR❑ DEMOLITION
Fz BOTHER
UNDERGROUND/SLAB [DYES Ifycs-IundersOndlhata C]aseAnwfa=mblyisruyuimd
`o UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL 0N Initial Lc. a
B.o.
__ _ _ _ COMMERCIAL:
kbO'.NOTcPOUWFLOOR UNTILABOVEHAS'rBEENSEXISTING ROOF COVERING ❑NEW BLDG/ADDITION CI DEMOLITION
UNDERFLOOR PLUMBING ❑TENANT ❑ 17001)SERVICE
UNDERFLOOR MECHANICALNumber of existing coverings IMPROVEMENT
0 (YfBER
UNDERFLOOR ELECTRICAL Te RnemovW Toberetaimul
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
;PLACE NO SU9FLOORUN iL"WI3OVEHAS BB F.EN SIGNED', ' TYPE OF ROOF COVERING
EXISTING: PROPOSED:
ROOF SHEATWDIAPHRAGM
❑ w [:1o-
PLUMBING Built-Up Rf Built-Up Up Roof
TUBS&SHOWER PAN C]Asphalt Shingles E]Asphalt Shingles
MECHANICAL ❑ Wood Shakes ❑ Wood Shakes
'LF-CTRICAL/POOL BOND C] Wood Shingles ❑ Woad Shingles
RAMING/STAIRS/E.EGRESS ❑ Other(Specify) C] Olher(Spccify)
INSULATION/VENTILATION Provide I.C.R.O.Report No.
;COVER NOsWORX`UNTiCABOVE HAS-BEEN SIGNEDr.,„..;« Provide Mfgr.Installation Specs.
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
SHEETROCK/SHEEHLOCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LATH
NO TAPE OR PLASTER UNTIL ABOVE HAS'.BEEN SIGNED
SCRATCH COAT
SEW F-R/WATER
TEMPORARY APPROVALS
OCCUPANCY
O.Z ;FINALS ..n.`,.,, v 'u,.
Z� PLANNING 777-x'408
Fy j GAS TEST
yp GRADE(P.W.777-3354)
D Z FIRE-CALL(408)378-4010
U O
( HANDICAP
W
O U ELECTRICAL
PLUMBING
[� G
U Z MECHANICAL
ENERGY
VISUAL FINAL ONLY
BUILDING
'OCCUPANCY�OF BUILDINGAS NOT PERMITTED y'' -Y'
UNTIL BUILDING FINAUIS-SIGNED BY BUILDING > ,,
SPECTOR r - _ > .�,, CERTIFICATE OF OCCUPANCY ❑
PRE-INSPECTION: PLYWOOD: IN-PROGRESS:
INSP. UNIT INSR DATE INSP. DKI'E
'PEAR OFF INSPECTION: BATTENS: FINAL-:
INSP. UNIT INSP DATE INSP. DATE,
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
01,16/2003 11: 13 818-767-0415 VISIBLE GRAPHICS PAGE 02
BUH,DINI;DIV'>H)N PERMIT � "",•'••• "•• •.,"'•••'•.___,__..
NIIILUINf,n❑DRESS:
9T 'J(5 ATFVFNQ C'RRFfK 2j,V$ .'NITS- —
Arl-LICATION sun UNIT
•OWNRR;C NAM[-,:
�'CT RM T1,jlj MFNTT_� Nji� T 216_$:1}Z�DNK RT,V $, 1 'J!1 (17 .E- -Zfl1l�_.—
>ANITARY CY IN'I R,11.Nn,
I10NE;
n-4 -1 11b7 ATLL"S r g 1 4 1 1
HI iMANG PI1IRN11I LNPrt
AVCHI(}..I'/LNGWEER mONF.N'
ll,fq HLf:CT PLI,IMII MliCll
CTAT•T,Z�yiN,IN ncR,
�w� INSPECTIONS V.1TG INSPFC, TO ARRANGE INSPECTION ,TOB DESCRIPTION
u� C,,LI.7T)-T22R MONDAY.FRIDAY 24 HOURS rti Fq-TJ,\I,:
w nCFORE REOUIRED INSPECTION'.JOR ADDRESS C7 SFDWI, I7 I(17'CIIIIN It FNl(
2�Z;, FOUNDATION/rlliltS/FLD.S. AND mRMITR ARE NECDED WHEN PHONINO. I..1 ADDIIION :I PI.IINInlN 11611
UFr;R GROUND O MUIM-UNIT S:I S'rRUCTI IRM.
e-=
PAD!$IiT BACK CERT ItF.CIUr.NTIAI_ COM1IPIGRCIAL_OTHER_ MODIFICATIOu
lu-. GARAGE SLARS/P2F_GUNITF_ lQ.A7 U$J_TRF AREA ❑ Ih'TCr.IVI: 17 CI'IIMNEY RIiPAI
w 3.i Lt. .A. D. IMPROVEMENT n SWINIMING PCK
t u N POUR NO CON(:RBTE UNTIL ABC"!:II+S BE- SIGNRD —_ El RATpI RFMODIiI./REPAIR 1.:I DFN'I0l.1JInN
0 YESIr r••.I nuAnnmJ the o CIuvY inn!n..:mey n mquirta,
UNDFRCROUNO/SI_.\R ❑ OTI{nR _.. -
d^— PLUMOINC I'1 NO bldinl
t ELECTRICAL
rR.CIAL:
uNi ° DO NOTPOUR FLOOR UNTILABOVF HAS nErN SIGNED E-TIsT'INGtli lOI:L[OVI:;RIp',G I_I NT;w DI.DG/ADDITION CI 011MOLITION
L
PLUMISING m,,IIl 'f PI vji 6'�a•<riuga ❑ TF.Nn NT (l 1=000 SFRNICL
' - IM 191O`.'EM ENT
MECHANICAI. _
'h,Pc rcluu.cd To lx ral,ilv,ol 1:3 171'11ER .... —_.._.__
CL.ECTRICnL
FRAMING VBNTS
INSLII.ATIDN .
TYPE DP ROOP Cf)V GRING
PLACENOOR I,IM1 TIL,IBOV[hln;l'F:RN SIGNEDI;%Iti:I'1[iG; PROl1SGQ:
ROOF SHEATI TIUnIAI/DIAI'IIRA NIt
—`—{I�
PLUM nING l. a
Roib-UI, n„r U m,iR-!y fl.ri
IJ AxphRll Shinglce ❑ n:ph:Jl Shin_I<.
TUBS k NHOWER PAN [I w„i„I 5hak.y n W'.... ShIll”,
MECI1ANICAL rl Y\'ewl Shing!.:.
EI_ECTRICAI!POOL R(1NIJ � tlrhu lSprcilyl --
FRAMMGS'I'n11i5/F,T.Imh:SS � rrn.�IJc LCA.O.ugton M+., ...—
INSIII,ATIONNEN'TB,ATION rrrvlJc Pi rcl'.L-:dHlla;mR.tipcc.. ,_
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE-D -
FXTRRIAL SHEAR/TIULb DOwN
INTERIOR SHRn1{/HOLD OTVN INSrecTION SPECIAL.INSPECTION REQUIPED L1 DNu; u
SHGETROCIVSIIF.ETROCK SITP.AR
EXTERIOR I ATNIW-GCRI;rn
SHOWER LATH
NO TAPE OR PI,ASTEIt UNTI L,mOV E H.4S BEEN SIGNED
SCRATCH COAT
SGWnRIwATE:R
TEMPORARY ArPROvAI.s _
OCCUPANCY
fINAI.s
.. 7 PLANNING 777-))ar
Z p .GAS TEST —
GRADE:(P..W..777.}}9d) _
r1 FIRE
Z
C' 11ANDICM`
U p EI,CCTRICAL
QMECHANICAL
F h ENrRGY
U Z_ vlyUAL FINN_ONLY I _
BUII.DI_NG l
OCCUPANCY OF RIJILDIN'G IS NOT PERMITr;0
UNTIL BUILDING FINAI.IS SIGNED nY BUILDING CF.RTIFIC.ATL- OF OCCUPY%NCY❑
iNSPF,CTOR.
PRF.-INSPECTK7N':
PLYWOOb: IN-PRCtORESS .
INSP._.
DATE_.__ INSP.
TEAR OFF INSPEITiON:
BAT rr.Nq: FINAL:
INSP. .— DA:r.___
INSP._ DATE_ INSP._.
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
APPLICA:`JT;
01F16/2003 11: 13 618-767-0415 VISIBLE GRAPHICS PAGE 04
• CITY OF CUPERTINO
:tem 1 of 1 PERMIT RECEIPT OPERATOR : Zonniew
COP_ #
Sec : Twp : Rng : Sub: B1}:: Lot :
APN 32627035 . 00
DATE ISSUED. . . . . . : 07/.18/2002
RECEIPT 4 . • . . . : 09115 0
REFrRENCE ID 4
SITE ADDRESS . . . . . : 21265 STEVENS CREEK BLVD
SUBDIVISION CUPERTINO
CITY . . . . . . . . . . . .
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WESTERN INVESTMENT MANAGEMENT
ADDRESS BS'
CITY/STATE/ZIP . . .
RECEIVED FROM ALL NSI1CGN SERVICESAVE LIC 21839
CONTRACTOR . . . . . . A
COMPANY VISILE GRAPHICS
ADDRESS . . 15216 BURBANK BLV, SUITE 102
CITY/STATE/ZIP . . . : VAN NUYS, CA 9.1411
. TELEPHONE (518) 787-0477
UNIT QUpu4TITY AMOUNT PD-TO-DT T :IS REC NEW BAL
FEE ID - - - - - - - - - - - - -- - - -- - -
-- - -- --- -- - - - -- - i16 . 45- - o- -- - 0 . 00 116 . 45 0 . 00
BPLANCHK PERMIT FEE 17 . 000 . 00 137 . 00 0 . 00
BPERMFEE VALUATION 7 , 800 . 00 17 . 00 10 . 00
0 . CIRCUITS BREMSIGNAD NCUITS 1 . 00 4 . 44 0 . 00 4 . 44
RATE 1 . 00 96 . 00 0 . 00 98 . 00 0 . 00
BUSLIC FLAT RATE 2 00 44 . 40 0 . CO 44 . 40 0 . 00
BREMSIGNS NO SIGNS/MARQ 68 0 . 00 1 . 68 0 . 00
- - - -- - - -- - --
BSEISMICOM VALUATION 7 , 600 . OG1 - -- - - - - - - - - - - - - - --- -
1 e
TOTAL PERMIT 401 . 97 0 . 00 40' . .7 0 . 00
-- - NUMBER
METHOD OF PAYMENTAMOUNT - - -- -
-- - - --401 97 5989
CHECK ___
TOTAL RECEIPT 401 . 97
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION _ ________________
UFER
101 FOUNDATION 105 ANCHOR BOLTS
104 REBAR 505 FINAL ELECTRICAL
304 ROUGH ELECTRICAL
514 FINAL PUBLIC WORKS
•
01/16/2009 11: 13 616-787-0415 VISIBLE GRAPHICS PAGE 03
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # : 2
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 32627035 . 00
DATE ISSUED. . . . . . . : 07/18/2002
RECEIPT #' . . . . . . . . . : 19115
REFERENCE ID # . . . : 02070110
SITE ADDRESS . . . . . : 21265 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPE.RTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WESTERN INVESTMENT MANAGEMENT
ADDRESS SS1
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ALL SIGN SERVICES
CONTRACTOR . . . . . . . : MAHN, DAVE LIC # 21839
COMPANY . . . . . . . . . . : VISIBL.E GRAPHICS
ADDRESS . . . . . . : 15216 BURBANK BLV, SUITE 102
CITY/STATE/ZIP VAN NUYS, CA 91411
•
TELEPHONE : (818) 787-0477
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-
-- -- - ---- - -- -- --- - -- - ---- - - - - -
SPLANCHK PERMIT FEE 137 . 00 116 .45 0 . 00 116 . 45 0 . 00
BPERMFEE VALUATION 7 , 800 . 00 137 . 00 0 . 00 137 . 00 0 . 00
BREMSIGNAD NO. CIRCUITS 1 . 00 4 . 44 0 . 00 4 . 44 0 . 00
BUSLIC FLAT RATE 1 . 00 98 . 00 0 . 00 98 . 00 0 . 00
BREMSIGNS NO SIGNS/MARQ 2 . 00 44 . 40 0 . 00 44 . 40 0 . 00
SSEISMICOM VALUATION 7 , 800 . 00 1 . 68 0 . 00 ---- -1_68 - ---- -0 . 00
TOTAL PERMIT
401 - 97 0 . 00 401 . 97 0 . 00
METHOD OF PAYMENT AMOUNT - - - ---NUMBER
--- ---- ---- - --- --
- -- --
CHECK 401 . 97 5989
TOTAL RECEIPT 401 97
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
i01 FOUNDATION 103 UFER
104 REPAIR105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS
0
01/16/2Z)@3 11: 13 616-707-0415 VISIBLE GRAPHICS PAGE 01
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FAX TRANSMITTAL
DATE: January 16, 2003
TO: Christy
COMPANY: City of Cupertino
• PHONE: 408-777-3228
FAX.- 408-777-3333
NUMBER OFPAGES INCLUDING COVER SHEET: 4
FROM: Dave Mahn
RE. Jamba Juice / Cupertino Job Card copy
MESSAGE: Christy. Thanks in advance for your help with this: Please don't
' hesitate to call me with to call me with anXquestions or concernsor concerns:
Dave Mahn @ Visible Grn hics
IF THERE IS ANY PROBLEM WITH THIS FAX,PLEASE CALL US IMMEDIATELY@(818) 787-0477.
•
14732 Calvert Street, Van Nuys, CA 91411-2705 • Tel: (818q°49"t 4°�415
www.visiblegraphics.com