00040184 CITY OF CUPERTINO PERMIT NO.
BUILDING DIVISION PERMIT CONTRACTOR'INFORMATION: v
BUILDING ADDRESS:
7,--
SANITARYNO. APPLIC_IONSU-00 ATI
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CI11TL.C'I' ..GINP.ER 1 BOL DING PERMITINFO
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H g"�' LICENSED CONTRACTOR'S DECLARATION
7
zO
_ I hereby N
by aei 1 am licrnscd tither previsions of Cnegcr 9(commencing Job ascription
oz4n with Section TOW)ofDivixiw3ol Ne Business and Rofeviaw GCdc..M my licenx is
<.ywF DntC a in tullforce aM A � 716J/Ry'il'►/'a/t`�v U`,�'I\`1 4 V �B
Linares leu VV
Lir.
W CRD fir
ARCHITECTS DECLARA NY IT`y y ��
W'a S I undeu,eM my Puh ns shall used u publi<rds ����V��
.1 `�
d E'c licrnud Pmfeuiowl
OWNER-BUILDER DECIARATION
1-Z>' 1 Mosby affirm Nil l am esempl from Ne,Cmeractor.Limese law for the,
f F G following reason.(Section 7031.5,Business aM Promaknu Code:Any city w coumy
iC$ which impfirm a perm to maumuct,ohm,improve,demolish,m repass any,vuclurt
3_ prior to its ia,unrcgalso repuirnriver applicant forsuchpemmin file signed statement Sq. Ft. Floor Area Valuation
Net he in licemed panwnt to Nc Proviaiom of Ne Convactara Licrnx taw(Ctxgec 9
«nmme,Mixemittherfro?DomnfDiasiinfrorNeepa�xxewdm, A.voilso ,of APN u her `Accu sect Type
Nal he is exempt therefrom and Ne breis far Nn e11cgN rumptian.AnY violation of I { Y YP
Section 7031.5 by my applicant fora permit subjects Ne applicant to a civil penalty of
Qt moorthan hve hundred dollen($500).
L as ownnor de moper,or, cmplayeca with wages as their solecnmpewamm. Required Inspections
will dons i..Const swcmrcianmimeMNorawdos We(Sec .annme,a
W ort w ow Codc:The Conuveoa i,"vid naw does na apply m If owwr m
his o nY wW builds pr improve Ncrth iropr who doe such intended
d d or o Nrougb
W own employeshe gildr, Nu such mirm is d w are nn inxr.f i offered for
We.If,howec withebuildingooimpmvenxm ihholdwind.amildori ompe,fin, Ne
owmerWilder will have Nc Wader of gavin6 that he did nor Wild w improve fa pro-
poseofule.L
I,o t me project of Sm.704 ant exclusively confessions with:)trued neraamon i-
cense La Ne esntapply
to
ownBuser
of,and Professions Code:)The Cr therms. rad
come law don not apply m an uwner of popery who Wilda or improver Nceon,end
whocontracts fm ouch pojecu with a conwdor(spicenxu
d pursuant the Canusemla
License
Law.
❑tare exempt under Sm. .BRPCfor this ea+ou O r O
owner
wa Dex
n WORKER'S COMPENSATION DECLARATION
I bneby.frrm under piously o(perjuay one or the,following declarations:
I lent ind will meivWn•cenibwx ofmm
Co ,..xlf-insert for Worker,ComPm-
tion,u provided for by Section 37W of Ne Lator Code,for the perfomurce of the
�Is for which this permil is issued.
I have and will mi Worker's Compensation loommce.as«qui ed by Section
of Nc labor Code,for the perfonnanoc 0f Nc work for which Nia permit i iuwd.
My W r r n and Polis Z
Came Policy Na:
CERTIFlCA OF EXE PTION PROM WORKERS'
COMPENSATION INSURANCE
(This vecti wad nolive lend"dwy rmliaforone huMrmdollese($IM)
or loss.)
I renify le swakfurwhich NispermilisiuuM,lshall
not employ my .ray m • m 'ar m Ne wedu n'compen-
ulum laws of
Applicant A 10 1V 10.411
NOTICE TO AP :If cr ifgex of Encmption.you should
hecnme subject to the W«sora Compenution previsions of Nr labor Code,you must
fonhwiN comply with such provisions m Nis permit sbdl be domed revoked.
CONSTRUCTION LENDING AGENCY
0 I hereby affirm Nm Nen is a comwrmse boding agency for the perfom ame of
Z' Ne wmk for which this
permit is issued(Sec.3097,Civ.C.)
Undoes Name
Linder,Addrtu
W I caury rhu I have nand Nis application and wax Nat Ne above info d..is
4 carat.I stem to comply with ell city and county ordlnuxes ab arae laws reluing re
7 Z buudinBromuucuon,and bermY.uNoriee rege,amnmiver ofdtis city to enxr upon the
U Q aMve.preminnes propeny for inspection purposs,
Ii [=:.,
m tine,indemnify and keep hnmleu Ina City of Cugnino apumet
O IF.7 liabileau penx,whichmaymany way.-n-adaimtuid(City
fN g Ni,permit.
NI 5, NII WB.L COMPLY WITH ALL.N(3NdO1N'r
l, I)
v z ^Z1'c>D
Sigwt eof APPlic o sur Dec
HAl.ARDOUS MATERIALS DISCLOSURE
Winythe
applicant
rtin future Wilding e.Chaptumem handle Haatadous mormalSeely Re-roofs
sure,Se by tix32(al?Cupertino Municipal Code,Chapter 9.12.W she Hat am Safety Type of Roof
Code.Section 25532(q?
❑Yes �No
can Ne applicant or future Wading umupam use equipment or dcvim.which All roofs shall be inspected prior to any roofing, material being
mi,heurdous au conumimmus as defined by the Bay Ase Ah Qudity Management installed. If a roof is Installed without first obtaining an inspection
isfeiet? I a ree to remove all new materials for inspection. Applicant
❑Yrs IRNo
Ile caad dx Haus r` ,cdal.rtyuirtmens soler Chapter 6,q5 of the Cali- Un erstands and will comply with all non point source regulations.
I
Sefr1Y25530.I undmund the,if Ne t t Nun is my responsibility n reify the occupem
f the sup hit tit mueuuxr ofaCenif ax ofOeu
Signature of Applicant Date
hvit" r. m gent a¢
All roof coverings to be Class"B"or better
OFFICE
.i
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:32647011.00
DATE ISSUED.......: 04/28/2000
RECEIPT 4. ........ : 12109
REFERENCE ID k ...: 00040184
SITE ADDRESS .....: 10300 STOKES AV
SUBDIVISION ...... .
CITY .. . . . ........ : CUPERTINO
IMPACT AREA ...... .
OWNER .... . . . .....: POPOV MICHAEL L AND JILL
ADDRESS .... . . ....:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1232
RECEIVED FROM ....: JOE S
CONTRACTOR .......: GRIDLEY, LINDA LIC # 17555
COMPANY ....... .. .: GRIDLEY COMPANY
ADDRESS ....... ...: 19 S 3RD ST
CITY/STATE/ZIP . . .: CAMPBELL, CA 95008
TELEPHONE .... . ...: (408)374-0900
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS RED NEW BAD
---------- ------------- ------- ---------- -___---
BPFIXTURE UNITS 2.00 16.66 0.00 16.66 0.00
IE
UNITS 2.00 16.66 0.00 16.66 0.00
CEPT NO. OUTLETS 3.00 3.33 0.00 3.33 0.00
EE VALUATION 37,000.00 396.00 0.00 396.00 0.00
NFAN NO UNITS 2.00 47.74 0.00 47.74 0.00
TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BSEISMICRE VALUATION 37,000.00 3.70 0.00 3.70 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 590.65 0.00 590.65 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK
-- ___CHECK 590.65 14908
TOTAL RECEIPT 590.65