00070169 CITY OF CUPFRTINO
BUILDING DIV1S1ON PERMIT CONTRACTOR INFORMATION:
HUILOING ADDRESS: PERMIT NO,
OWNFR'SNA110204 S. TANTAU AV APPLICATIO .
egoIONS: ,TOYCE PATE SANITARY NW.//eb.Z0AIttlAo. -
°mZ ARCHI'I CCT71ENGINIiIR - BUILDING 111114NI'IINTO
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LICENSED CONTRACTORS DECLARATION Job Description
Z=O E hereby mhrm mit 1 a 3licensed under pmvi,ions of aaCode9 nation,
nmcndng
y 1-w iis s in llt...7l.gq of Dlviaion ial the liminms mJ Pmlessi9m Code and myliaenw
l g-�
is in full force wW elicct.
K W a,S Liccnw,Clea ].it.g
°d„ Date Corrector INTERIOR REMODEL
w 3 a� ARCHI'fECI"S DECLARATION /
,-On 1 understand myp .hallh used as public recoup,
sl
na�s O O Lice al I :. I
% OWNER❑UIIIll to DC CT ARr �//
Ih adjoin hY' ktl' III h Contractor
L' 1 a
Pthe
i-Z billowing waore(Section 713I51{ n dl I Code An,ch,Or reality
which remain.,a re in a„nmu,.ltc¢improve,d<,ol',h,or npa'r a iy„r con O
cinprior nit, ,anac,ulu,marine,tlie appliaum fa,mb perad, ,,filaasigned„mennmI
e. - ihmheis imnnedpmsuammlie pnwnion,ofthe Commiov,Larose Law(Chapter 9 Sq. Ft. Floor Area Valuation
mommenei ng with Section 701111)(it Vivito°°7 of the Business and Professions Code)
or ma he is exempt theafmm and the basis for the alleged exemption.Any violation
Of Section 70715 by any applicant for a permit subjects the applicant o a civil penalty
,it ofmnn:manfive hundred dollars($500), APN Number Occup ) e
❑Luxnwna"Alhapropmy.ter... enaployxe,wile wage,ma d,air,ole mmpnm,11tion. .
will do he.,rte,and the anmwre is not inboard or 011.1 ba at,(see.7044,
nunlncs and Professions Code:The Connnwar s Licen37507033.Law does not apply r,it. • 90lUlred Inspections
nis r of property Who builds or Impmees meum.,end who docs such work himself
ter hmugh his awn employees.polled that such immyrments arc not intended or
offered for sale.IL however,the building or improvement is sold within one year of 101 — FOUNDATION
umpletionJhc oe nor-builder will have the burden elbowing that he did not build or
.arnrpmposeofsde.) 102 — PIERS
nhRiepmperty,nme.alts.melycomnalingwilliliceo.edrwnramor„” 1.03 — UFER .
msuuctwthe project(Sce.7144,Iwsine.sc and Pndosin is Code:)The Cammemr's
i rm'r Law eoe,sun apply m an owner of property who hd1d,ar improve,mere°°, ].04 — REBAR
and who context,for such projects will,a comraemgsl licensed puuoam to the
cnmennnLicereeLave 105 — ANCHOR BOLTS
❑lam an order See R h P C births,aeon
D to— 1.0 — SEWER 8 WATER
" ic;R'scowrlarvsm'lorvurcl, n l 2022 — UNDERFLOOR PLUMBING
I hereby atlinn ander penahyof pigmy carol he following dcclaetimaa 203 — UNDERFLOOR MECHANICAL_
I have and will initiation a Cenireane of Canwnt to,elfuinsum lot worker, 204 — UNDERFLOOR FRAME
Compensation, as provided for by Section 1700 of the Labor Cale. for the
,dfurmmce of the work for w arch his p<rt,,it is I"ned, 205 — UNDERFLOOR INSULATION
C I have.,it will amount t worker.Coo ls:ioninn m.unnae.a,requited by Section 301 — ROUGH PLUMBING
1781 Of the Lubar Calc,for the frilranenec of the work or which mi,panni[is
issued.MyworkersConifen,afloofomaocxcarricrandpolicy onoberare: 302 — TUB 8 OR SHOWER
Carrie policy Na.: 303 — ROUGH MECHANICAL
cERHPICAT'1ON OFENrMITION FROM WORKERS X04 — ROUGH ELECTRICAL
COMPENSATION INSURANCE - .+
UM,see.ion need mot be complied if he pen„it i,for one hundred dollar, 305 — FRAME
(sl)0)onx,,J 306 — HOLDOWNS
I certify hot in he perk°natue tel the work lin which his permit i,owed,1 307 — INSULATION
.hull not employ any person in any manner so.as In hcmmc subject to the Worker:
Compensation Laos of Califomm.Date 308 — SHEETROCK
Applicam
NOTICE'1'0APPLICANT:If.after making this Cenifcale of Ewmptioso you should 309 — EXTERIOR LATH
hecomo,uhjcet him,W we,Cnmlcn.aonn on,"I'm,of he Lube.Cale,you ain't
p 0 fenhwhh eond,ly with.wcn provi,imas or mi."nal shah be donned revoked. 31.0 — INTERIOR LATH .
CONST RUCfl ON LENDING AGpNCY 311 — SCRATCH COAT
x > 1 hereby anima that men i,a construction lending tsime,Iia be parfntnmmce
of the work for which this permit is issued _(Sec.7197.Civ.C.) 313 ROOF, NA I I_
y p Lenders Name
Lenders Name 501 — FINAL ELECTRICAL ENERGY
�d O I emitythat Ihave rest]thapplication and statethat the aboveinformation is 502 — FINAL PLUMBING ENERGY
Ice ty saivvt.l agme, ply m 11 ily. 1 catinlyoldma-cs und: t rcrrmg
O Utondo b u by d p ht ,of his cityt trr p"„ 503 — FINAL MECHANICAL ENERGY
he l, ' t h. pmt y t paid
S s 504 FINAL BUILDING ENERGY
[}. Uj (W I i d f) J..keep ban l ... the City f @ g t
h IiuNI t ) Jgmems, t J penins h h maY ga u_ id
v z City consequence eofthg t g(ifibi permit 5 — FINAL ELECTRICAL ��
APPLI NT UNDERSTANDS AN WILL CO LYl ro LNON-POINT Issued qua^ DateSOUR R REGU ATI0�'}� 6�0 r�x3—GAJ TE6T
Signal of i'heao i OLLItr V Date Re-roofs, 507 — FINAL PLUMBING
U, RDIIUS ALAI ERIALS DISCLOSURE
Will the opplicamnr town building occupant store or handle haowdous,na,arial Type of Roof 508 — FINAL MECHANICAL
a..defineel by the Cutworm Municipal Cade.Chapter 9.12,dad the Health and Safety
Ctde.Section25572(a)7 509 — FINAL GRADE
❑Ye, 0N All roofs shall btgji0pecte0g91AAEo Vy WqINK,erial being installed.
Will the applicam,Or more building trcepant use equipmum or devices which If a roof is insta,Yl1g d with°y(yP1j'�{�pbt• 1 a is agree t0 remove
...mi,ha,usonr 1111 com,an,inamaoderned byte,flay neo Ai,Quality Mamgcmcnt µt 4. 1' lIVMI- F'l1I}L lis. WLJ f{ISO
i,ninn all new muterrt s or Inspection. Applicant uncerstan s and will comply with
Cl Yes C)No all non-point source regulations,
have read the ha>aNuas mmurcut,requimanots under Chapter 6.95 of,he
California health R Safety Cade.Sections 25505.25577 and 35574.1 undewand that
if the building does not currently have a teem,that it is my responsibility a°miry the
occupant of the requirements which mot be met prior to issuance of a Cmiinne of
ilxamamay. - Signature of Applicant Date
Owner or aan,nrved agent Date All roof coverings to be Class "B" or better
' SIERRA PACIFIC REGION
/f �j � �� 3831 North Freeway Boulevard,,Califor Suite 120
``/ v ® Freeway to,California 95834
A l I M I T r o P A R T II T I s e I P Phone 916.649.6835 A Fax 916.925.2564
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lob Name lob Number
Location Sheet of I
Technical Representative By Dole
..us.\
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
.` CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chtietya
Sec: Twp: Rng: Sub: Blk: Lot:37507033.00
INVOICE DATE. . . . . .. 07/26/2000 _
REFERENCE ID # . . .. 00070169
SITE ADDRESS .....: 10204 S. TANTAU AV
SUBDIVISION .....
CITY ... ..........: CUPERTINO
IMPACT AREA .....
OWNER ....... . . . . . : JOYCE PATE
ADDRESS .. .. . . . . . . :
CITY/STATE/ZIP . . .: CUPERTINO, CA 95014
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ..
TELEPHONE ........:
i
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
BENERGY A 29.10 0.00 29.10
BPERMFEE P 97.00 0.00 97.00
SPFIXTURE P 16.66 0.00 16.66
BPGAS P 4.44 0.00 9 {{
BPLANCHK A 02.45 0.00 02.45
B TXT P 11.10 0.00 11.10
AT P 6.11 0.00
BB....,MICRE P 0.50 0.00 0.50
MPERMITFEE P 35.52 0.00 35.52
PPERMITFEE P 35.52 0.00 35.52
Il
318 40 0.00 318.40
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