00110041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
110ILDING ADDRI?SS: Q/J `� a PERMIT N
1032 WESTLYNN WY >( /t rJ ✓ ` 10110041.
OWNER'S NAME: �a./�tA sx/� a� APPLICATI 1,/ )ATE
HOFFMAN MABEL A AND M I CHA .I, 1V /,'J rlJln( �}v� p 1./�81,.000
TXARICHITECTIENGINEER:
SANITARY NO. CONTROL NO.
O IIUILDINGPERMIT INFOi LL LT P UMB MliCliLICCNSEDCOKIRACTOR'9DECIARA]ION Job Description
O zmmencingh Section]fgMl)nfDivi;ion?of the Business and Professions Coda.morr,licenmmnmrmeenfa— . /, 2 BATH REMODEL .AND RE-PIPE
rcense Class Lic.g3e ContmmorARCHIII:CT'S DECLARADON
I undenland my plans shall M used as public records
Wr
C of Licensed Prulissinnul
= OWNER BUILDER DECLARATION
hereby,(lino that 1 am exempt 1'om the Cessions o e:Any city
law for the
[_Z whichfollowinguiresa Saitt n5. urines and improve,
demolish,
Gdc:epairay urcounre
E Zt C which requires a permit to imsIIIconsume,alter,improve,Jemdish•m repair any mason
n6� list I uslicemmequbortyulms muvpdiarwnba Co pant's II License Lw(Cmemom
—
(commencing
is licensed Sectionnotaina 7000)of
nfNcCnmmdnesLirenmlaw(Chapter e) Sq. Ft. Floor Area Val .11
(cummcncis ewitht etion7(Ky0of Di vision30ltheleged nsmpionl An,violation
Gdc) $2t�J�Ia&
0r Sec he is exempt any aiom and the iasis for(lie alleged exemption.Any l pI,raio, -
of Section 7071 S by any applicant lin n Pemfif subjects me applicant m a civil penvhy a
of not more man five hnndred down($500). APN NumberOccupancy Type
❑ .asowner oflheprnperry,ormyemployees with wages astheir sole conpenmtlnn, 35927000. 00 d "
will to the work,and the slruelm'c is not mended nr offered for sale(Sec.7(9q,
Business and Professions Code:'I he Condarctor''s License Low does not apply to an Reqwired Inspections
owner of progeny Who builds or improves thereon,and who Joessech work himself 202 — UNDF_RFLOOR PLUMBING
or minutia his own employee,.to—mod that.etub impmvcments are am Imended or
offered On'salc.if,hows,•e., he bonding or imponammnt is and within one or of 301 — ROUGH PLUMBING
complelion,the nwnurbvilder will have the harden of moving that he did not Fu ld tit
mprovc fnrpmPave ormlel:. 502 FINAL PLUMBING ENERGY
❑I,its owner of the property.-atm exeweivcly contracting with ficenwd eamaemx ut 507 FINAL PLUMB T NG
constrict the pmjcet(Scc.7044,Eudin,s and Profcxuons Code:)Toe Conuanors
Liceme Law does not apply to an owner of prnpeny who builds or improves thereon,
and who contracts for such projects with a con renur(s) licensed puranum to the
Cnmmaors license low.
tum/,./xy�pt op��s�rj. ,11&PC lor,his reason
in -
WUItKER'S COMI'ENSATIONO/LAR%'PION
1 henhy affirm under penalty of Perjury one of the 1n11owing decl...im :
7 I have and will maintain a Cedificae of Consent us xdf-insure for Worker's
tmgcnmtion, as provided for by Section 7700 of the Lolxrt Cade, for the
performance of the work lin which lids permit is i fined.
❑1 have Dna will ra latma Worker's Cnmpcoundr.Itomence,us m,"ord by Section
3700 of the labor Code,for the perfmmmnee of the work for which this permit is
is,
My W r iters Compensation Insurance currier and Policy number um:
Camey, Policy No.: -
CLRTIFICAI'ION OF EXEMPTION FROM WORKERS' -
C'DMPENSAI'IONINSURANCE
(ITlv.vcainn need not he carld,,ol I lie permit Is Inaono hundred dollars '
(SIM)or ins.)
I certify th,l In the performance of the work for which this permit is issued,1 -
shall urn employ v n i yy inner so as m bosoms subject to the Wmkeri - '
omp:nsotion I'omilAaa -
plie:mt
NOTICE T(l PPLICAN'1':�I)cr nuking this CenifirmPf F.xanption.you should '
henmiflico ply it Workers Compensation Permit Ins)tthe Lmed mistke . must '
•� lonhwitb comply with such prvvisinns or this permit dsWl M Meme)revoked.
F Cn CONSTRUCTION LENDING AGENCY
1 henhy of itm tial there is a constriction lending storicy for the pcUnmwn.
Wof the work for which this Permit is ismcd(Sac.3097.Co.C.), v
L Q Lender's Nance
a Z Lender's Address
V 0 7 1 certify that I have mad flus application and state that the above infurmaion is
Iz E correct.1 agree to comply with all city and county ordinances and state laws rely ing
Q V to building construction,and herchy oumorim represematives of thiv citym emaremon ,
the above-mentioned property for inspection purposes. -
{.a 6( I (We)me.tosvve,indemnify and keep harmless the City of Cupertino against
L m lubilitics,judgments,costs and expenses which may in any way accrve against said
C,7 City in consequence of the 6 anting of this permit. -
PPLICAM'UNDERSTANDS AND WILL COMPLY Wo 11 ALL NON•PiUso y�,� ,C)n,/�.J„VCG - Date
+L)
s0 :L 'G'�S. Issuedb /�/`
gnumm n1 A�ppbatmVComracmr Date Re-roofs
IIAPARDOUS.MATERIAIS DISCLOSURE
Will the applicant or future lmilding=upon(store or handle hoeallous material Type of Root'
ns defined by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Cale.Section 25531(a)^
l °Yox FYY All roofs shall be inspected prior to any roofing material being installed. .
I Will the applicant or future Wilding uca'nNmuse equipmunnrchviccswhich If a roof is installed without First obtaining an inspection, 1 agree to remove
mil suzanlnusair cnmmni rams as duLned by me Buy Arc,Art Qnulity Management
rnaHce all new materials for inspection. Applicant understands and will comply with
°i 09 at none int . ere I
( 1 have read the fount materials rnquimmans tinder Chapter fi 95 of the
she Wildin,does
&Safety Code.flyhavea late 505.2553)and sponsi l mmeity,.purify
that b
the tra ntng dxs..i ,...ons have ,the net rues my suered of
tanmify the
ceupvnf til the regulon• to which maul M not Prior m issnuna of a Certificate of
"up"2 ��w Signature of Applicant. Date
O"Isretu'to. rtTlTrlxal ager, a„e All roof coverings to be Class `B” or better
OFFICE
CITY OF CUPERTINO
• 1 of 1 BUILDING. PERMIT RECEIPT OPERATOR: nancyc
COPY # 1
Sec: Twp: Rug: Sub: Blk: Lot:35927004.00
DATE ISSUED.......: 11/08/2000
RECEIPT #.........: 13974
REFERENCE ID # ...: 00110041
SITE ADDRESS . . . . . : 1032 WESTLYNN WY
SUBDIVISION . . . ....
CITY ... . . . . . . . . . . : CUPERTINO
IMPACT AREA .. . . . . .
OWNER ............: HOFFMAN MABEL A AND MICHAEL A
ADDRESS ........ . .
:
CITY/STATE/ZIP . ..: CUPERTINO CA, 95014-5022
RECEIVED FROM ....: JB
CONTRACTOR .......: LIC #
COMPANY . . . . . . . . ..:
ADDRESS .. . . . . . . . . :
CITY/STATE/ZIP .... ,
TELEPHONE ... .... .:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
__________ _____________ __________ __________ _____ ---------- __________
SREMFIXT NO. FIXTURES 4.00 4.44 0.00 4.44 0.00
BPREPIPE NO OF FIXTURE 12.00 99.96 0.00 99.96 0.00
SREMRECEPT N0, OUTLETS 2.00 2.22 0.00 2.22 0.00
ITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
ENFAN NO UNITS 2.00 47.74 0.00 47.74 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
__________ __________ __________ ----------
TOTAL PERMIT 225.40 0.00 225.40 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ ----______________
CHECK 225.40 2558
TOTAL RECEIPT •• .. 225.40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
•