01010112 CITY OF CUPERTINO
BOILDING DIVISION PERMIT CONTRACTOR INFORMATION:
❑UILDING ADUIl G55', PERMIT NO.
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OWNER'S NAMH. 11 API'LICA'1'ION Still TAT 1:
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SANITARY NQ CON'IR(II.NO.
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0O0 ARCHI'I IiG TIENGINITER: IA/' 1 / BUILDING PERMITINFO
— ❑I.DG PLIiCf" PLUMB MLCII
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LICENSED that
C(INTRd under SDIiCL,RFCh)" Job Description
5,4z I hecaby infirm mm 1 ant licensed under pall Petro of Chmpmr 9 anti
av,Fw witnScc,iun 911lNllnrlhvis:un3o(Ihe puniness and l'mfc,wions Cndc,and n:y license
xles a In lullfnmeyldenecl. —� n^ T• I t _j.�.—
Eswa License Class Lia. ,y..�`t�•w1 L• ' ✓✓ULL'V'(,6' tUX l: 'I'� IQ/� �i�
9 d Dam Cmnuutior W "t'T
�'a G ARCIIITr:G'1"S DECLARATON
F'a 1 undeatmtd my plans mall loved as pontic nenNs
le,
C�O Liaised Profcnsional
To. o OWNER-BUILDER DECLARATION
I hereby::flim,:lint I our exentn fn::u Inc Omunlou Li¢ttce law be the
F-7 didlowimg coal(Section 7031.5.Business and Prefewiom Cock Any it,or county
S O which basilicas a permit to construct,:doer,incinew,demolish,or tapir any swewm
caprior tons issuance.oho reyua�ethe eppllcdni fir such vouliur file u signed simeric:n
mal he is haetcsd pursaamm the provisionalhe Commacnu'.License law(Chap1pr 9 Sy. Ft. Floor Area Valuation
(commencing with Section JgMBof Div on 3 of the Bal and lno@aions Clout
,b that he is...lain Itmelrmn and bile basis for the alleged onallitinn.Any violation
of Section 7031.5 by any applicant for a rental subjects the applicant m u civil penuhy
of not tm,rathan five hnndreddollars Who)). APN Number Occupancy Type
❑I,as o,her mime proper on my ettrployces with wage%as their sole compcnotien,
will do the uork.:mJ the ntrucmre is net mountnr oBemJ for sale(Sec.]scat.
n.dbe,s and Profe..im„C de:'rte Ctmractor.License Law does'lot:apply m at, Required Inspections
owner of pm,wrty Who Milds nr impmvas thereon,and who dues such cork himself
rill nago hismm Iowa,.provided chat cash in 4m veme rc ns anab intended car -
nffced lor vola IIf,lin e Its building ur in,pmw:scut Is nold wllhin be ,in of
Iomplmion.the owmembuildet will have the burden of paving that he did hat build or
mprove tit pu,poce of calm),
❑I,as nater of the Notedy,um exclusively connecting with licensed central to
nwrum the pmjem(Sec.7014,Business and Pntencine,CaL'[be Comicaor's
Licrnae law does not apply to an on ncr al lanperly who builds or improves Inercon,
and who contents for such projects with a commences)licensed pursuant to the OV
CaninoLiect,Like, lI 1
C') eunt 0
1,no exunder Sec. .B k 1'C fon Ibis ea so
Owner Dane
WORKER'S COMITHNSAI]ON DIiCLARATION i
Imrehy altuou ubda penally of perjury ane of the India,ing dedmatlono
O 1 have and will naimda a Cenilicam of Cnnacnt w,self-insure for Wodar's �7
CnmMn,uti::n, us p:nvided for by Section 3]1111 of the ].all... Cada fir The
performance of the wed for which this parboil is issued
KIatve mad will nntlt.I Worker',Co..classic homan,t,as repuimd by Section
) ,I the Lassa Coda.for the pcdonal of,he work her which Ibis peril is
issued.My Worker's Coral Iron murenee canner and Policy minter ane:
Carrier: 1'olicyNu: 3�raT nil 0:l7 -
CERTIFICA ION OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 0
(This section need not he completed if the peril is for one hundred dollars C\
is 100)or It,,.) U
I cenity that in the p,dimnunce of the work for which this recall in issued,I
shell nn, Today any peons in any stnt sn as m Maohue subject u,me W..w, /
Campcn.miom Laws of Califnmia.rate um O
Appl unt
NOT ean10 AI'I'LICAN'1:Ill nfmr making this Ccnllin:ty of Emn,p,iun,you he Id 1\
Menne sanjacl to the Worker's Cnmpead%abon provisions of The L d,or Coal you most
Q O
omission comply with such provisions or this permit shit(M damned revoked.
F ^ CONSTRUCTION LENDING AGENCY
a 1 hereby sit! i the,hotels lending agency for the pcdoruna
of 0,e work lin which this pvictor:s Issued(Sec.3099.Civ.CJ
Q Iendcr's Nunn
z Lender',Acidic,
U Q 1 cenify that l hie had this application and shite that the above instruction is
a mc,.l agree to comply with dl ell,and aamty oulicauct,rend store lows relining
Q V ,n Mllding elaboration.and Initially authmimapmsetnativesnlthis city It,enter ulon
} ,he uMromcationed Moriarty for inspection parpro
ry (Wo)agree m s:wo,imlc,mary trod keep,...bit s he Cis of Ci pemom agoiret
In liubili,ics,judgments.costs and es,scoLes which,nay in:try war accme against.said
C) z City in rom ilreacc of the granting of this I,emtit. qq �
APPLICAN'I'U DERS ANDS A DWII.L COMPLYWITHA NOPOINI' Issued by: '�— Dille
SOURCE ATl S 1 ��
ti a-
Slgn:aurc cat npnlicem( n1p. ,e Dale Re-roofs
IIA.A DOUS MATItextr DISCLOSUndi
Ali]me a Ca"I m Scam Medmg«vahm ream mend he hvanWas mamtm Type of Roof
a,r li Sed by,rte 32(d?nu Municihul coda.Chi car 9.12,and bile Ilcallh and Sule,y
c,de,section zsv±con ,/
Dyes ' ✓(No All roofs shall be inspected prior to any roofing material being installed.
• WiumeappueamM
orlatticendingoseupnllsoce,riptnentorde.ice>which If a roof is installed without first obtaining an inspection, I agree to remove
cat h:vaalous au concrommunt a efined by the Bay Area Air Quality Management
nater? all new materials for inspection. Applicant understands and will comply with
°Yes "' all non-point source regulations.
I have,cad tba ha arcloms toned:d,ne,i:mnems nada,Ctop,n 6.95 cr the
Califnmia Health A,Safety Code,Satirical 25505.25533 and 25531 I bad cmmad the,
if the building does not currently have a cement,that's is illy msponsibil ity to nosily the
«cusum of the r.,bire,tems is lot,[, Lou,,Ica:met afar or Ism:mce of a Celli fiesta of
Occupant y _ Signature of Applicant Date
owmn o,aammdee .gin Ume All roof coverings to be Class "B" or better
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CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY q 3
Sec: Twp: Rng: Sub: Blk: Lot:31605051.00
DATE ISSUED. . . . . . . : 01/26/2001
RECEIPT 9. . . . . . . . . : 14537
REFERENCE ID 11 . . . : 01010112
SITE ADDRESS . . . . . : 10905 N WOLFE RD
SUBDIVISION .. . . . . .
CITY .......... . . . : CUPERTINO
IMPACT AREA .. .....
OWNER .. . . . . . . ....: TANDEM COMPUTERS INC
ADDRESS . . . ...... .:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3548
RECEIVED FROM . . . . : CHUCK C
CONTRACTOR ... . . . . : ALLEN LIN LIC 11 22174
COMPANY ..... . . . . . : ALLEN SIGNS
ADDRESS .. . . . . . . . . : 1982 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408)280-6500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS RED NEW BAL
-------- ------------- ---------- ---------- ---------- ---------- ----------
BREMSIGNAD NO. CIRCUITS 1.00 4.44 0.00 4.44 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
PERMIT 39.96 0.00 39.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -------------"__._
OTHER 39.96 VISA
TOTAL RECEIPT .....-v39 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
..e..... ........ ............................
101 FOUNDATION 103 UFER
104 REHAB 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS
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