00040136 CITY OF CUPERTINO - PER No.
BUILDING DIVISION PERMIT CONTRACTORTNFORMATION: (�/�b 6
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BUILDING ADDRESS:jpq Ig Al. n
S / e �gd a '/n _ _ C' SANITARY N(l. APPLICATION SUBMITTAL GAT'.
OWN,4 l , 1/I //I/VI / Ytss p. //I n rl /J�1 \jjjwe AtAe NIC CONTROL#
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Vj LICENSED CONATI
TRACTOR'S DECLARON
oJpt3 Description
O 0-p 1 hereby affirm that 1 w licaued mdo,Prwi4ions of Chaper 9(commencing p
wish Section 7000) f Division 3ofthe Busiaaa and RofeaaiOm Code,and my liceauiF � ,r
<y J in full fan and cR `O"{l'//
JJ cf1 'I7/ 'I /��//q��./I�
m m¢ LicenneC `'—` Lic.N D J-t' wml� OV
LO6C1 kA,.
3 u Dne Conuacmr -
4,u.O¢ ARCHITECTg DECLARATION
v�v._ 1 undneaed mY Plw shall M used u Public records
wap 00
Licensed Professional
OWNER-BUR,DER DECLARATION
i, >' I hereby afrm Vas 1 w exempt from Ne connector.License law fm the
4 7 foibwing mson.(Sation 903 I.S.Business and Prokasions Code:Any city a matey
is which reclaim x^nir fin construct.aw.imPmve.�a^°lio.m mp.ir any apa�'a� Sq. Ft. Floor Area Valuation
prim m its etmanee.also regains the Applicant for such permit to rite a signed statement
Net he is licensed parental o the previsions of the Contractors Liana law(toper 9
(c.loing with Suction 7000).17 Division 3 of the B.,mas and Pmfeniom Code)car ApN Number Occupancy Type
Nat he is exempt Mertfmm and the basis for the alkal exemption,Any violater of e-b ( _ O�O
Se W]0313 by any q fieavt fm a pemdt subjects the applicant m•civil pmlry of JS
I more than five
hundred dollen($300).
p I.acowner.ftheprnPeny.urmyempioyeeawimwagmau irwlecomxm mt. Required Inspections
wind.R¢work.anatheewaure isnotimandedmoBemAfo...k(Sce.10M.eurim.
and Professions Code:The Cont actor's Liana law door an,apply to w.sumac a
propny who builds or improves Nemo,nod who does such work himself.r through
his own employees,Provided Met such impoamenta an,nor intended or offered for
We.If,however,Me building or improvement is sold within one year of completion,the
owner-build.,will have On buNen of Proving that he did nm build m improve for ptr-
poac of sale.).
(]I,as owner of the property,am exclusively contracting with licensed conlramor l40
comvuct the project(See.70414,Busi....red Professions Code:)The Contractor.Li-
cense law does nut apply ro w owner of propny who builds o,impovm Merton,and
who concretes fa wch Projects with acom mors)Ikenaed pustuwl on the Contractors
Licanee Law.
I]I w exemptunder Sac. .B @ P C fm this won
O.aar Date
WORKER'S COMPENSATION DECLARATION
1hereby affirmander,pemlry.foffjory ons,ofthe inSumfngdookeeti o
Ihave and
ro will mein byeCor,37W of Me LaIWoCode.(orthe Workers Compo
asiyn,as provided(are gator,1900 of the labor Cada,fm the pc,fomuree of the
wok(a which ll.pmdi is inued.
1have La willedi,for
Wmk,r'.Compensation lmuoance.as r whihhisPer by section
My orrhe Labor Code,forthemuntecaMeofthe Wmk for which thispnmili.inured. f
My Wod C nsey ! i s^ccemmull No.:.nRmQcCart'g9
Cuncc Policy O .WORK
CERTIFl O OF EXEMPTION MOM WORKERS*
COMPENSATION INSURANCE
(This acerin.need nor becompleted ifthe permit i.!Drone humhaldmlen(5100) 1
or ku.) J
(certify Vatinthe pyneso necofthe work for which this pen ds isissued,Ishill
rot employ any Anon in any mann,an as m bcwme wbjauo the Wohaa'Compen-
Appli Laws of California.Data
t
NOTICE
NOTICE TO APPLICANT:If,afar.taking this Certificate of Exemption,you should
Wc.me wbjecs to Ne Workers Compensation this p.ialom a!the labor Code,you muss
foMwith comply with such Provisions or this pmnh shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby olfirm Wl Nem is.,...home.lel ling agency forth,perf.muc s a
r the work for which Nis permit is issued(Soo.3091.Civ.C.)
lenders Nature
a > I.emlers Address
I certify that 1 base read May.,headm and stme that the above infomation is
00 C correct.I agree to comply with all city and county nations""and atau laws abling to
D Z building comtmeuon,and hereby auVwrire representatives of this city to enter upon Ne
U 0 atuwamartioned property for inspection purposes.
I,. F (We)all ho use,indemnify and kap hmmlas the City of Coleman against
U liabilities,judgmcros.created cspeaeca which may in any wayacerueagelmt said City
�,. W In comequcMe of the grana,of Mir permit.
[� 1 API'RcER'I'UNUERgI'ANIlS AND WILL COMPLY WITII ALI,N NQ PINT
gO�UHyySG,/PH IULAT NS. 4-, 1 "used
SighiAurto Apf"'.VC tenet r Oat,
RDOUS MATERIALS DISCLOSURE
wiRMcggh .1 future Wildingrace upmnnueorhandlehazmdousma¢hnl Re
-roofs
as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health aM$,Cry T e Of Roof
Coda Section 35532k)1 yP
❑Yes IN.
Will the applicant o,future W.1dingoccupant use equipment.,devices which All roofs shall be inspected prior to any roofings material being
emit harndous air contaminants u defined by Ma Bay Arca An Quality Mwagemcm installed. If a roof is installed without first obtaining an inspection
Di,mc,l I a ree to remove all new materials for inspection. Applicant
i �. 0Yes o g
I have road the„adorer entered.requiremmnruMer Chapter 695.17the Gli. understands and ill comply with all non point arca regulations.
NA.8 ..& ed Cycle.Sects 35505.25553 and 25SS0.I w mifY thus if Ore .T�f�
M1uildingdasrm¢,r 1, l�waateuemricr ojismose.f.aibilirywmaify the ouvpwt p vv f/y
of 'ernenh h' rear od ten Dria w huuae.f a Cppyy li ere of cupem'y.
W 2� Signature of Applican Date
G` ,or audurn d lent Dau
II roof coverings to be Class"B"or better
OFFICE
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Ory. if Applicable Fee 10 Fee Description Fee Group
IBPER&IFEE (BLDG PERMIT FEES 18UILDING I
gEJIISCO
NS
T�_
AX (CONSTRUCTION TAX IBUILDItryG
IBENERGY (ENERGY IBUILDING •
IBENERGYADO (ENERGY ADD MULTI IBUILDING
�BOVERTIME INSPECTION OVERTIME IBUILDING
II
BTENIPPERM TEMPORARY BLDG PERMIT ISUILOING
BMITIGAT HOUSING MITIGATION FEE IBUILDING
IBPLANCHK IPLANCHECKFEE IBUILDING
SPLANCKADD PLAN CHECK ADD MULTI BUILDING
BPLANCKREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT REINSPECTION FEE BUILDING
BSCBLVD SCS SPECIFIC PLAN BUILDING
BSEISMICOM SEISMIC COMMERCIAL BUILDING
BSEISMICRE SEISMIC FEE RES BUILDING
ESPECIAL SPECIAL INSPECTION BUILDING
BSWIM SWIMMING POOL BUILDING
7A00CHG ADDRESS CHANGE BUILDING
EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL
BELEC1000 ELEC 600V —IOOOA ELECTRICAL
6ELEC1001 El EC 500V>1000A ELECTRICAL
BEL.EC200 ELECT SVCS 600V 4=200A ELECTRICAL
BNEWMULTI MULTIFAMILY RES ELECTRICAL
BREMBUSWAY REMODEL BUSWAYS ELECTRICAL
BREMFIXT LIGHTING FIXTURES ELECTRICAL
BREMMISC MISC APPARATUS ELECTRICAL •
BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL
BREMPOLE POLEIPLATFORM FIXTURE ELECTRICAL
BREMPOWER POWER DEV ICEIAPPARATUS ELECTRICAL
BREMRECEPT . RCPTL, SWITCH BOUTLETS ELECTRICAL
BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL
BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
BSF&2FAM SINGLE&2 FAMILY ELECTRICAL
OTEMP TEMPORARY POWER , ELECTRICAL
BTEMPSVCS . TEMP DIST SVCS ELECTRICAL
MPERMITFEE IMECH PERMIT ISSUANCE MECHANICAL
BAPPLOTHER OTHER APPLIANCES MECHANICAL
BBOILERI BOILER 100,000 BTU MECHANICAL
BBOILER2 BOILER>100KTOSOOKBTU MECHANICAL
BBOILER3 BOILER>SOOKT.O 1M BTU MECHANICAL
BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL
BROILERS BOILER> I*75M BTU MECHANICAL
BREMAPPLI APPLIANCE INSTALL MECHANICAL
BREMHEAT HEATER INSTALLATION MECHANICAL
BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL
BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL
BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL •
k of2
Pnixd L10M
BR°MACOVER IAC UNIT >IGGOGCFNI I,�I EC-AN iC ;L1.
IBREMAIRHAN (AIC UNITS <= 10.000CF�NI IMECHANICAL
IBREMFURN .(RELOCATION OF FURNACE IMECHANICAL
• IBREMFURNOV IP.ELO FURNACE > iCK BTU Ij\,IEC-iNIG L
BREMINHOOO JINSTALLATION OF HOOD IMECHANICAL
BRE�IRELOCA IRELOCATION OF HOOD IMECHANICAL
---------------
BREMREPALT REPAIR/ALTER HEATING IMECHANICAL
BREMVENSYS (VENTILATION SYSTEMS IMECHANICAL
IPPERMITFEE JPLUMBNG PERMIT ISSUE PLUMBING
BNUMULTI NEW MULIFAMILY RES (PLUMBING
BNUSFD NEW SINGLEFAMILY RES PLUMBING
BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING
BPCESSPOOL CESSPOOL PLUMBING
BPFIXTURE PBLG FIXTURE PLUMBING
BPGAS GAS PIPING SYSTEM FEE PLUMBING
WIN I rMCr IND WASTE INTERCEPTOR PLUMBING
BPREPIPE REPIPE OF FIXTURES PLUMBING
BPSEWAGE SEWAGE DISPOSAL PLUMBING
SPSEWER SEWERS PLUMBING
BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING
BPSTORM STORWRAIN WATER PLUMBING
BPTRAP KITCHEN TRAP PLUMBING
BPVENT JALT OF DRAIN &VENT PLUMBING
BPWATER INSTALL/ALTER WATERPIP PLUMBING
BPWHEATER WATER HEATER/VENT PLUMBING
BPWSVC5 MAIN WATER SERVICE PLUMBING
• ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING
ZDIRTM DIR TENT MAP PLANNING
ZFULLHR FULLAPPLBAS=+HR PLANNING
ZFUU TM FULLAPPL TENT MAP PLANNING
ZFULLUP IFULL APPL USE PERMIT PLANNING
ZFULLZONE FULLAPPLZONING PLANNING
ZGPAMENO GENERAL PIAN AMEND PLANNING
ZUMAMEND LIMITED AMEND PLANNING
Z.uMTM LIMITED TENT MAP PLANNING
ZUMUP LIMITED APPL USE PERM( PLANNING
ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING
ZMINHIL.LEX MINOR AP PLHILLEXC PLANNING
ZMINSIGNEX MISC SIGEXCEPTION PLANNING
N
ZMINTM MINOR APP TENT MAP PLANNING
ZMINUP MINOR APPL USE PERMIT PLANNING
ZMISCASA MISC ARCH SITE PLANNING
ZMISC MISC TM AND UP EXT PLANNING
ZMISCFENCE MISC FENCE EXCEPTION PLANNING
ZMISCGEN MISCELLAPPLGENERAL PLANNING
ZMISCPCINT MISC PC INTERPRETATION PLANNING
ZSIGN SIGN PERM( PLANNING
ZTEMPSIGN TEMPORARY SIGN PLANNING
ZVARLANCE DIRECTOR VARIANCE PLANNING
• 2 oft
• RRrised UIC99
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE 'OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: Lot:31605053.00
INVOICE DATE. .....: 04/20/2000
REFERENCE ID N . . .: 00040136
SITE ADDRESS ..... : 10919 N WOLFE RD
SUBDIVISION ...... .
CITY ... . . ........ : CUPERTINO
IMPACT AREA ...... .
OWNER .... . . . .....: CUPERTINO VILLAGE
ADDRESS ..... .....:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3548
CONTRACTOR ... . . . .: ALLEN, TIMOTHY LIC k 21033
COMPANY ........ . .: ALLEN ELECTRIC CO
ADDRESS ..........: 1498 WINDING STREAM DR
CITY/STATE/ZIP ...: LIVERMORE, CA 94550
TELEPHONE .... . ...: 8008460886
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- _-- --------- ------------ _--__-_--__
BREMSIGNS P 22.20 0.00 22.20
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
57.72 0.00 57.72
VOICE ID DESCRIPTIONVOICE ID DESCRIPTION
----------------------------
__ --6
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS