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00050059 (2) CITY OF CUPERTINO PERMITNO, . BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDINGADDRPSS: p /�/I /" qtr r l/ J - , \ O W A(yn�J/�r G 5661/ G C-- SANITARYNO. APPLICATION SU MRTAL DATE ow R'S A I. 1, V,01 N/C CONTROL# PHONL: 56 J;7 r ARCHITECT/ENGINEER IULDING PERMIT INFO aqs. . Zz�� < .1...7'^ LICENSED CONTRACT'OR'S DECLARATION Q�_ WO 2M h. slim that sthan I ane licensed under provisions,err Cham.9(mmm�ming ]ob Dp esert tion with Section] )Of Division 3 of me Business nJ Profession, M se Code.amy li.ois License axis df¢f O Lic.N o . 3 u F Dem 'Cmvacmr / a�O ARCHTTSCTTSDECLARATION u m I undeistmd mY Plmt shaft be used.Public records of o S 1/i _ s//•� o Licensed Professional , I OWNER.BUDDER DECLARATION L Z< 1 W.1hy ti irm that f sus exempt from the Consciences License law for the Ofollowing rtuon.(Section 703 t.5,Business sal Profeuiom Code:Any city m county a x which require'a permit to '" dm,improve,°`"sm comm ' oli'"• t<pair my samemse -Sq. Ft. Floor Area Valuation Prix to its issuance,slatt<quirts the applicant for such permit w file. ilm dsumment - that he is licensed punumt to the pmvidons of the Contractors License law(CTaRer 9 " (commend"{with Section]OW)ofItivitum 3ofthe Business sod Rofeuiau Cade)" ApN Number occupancy that he Is exempt therefrom anal me Weis for the alleged esempdm Any viola.of _ P Y Type Section TO31S by any applicant for a parent subjects the Wheat to a civil Pendry of "1 " nM mom then five hundred dollen($500). - ❑1,.owonr errthe propeny,mmy employ.,with wag.uthea wle comRnsatioo, Required Inspections - - - Will dothe work,mdthesmctua isnM im<Med.offeted for ule(Sa.'rIMa,Bmdmu - a d Friedland.Code:The Conumna's Licence law does me apply to sat owner W property.wed Wilds or improv.Merton,ata who does such work himself or through his own employe.,Provided that such improvements sec not intended or offered for ash.If,howesen the Wilding or impovemrnt le aid within me ye.ofcomplruwn,the / owner-Wilder will have the Wrden of proving met W did at Wild or improve for.pear, pose or.le.). I,a owner of the property,an exclusively connecting with licensed comments to ' ..,into me proj.t(Sec.7044,Bottom.atd Profeulom Code:)The Clinometer.U. ' .me law doe,not apply to an owner of yrafteny wed Wild'or improv.memo".ad ' who connects for such projects with a conmeort,)licensed pursuant in the Corawmea m U..Taw. ❑Ism exempt sunder Sec. .B m P C for this reasun Owner OR WORKER'S COMPENSATION DECLARATION - 1hereby ndwaffirm temspmdDofp Comicote ofdainare iogwensee,ci ` V Iheve providlmarby etion37aMCOnsenuaCoda,suaf.Workers Co ofa. de Q workf r provided far mi Ss ems 3]00 or the Labor Cade,for the performamse of the work for which ill,permit is rata°. , ❑1 have and will mein."Workers Compensation Insurance,h rtquiad by Section 3]OOofth 4Wr Code,forme#edacmn of ds wort fmwhich this#''mita irtued. M Worker' on ion w V erPolcryNo.Ynu —O6 . EUMCATEOFM MPf10N FROM ORKERS' - COMPENSATION INSURANCE (]hi,.,a.xed rise has completed ifthe pemtit it for one huntred colla t(IIW) - T oymi(y'pat io the pedmanor o as to hek r.whichmia the W dsemm Compc B rot employ any Raton in any manner eco.to become sublect m me W<itrre'Compen- - - cationlawnofGlifomia.Doc - ' Applicant NOTICE TO APPLICANT.If,after malting this Cenificate of Exemption,you should been.subject nc the Worker',Compensation peavisians M the labor Cade.You man - fmhwithcomply with such provisions or this Rmmit shell be doemed"voiced. - CONSTRUCTION LENDING AGENCY Ihereby affirm that mem inconstructionlnJingagency f.me Rdonnmce of the work for which this permit is iss.d(Sce.Y)9],Co.CJ ' Lenders Name ye Lendels Address A - W 1 certify met I hove ret app u anal sue than Bs above information is L comet.I spite to comply wiy c ty.di a and sure laws aladng to " .7 rZ buadimcm,aucdan, ho ' .afthi,citymmaruponme V 0 above-mentlaned pmRm foW a us, -(We)a uv,iy banml as the City of Cupertinoagainst liilides,judgme ,,.s aa hmayi any way same against said City mcq.mco ting ria'API ACANTU DEES \ND 1 COM .Y WITH ALLNON-POINTV ZSOU CE REGU.ATIO S.pli A'AdATERIALS DISCLOSURE Willthe app icon orfmua Wilding.cupmt Wore or handlehwNmt mere°°' Re-IOOfS ` do mad by ted pe inn Muvcipal Cade,Chapter 9.12,and the Health eM Safety sec`s"zs 53 Type of Roof - ❑Yes ❑Na r .lion :;pli<mtarfmmWildnBa.mRnmUe gmpm,tarovl.e which All roofs shall be inspected prior to any roofing material being emithnuNomaa tmasurninentsasdefinedb the Bay ArmAihQudityMmagement installed. If a roof is Installed without Irst.obtaining an inspection °'"^" I a ree to remove all new materials for inspection. Applicant ❑Y<s �No ' g x INvcaaa material musts C'Iuger695aftheCdi- understands and will comply with all non point source regulations. 'a Heelm&S retY e,Sectims 25 , 333 m 330.1 understand mat If the - dingd.atm t Wvee anent. ri miNlityncmtifY tis occupant •-. . of kyuucrts ,w ' nee con name, re Cad aMO.upercy, Signature of Applicant Date " err`amus": erg t Dam _ - All roof coverings to be Class"B"or better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE '• _ CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: RnB: Sub: Blk: Lot:34259003.00 INVOICE DATE......: 05/10/2000 REFERENCE ID k ...: 00050059 SITE ADDRESS .....: 21180 CANYON OAK SUBDIVISION ...... . CITY .............: CUPERTINO IMPACT AREA ....... OWNER .... ........: 0-BRIEN ADDRESS ..... .. . . .: CITY/STATE/ZIP . ..: CUPERTINO, CA 95014 CONTRACTOR ...... .: LIC M 21563 COMPANY ........ . .: ACME & SONS SANITATION/ELECTRI ADDRESS ..... . . ...: 1880 S. 7TH ST CITY/STATE/ZIP .. .: SAN JOSE, CA 95112 TELEPHONE ........ : (408)275-2263 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE ___ --- --------- ------------ ----------- BTEMP P 57.50 0.00 57.50 EPERMITFEE P 35.52 0.00 35.52 --------- ------------ ----------- 93.02 0.00 93.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION e= ------ --- -------- ----n------e=------see-----n OPER 304 ROUGH ELECTRICAL • Ory if Applicable Fee ID 'Fee Description Fee Group IF jBP-_RbIF== BLDG PERMIT F==S IBUIL06�G ISCONSTAX lCONSTRUCTION TAX BUILDING • BENERGY ItNERGY IdUILIJINU JBENERGYAOD ENERGY ADD MULTI (BUILDING 1BOVERTIME INSPECTION OVERTIME IBUILDING STENIPPERM TEMPORARY BLDG PERMIT BUILDING BMITIGAT HOUSING MITIGATION FEE IBUILDING �SPLANCHK IPLAN CHECK FEE IBUILDING 8PLANCKAD0 PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING 8SEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZAODCHG JADDRESSCHANGE BUILDING EPERMITFEE JELEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC600V <=1000A ELECTRICAL BELEC1001 SL-EC-600v>t000A ELECTRICAL BELEC200 ELECT SVCS 600V <=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODEL BUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL • M MISCAPPARATUS ELECTRICAL P REM NON-RES APPLIANCE ELECTRICAL POLE/PLATFORM FIXTURE ELECTRICAL ER POWER DEVICEIAPPARATUSELECTRICAL PT . RCPTL, SWITCH &OUTLETS ELECTRICAL PP REMODEL RES APPLIANCE ELECTRICAL AD RMOL•SIGNSAD0BRANCH ELECTRICAL S REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSFS2FAM SINGLE&2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS . TEMP DIST.SVCS ELECTRICAL MPERMITFEE MECHPERMITISSUANCE MECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER 100,000 BTU MECHANICAL BBOILER2 BOILER>t00KTO500K BTU MECHANICAL BBOILER3 BOILER>500KW IM BTU MECHANICAL BBOILER4 BOILER>lM TO 1.75M BTU MECHANICAL BROILERS BOILER> 1.75M BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION. MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULH NEW MULTI-FAMILY RES MECHANICAL • BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL I oft nsrlua 9110M BR°NIAGOVE' IAC UNIT >IG000CFNI AL �BREMAIRHAN JA/C UNITS c= 1MGCCFlI IMEC.HA.141CAL I JBREMFURN RELOCATION OF FURNACE IMECHANICAL I �BRENIFURNOV IRELO FURNACE > 10K BTU IiNIECHANICAL BREMINHOOD INSTALLATION OF HO IMECHANICAL BRENIRELOCA RELOCATION OF HOOD JNIFCHANILAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION 5YSTEMS IMECHANICAL IPPERMITFEE JPLUMBNG PERMIT ISSUE PLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING M. MBNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE IN PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORWRAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN h VENT PLUMBING BPWATER INSTALUALTER WATERPIP PLUMBING BPVWHEgTER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZOEVAGREE DEVELOPMENT AGREEMENT PLANNING A ZDIRTM OIR TENT MAP PLANNING ZFULLHR FULLAPPLBASE+HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFUU20NE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZUMAMENO LIMITED AMEND PLANNING 7�piTM LIMITED TENT MAP PLANNING ZUMUP UMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EAC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING 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 MISCRI APPLGENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE JOIRECTOR VARIANCE PLANNING 1 oft O • Rr,vcd vlass