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00040184 (2)poi; ceI zoy– Oy 7 SCC pyU wary C�GJ tri au 1–z6 cc G i3C$ BUILDING DIVISION PERMIT I CONTRACTOR LICENSED CONTRACTOR'S DECLARATION I hereby alarm Nal 1 am limused under provisions of Chapter 9 (commencing ith Sation?OW) ofDivisirn 3 of Ne BusiNrs sod Rofessiom Cade. and my licenx is in r�""ar aM Rr /�� Licenne lass _JI "" Lic. N Date C. holig ARCHITECTS DECLARA �N I understood my puns shall he used a public records licamd Prefer.imW OWNER -BORDER DECLARATION I hereby aRnm Nat l sin exempt from the Contractors License law for de following no wn. (Satins 7031.5, Business ad Professions Cods: Any city es county which requires a permit m eomract, aper, improve, demolish, m repair any avunme prim to its issuance, am requim permit the applicant for such peit m file a sipd autement Net he is licemed pannsnt to the provisions of Ne Convacrars Umme law (Closer 9 (commcming with Section?000) of Division 3 of the Busiona and Protim.a. Cade) or that he is exerpt therefrom and the basis far Ne alleged exemptian. Any violation of Section 7031.5 by any applicant for a permit wbjmts the applicam to a civil penalty of not mom than five hmdrtd dollars ($500). I, as owntt or Ne moKnY• m my cmplayas wind wages u their role componsedon. will do Nowmk, ad Nc awnurc isnm, Licenso Law We(Sly 1.an Bmla Pod Prfesaions Codc: The Conveem i License law docs nm apply to If owner d his oP-Pory wW builds pr improves, such i pr who sou such work nked or a monmeed for W own ism"occa. provided Nu such i ent is W nw art fid inendd ca peemd for We. If, however,due buildingorimprownem is addwithinamyNrafcrrove,per the rwmem se'ecr will haw rod Borden or proving that he did nor Wild m improve fm pm - 0 1, a uwne I, u owner of the Sm. proper, , Business xsi ad Protrusions wind licenwd conramon to construct Ne project pply to n wnrfrod Professions ds or i pro convenors fid whoa law does not appy a m owner err praperty who Wiles m improves Ncreon, end who convects for men pmjau with a contrcmmfsl license pursuant to the Cantracmra ran Law. 0 1 em exempt under Sm. . B R P C fm this reason Owner De¢ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury case of the following dalaretiom: I lust and will meivWn • QniRPae or Consent m xlf-invert fm Woheh Compen- at ion,, as provided for by Section 3700 of Ne tabor Code, for the perfomunm of Ne Kfor which this pemm is issued. have and will maintain Worker's Compensation Immense. as required by Section of the LsWr Code, for the performance of the work for which this permid �t iw_u. Ms Wmk.",,aM.Lupo jpwrNSG pWHer and Pat isXglgBbGr(®Ki/:iA CONSTRUCTION LENDING AGENCY 0 I hereby affirm thas there iso cmumordon lending agency for be pttfomume of Z 2 Ne wink for which this permit is issued (Sec. 3097, Civ. C.) F4 Undoes Name Under s Address WE I m rify rho I have red Nis application and nam don, Ne above information is L correct. I .gra to comply with 110y sol county odiwucs sol amr laws sluing re 7 z baddinB .do.. hmmY.uduritc xpescnwiver-fres city In corer upon the U O stove -mentioned property for inpemou purpox, fiWc) egrcr m saw, indemnify and kap harmleas tba City or Cupertino against O IF.7 liebili s,judgmenrs, emu anseswi icnmayinary rosy.—Mamstuid City } ta7 in co nee of N g this permit. it 4 AVL' ) UNI 3 Y, ND WB.I, COMPLY WITH ALL N0Nd01N'r tiUtl I I Wl. ) v z ^Z1'c>D Signsm rtof APPlic o car Dax HAl.ARDOUS MATERIALS DISCLOSURE Will the applicant m ensure building acupwt came mart s e H ardour material u dcEnd by IM Cupertino Municipal Cde, Chapter 9.12, ad the HWN sad Safety Cole, Section 25532(q? ❑Yo >gi!No Will the applicant or future Wilding mcup nus use equipment or devices which mit heudaus au mnruninurs as deEnd by the Bay Arca Ab Quility Mmsgement istriet? ❑ Ycs �` IRN. I N e rod de h. menials requiremenu under Chapter 6,q5 of the CO- fmnis HN Safetye. Z5. 25533 mW 25530.1 understand Nat if tho Wildinse m t m duan is my tcepomibility to ratify me occupant .Rite fond hieum so iewarced.ceoif ax nfOnu Owner or d gent ate SANI'TARYNO. APPLIC [ONSUBMrITALDATI rpNIC CONTROL BULOINO PERMIT INFO 'f;.': I#". �v s' v v '��l'�� b description t Sq. Ft. Floor Area I + ,7 Valuation 4 -1 Re -roofs Type of Roof Is: /'q/� O O All roofs shall be inspected prior to any roofing, material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant Date All roof coverings to be Class "B" or better OFFICE COMPENSATION INSURANCE (Thovei,nadombec leudifthcpuromm iaforone huahmmallan($100) or loss.) I anify Pe mwork for which this permit is issued, l shill nm employ any 71hislanwMect m the Worlar. Compm- umionlawsof App icwt NOTICE TO AP A%tT–IfVdIrA4dWj1V VaAate of Exemption, you should become subject to the Wmkaes Compensation provisions of the Labor Come, you most forthwith comply wit such provisions or this vommit"I be domed revoked. CONSTRUCTION LENDING AGENCY 0 I hereby affirm thas there iso cmumordon lending agency for be pttfomume of Z 2 Ne wink for which this permit is issued (Sec. 3097, Civ. C.) F4 Undoes Name Under s Address WE I m rify rho I have red Nis application and nam don, Ne above information is L correct. I .gra to comply with 110y sol county odiwucs sol amr laws sluing re 7 z baddinB .do.. hmmY.uduritc xpescnwiver-fres city In corer upon the U O stove -mentioned property for inpemou purpox, fiWc) egrcr m saw, indemnify and kap harmleas tba City or Cupertino against O IF.7 liebili s,judgmenrs, emu anseswi icnmayinary rosy.—Mamstuid City } ta7 in co nee of N g this permit. it 4 AVL' ) UNI 3 Y, ND WB.I, COMPLY WITH ALL N0Nd01N'r tiUtl I I Wl. ) v z ^Z1'c>D Signsm rtof APPlic o car Dax HAl.ARDOUS MATERIALS DISCLOSURE Will the applicant m ensure building acupwt came mart s e H ardour material u dcEnd by IM Cupertino Municipal Cde, Chapter 9.12, ad the HWN sad Safety Cole, Section 25532(q? ❑Yo >gi!No Will the applicant or future Wilding mcup nus use equipment or devices which mit heudaus au mnruninurs as deEnd by the Bay Arca Ab Quility Mmsgement istriet? ❑ Ycs �` IRN. I N e rod de h. menials requiremenu under Chapter 6,q5 of the CO- fmnis HN Safetye. Z5. 25533 mW 25530.1 understand Nat if tho Wildinse m t m duan is my tcepomibility to ratify me occupant .Rite fond hieum so iewarced.ceoif ax nfOnu Owner or d gent ate SANI'TARYNO. APPLIC [ONSUBMrITALDATI rpNIC CONTROL BULOINO PERMIT INFO 'f;.': I#". �v s' v v '��l'�� b description t Sq. Ft. Floor Area I + ,7 Valuation 4 -1 Re -roofs Type of Roof Is: /'q/� O O All roofs shall be inspected prior to any roofing, material being installed. If a roof is Installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. Signature of Applicant Date All roof coverings to be Class "B" or better OFFICE •i CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot:32647011.00 DATE ISSUED.......: 04/28/2000 RECEIPT 4.........: 12109 REFERENCE ID k ...: 00040184 SITE ADDRESS .....: 10300 STOKES AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: POPOV MICHAEL L AND JILL ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1232 RECEIVED FROM ....: JOE S CONTRACTOR .......: GRIDLEY, LINDA LIC # 17555 COMPANY ..........: GRIDLEY COMPANY ADDRESS ..........: 19 S 3RD ST CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)374-0900 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS RED NEW BAD -___--- ---------- ------------- BPFIXTURE UNITS ------- 2.00 16.66 ---------- 0.00 16.66 0.00 UNITS 2.00 16.66 0.00 16.66 0.00 CEPT NO. OUTLETS 3.00 3.33 0.00 3.33 0.00 EE VALUATION IE 37,000.00 396.00 0.00 396.00 0.00 NFAN NO UNITS 2.00 47.74 0.00 47.74 0.00 TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 BSEISMICRE VALUATION 37,000.00 3.70 0.00 3.70 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 ---------- TOTAL PERMIT ---------- 590.65 ---------- 0.00 ---------- 590.65 0.00 METHOD OF PAYMENT AMOUNT NUMBER ___CHECK ----------------- ------------ CHECK -- ------------------ 590.65 14908 TOTAL RECEIPT 590.65 i