00020182 Cieat ofcDSONO PERMIT
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DIVISION PERMIT CONTRACTOR INFORMATION: QO72 b �
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BUI.DINGADDRESS: - - -
�� SANITARYNO. APPLICATION SUBMITA,DATE
N/C CONTROLp
. ARCHITEC(ENGINEER BOLDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION Ix 2-
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z I hereby alfmr that 1 sum licensee under provisions of Chapter 9(commencing Job Description
Fm_..I--1 with Sarceanda)ecDivision3ol We Busincsa arM Rafeviam Code,and myliunu is
.
<—e4,c in full farce and affect. _ /,as P�
z�i V on.class Li, G �.. e G��,�9 e ow
a 3 u,f„ Dem
Co.
[- O ARCHITECTS DECLARATION
f m o, I undersand my plans shall W used as public records _Co
-
i a o s Licensed Professional '
OWNER-BUILDER DECLARATION
Z>' 1 hereby of Tin that 1 am exempt firm to Contractor's License Law for the
f D following mason(Section 7031.5,Business and Professions Cade:Any city as county '
3 winch mspJmx.pemm tom ax;a war,impmve,demo]iA.m m*r my.muctme Sq. Ft. Floor Area ^VaV u tion
requiresc. er .,
From to its issuance,also Ne applicant for such pmto file le a signed statement tel'V
Net he is licensed puraanuu the pmvisiom of the Contractor's License Law(Chapter 9
fcatmtRncmgwith Semlon7W)of Divisim3of N<Businemmderafessmm Cndc)m APN NumbOccupancy T
Wt he is comps therefrom and the bub for she allalleged!examption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applinnt w a civil penilry of J G G ,6 O' er ane
pYYPef'
nm tome Nan rise hundred dollars
1d I.as owner of theImpacts,or my employees with wages u thew sole compersadom. - Required Inspections
`lI eco Ne wmk,and the structure is rot intended or offamd fm We(Sec.70,,,Budneu
and Prefessimu Cade:7W Contractor's Liume law does rat apply to an owner a -
property who builds or improves Hereon,sad who does each work himself or through
his own employes,pmvidW that such impnovemmss are am intended or offered for ,
We.If.however,ted Wilding or impovem nal is sold within me year of completion.the '
owner-bilks will hats the burden of proving that he did nm Wild or improve for pm- ,
pme of ai
L] ,a awns of the property,am exclusively connecting with Iicensd convsctoa to
canwct the project(Sce.](1,,,Businss sed professions Cade:)The Corrosion's Li-
cert Law does we apply to an owner of property who Wilds or imp.oves thereon,and !
who contracts for such projects wish a contractor(s)licensed pursuant in me Contmcter's
License Law. n •
❑
1.eiempt under S B&P C far this
0.."15
Daze
WORKER'S COMPENSA N DECLARATION
I hereby affirm under penally of perjury art of the following dulareions: '
I have and will mainuin a Certificate of Consauo self-insurePor Worker's Compcn-
.tion,ea provided for by Section 3700 of the Labor Code,for the perfmmonce of the
work far which Nix permit is issued.
❑I have and will morain workds Compensation Insurance,as required by Section
37W of the Lahr Code,for the pedumname of the work for which this permit is issued. '
My Workers Compensation Insurance tuna and Policy number are:
Carrier, Policy No.: ,
-CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This satinn need nth be completed if the permit is fortune hunduesiM as(Sldly
or leas.)
I Certify fast in the perfmartme MNe work for which this permit is issued.Ishell
not employ say person in any manner,an as m become subject to the Workers'Compen- -
.tion taws of Calif nnut.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation Provisions M the labor Code.you mus
forthwith comply with such provisions in this permit andl be deem<A revoked. -
CONSTRUCTION LENDING AGENCY
p the aRrtn permit dust Nem is a construction lending agency for flue peRarmarce of
z Ne wink for which Nis is issued(Sec.3097,Civ.C.)
A '
IerMera Name
(� > lender,Address -
W I cati(y,that 1 have rad this application and sea Nat Ne above infomadon Is
0., z cones,l agree to comply with all city and county ordinances and etre laws relating to
U building concoction.sad herby authmlu representatives pentatives of this city to enter upon Ne
ehov,memiond property for imps tion Impso.
W E`., (We)agree to use,indemnify and kap Iamd<cs the City of Cupertino against
V lubillties,judgments,crisis and expenses which may in any way secme against said City
. '., W in eonsect.a.of the granting of this p.i,.
f•' C6 APPLICANT UNDERSTANDS AND WILL.COMPLY WITII ALL NON MINT
U..� gOlr BRf:GOI, IDNl. ,
A=It910:1N �.� sYl,o f
ti Signature of A,ticantlConr rices
HAZ RDOOS MA7RIALS DISCLOSURE
Win the apybcaut or future Wilding occupant stare or handle hvaJous mamriw Re-roofs' .
as def had by the Cupertino Municipal Code,Chapter 9.12,and thc Health and Safety Type of Roof `
Cede,Section 25532(g)7 •sl"o yp
❑Yes e �
will applicant or future building mcupmt use cquipmem or devices which
All roofs shall be inspected prior to an roofing m.aterial'being
cmit hawdous air contaminants as defined by she Day Area Air Quality Mavgcmcns installed. If a roof is installed without first obtaining an inspection
Dian'? I aree to remove all new materials for inspection. Applicant
❑Ys Yflao. - g
Iaseread uz
ane hrdous anderads regmm rtmerunderCht aer595 muse C.h- understands and will comply with all non point source regulations.
forma Hsub&Safety Code.Sections 23505.25533 and 2553,.I understand that if the
Wrlmn does. asv<atevnh azif is mY rtspomibility iorotifYtW oaupmt '
a tow mealy/ fro is.aref.Cenif. u� Signature
�/gp�t/Q/a�/-•�— -6 N/♦0 nature of Applicant Date
Owar m.uNdriAdV$edt Da - .
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: chriatya
Sec: Twp: Rng: Sub: Elk: Lot:36616018.00
INVOICE DATE...... : 02/24/2000
REFERENCE ID k ... : 00020182 ,
SITE ADDRESS .....: 7505 LEEDS AV
SUBDIVISION . ......
CITY ....... .. . ...: CUPERTINO
IMPACT AREA . . . . ...
OWNER ............ : DE LA CRUZ BRUCE N AND DELACRU
ADDRESS . . ........ :
CITY/STATE/ZIP ... : CUPERTINO CA, 95014-5260
CONTRACTOR . . .....: LIC N
COMPANY .... . .....
ADDRESS ... . . .....:
CITY/STATE/ZIP .... ,
TELEPHONE .... . ...:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BELEC200 P 22.20 0.00 22.20
EPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
57.72 0.00 57.72
ID .DESCRIPTION VOICE ID DESCRIPTION
.. ___. ....__. ............ ......................... ...........
304 ROUGH ELECTRICAL - 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECPRICAL