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00040016CITY ov RONO NPERMIT CONTRACTOR INFORMATION:000` PERM]"Tho. BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMrITAL DATE ^V� /�/ / Gam � / 5,a/jaLzll alk.' i q —S' OO OW ERS:AMCSt/3aV�" NIC CONTROLB �1711U 19 C El PHONE:9 53 + �CHITF,CHENGINEER ', BULDING PERMIT INFO LICENSED CONTRACTOR'S DECLARATION Ihereby amrmthin Iwliceased under provisions of Chapmr 9(commencing - > Job Description with Sextion7Ws))ofDivision 3 ofrhe Busocssind Profassimu Cods, and my Werim is in IT (ina49I Dine s' o Conmct« iaa C_M Ha✓ P!✓w� ��P1 ARCHTfECI'S DECLARATION—� I undrnYnd mY PWrs shall bc'u� u public meeamds , 6lceaaed Paofesaiood OWNER-BUILDER DECLARATION I hereby affirm that I am exempt form the Contractors License Law for rhe following reason. (Smtion 7031.5, Burimeas and Profusions Code: Any city or mainly Sy. Ft. Floor Area Valuation which rectums a permit in construct, alum, improve, demolish, or mpair any sracmre prim to its issuance, also mquiets the applicant for such pemin to file a signed statement �.y �q'1 QVG•VV' thnheisliceadpursuammtheporvisiodsof Ne Conainmri LicdwLw(Chap(er9 / ionsCedd« xemithsechont000)ommasisfrth APN Number Occupancy Type heallegedexemption.An violation of dusthe is exempt thaerrom ind du bears for the alleged exemption. p y •,1 t) a civil Sections by any f« L pemdr subjmb the applicant to a civil penalry o! Si O'Z • s., -//��7�='L then dred dant n m mart then five hundred dollarx (xempl their sole compensation, wi Las the employees with wages Required Inspections use arny,mmy will do the wort, endthe swaur...a tended r othe work, it t0 a0,cavom _ J and Prohsbm Code: Thc Canuamors Li«rue law does apply se owmr of licanu«oRcredf«vlapply wout if w W Wilds pr ivided u thereon, pr who d«s such w«k himself or through gh Far , his own employees, a the such .., arc nd iyeae m ala«ed forciln . cd Want, is sold within. is soldddrWild (/ owneLhower will mWilding«ion ofprvinr in improve fee omnW il4r will have the buNcn of proving that he did nm build m improae (m pm- ,mmvf.ulc,). T/ / Cl I, u. of the proper, am exclusively caoacfing with ncenred canvanon to / construct the projmt (Sec. 7044, Business ad professioas Code:) The Common's Li- - mrom taw door mupply to an owner of properly w W builds m immavc thereon, and' _t whocomracts for such pm ycu with a comacmms) licensed pursuant to the Contractors - LicenseLaw. - ❑.Iumexempt under Sm. B R P C for Nis meson owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Pendry of perjury orm of the following dmleetioru: -] Ihave and will sof Worlds Comp roomers Codinsuufw the for b Section 3700 of the labor Code, for the performance, of the tion, a provided for 37 the Labor k r« hi,h this permit is issued. mi , eve W will mainuin Worlds Came required by Section IrIc oftheon orthe laborCde,f«IW performance of the work f«which Nis Formal uissuW. h for which - My mwPnii,y nniibRt�S'>542 Mr.mtr oro wi n�pti �I c' Cortin: 1s e N I. �^ I Policy Sn CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE ' (This section oud rot becomplenal permit it forum hundred dollars (SIM) , or less.) ? - - I cenify Out in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so as m become subject o the Workers' Compen- ,.tion Laws of Cdiromia. Data ' APplinaf .. NOTICE TO APPLICANT If, arm, making this CaniOcaca of Excmptioa, you should hecomc subj«t to Ne Workers Compensation provisions of the labor Code, you must '. forthwith comply with such provisions in this permit shall W domed revoked. CONSTRUCTION LENDING AGENCY ' I hereby athmr the there is a...do. lending egenry for the pmf.c of ' ON, work for which this permit is is mid (See. 3097. Civ. C.) 1 LCMds Nm . - Lender; Addrtas I unify the 1 have mad Nis application and store Jut the above information is moreet. I agree to comply with all dy ad coumY ordinances ad scar, laws relating to Wilding construction, and Wmby authodac repreamiatives of this city to enter upon the ' abnvCcramo nd properly for inspection popxraes. (We) agrm ro ave, indemnify and imp harmless the City of Cu,mW against ,. liahi)itics. judgments, Orion, and cxpensss which may in any way ¢core against said City in conartician, of then gmntlag of this pe r. MITILICANJUNDERS1HS'1' D. 1 YWI'TH ALL NON PRINT - l y-s-ao Signatureo pplicimuCcuri actor Dau HAZARDOUS MATERIALS DISCLOSURE Re-roofs ^ Will the, applicant or forum Wiwi, omigartstore at handle handout mnaid as defied by the Cupertino Municipal Code, Chapter 9.12, and the HeAM and Safety - Type Roof Code ,Sachem ViS3200?^— of .. ❑Yes lTo All roofs shall be inspected prior to any roofing material being Will the applicant or future Wilding mention use equipment or devices which iros defied Area Air the Bay AAh Qudiry Manaent gem emit Mvrdous air comsmutas installed. If a roof is installed without first obtaining an inspection DIA1nC' ❑ Yea I agree to remove all new materials for inspection. Applicant understands and will comply with all non point source regulations. ' I love read the harardms materials regdremenb under Chapur 6.95 of Vic Cali- 1 demand the'f that Sections 25 5, 25533 a534 u forma Health & Safety Cash. d 25 bre lding elms name dy ten that us ponerbil'rymnmdy the«upmt �, ' ofpm¢y. / Signature of Applicant. Date -wrvm,,p%vWmrd.gmu All roof coverings to be Class "B" or better OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE 4 CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: yvonnek Adilk Sec: Twp: Rng: Sub: Blk: Lot:35717023.00, INVOICE DATE......: 04/05/2000 REFERENCE ID N ...: 00040016 SITE ADDRESS .....: 21691 LOMITA AV SUBDIVISION ....... CITY ........... ..: CUPERTINO IMPACT AREA ....... OWNER ............: JENNY & STEVE MAYHEW ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5910 l_v-.. - _mas. ID DESCRIPTION - 2120vv UNDERFLOOR PLUMBING 502 FINAL PLUMBING ENERGY VOICE ID =------ DESCRIPTION - 301 ROUGH PLUMBING 507 FINAL PLUMBING CONTRACTOR ....... : CARDIA, FRANK L LIC # 612 COMPANY ..... ..... : CUPERTINO PLUMBING ADDRESS ..........: 10297 S DE ANZA BLV CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: (408)283-0618 NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING FEE DESCRIPTION CHK TOTAL FEE PAID -TO -DATE BALANCE DUE --------------- BPREPIPE ------------ P --------------------_-- 41.65 0.00 41.G5 BPWSVCS P 8.33 0.00 8.33 --------- ------------ -------""- 49.98 0.00 49.98 l_v-.. - _mas. ID DESCRIPTION - 2120vv UNDERFLOOR PLUMBING 502 FINAL PLUMBING ENERGY VOICE ID =------ DESCRIPTION - 301 ROUGH PLUMBING 507 FINAL PLUMBING • �- ItlK�NIAUU`Jtrt INU UNI i +Iuuuu�rrn L••_•-. .. .. .. _. •- IBREMAIRHAN IA/C UNITS <- 10.00CCrM IMECHANICAL IBRENIFURN RELOCATION OF FURNACE IMECHANICAL I IBRENIFURNOV IP.ELO rURNACE > 1CK S U INIECHANICAL BREMINHOOD JINSTALLATION OF HOOD IMECHANICAL BRENIRELOCA RELOCATION OF HOOD NIECHANICAL BREMREPALT REPAIR/ALILK HEATING MECHANICAL BREMVENSYSVENTILATION SYSTEMS MECHANICAL 'x� IFPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING I BNUMULTI INEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE BPGAS PBLG FIXTURE GAS PIPING SYSTEM FEE PLUMBING PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING SPSEWER SEWERS PLUMBING SPSPRINK LAWN SPRINKL.ER/BACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN & VENT PLUMBING BPWATER INSTALLIALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE ZDIRTM DEVELOPMENT AGREEMENT DIR TENT MAP IPLANNING PLANNING ZFULLHR FULLAPPLBASE+HR PLANNING ZFULLTM IFULL APPL TENT MAP PLANNING ZFULLUP IFULL APPL USE PERMIT PLANNING ZFULLZONE IFULLAPPLZONING PLANNING ZGPAMEND IGENERAL PLAN AMEND PLANNING ZUMAMEND JUMITED AMEND PLANNING ZUMTM LIMITED TENT MAP PLANNING ZLIMUP JUMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHIL.LEX ZMINSIGNEX MINOR APPL HILL EXC MISC SIGN EXCEPTION PLANNING PLANNING ZMINTM ZMINUP ZMISCASA ZMISC ZMISCFENCE ZMISCGEN ZMISCPCINT ZSIGN ZTEMPSIGN ZVARLANCE MINOR APP TENT MAP MINOR APPL USE PERMIT IMISC ARCH SITE MISC TM AND UP EXT MISC FENCE EXCEPTION MISCELLADPLGENERAL MISC PC INTERPRETATION SIGN PERMI TEMPORARY SIGN DIRECTOR VARIANCE PLANNING PLANNING PLANNING PLANNING PLANNING PLANNING PLANNING PLANNING PLANNING PLANNING 2 oft Re.vv] 6II699 . Dtv. if Applicable Fee ID Fee Description Fee Group �BPERNIFEE ISLOG PERMIT FEES IBUILDIv6' 11 l JBCONSTAX 1CONSTRUCTIONAY, 1BUILDING ISENERGY ENERGY JBUILDING ISENERGYADD ENERGY ADD MULTI IBUILDING 1BOVERTIME JINSPECTION OVERTIME 1BUILDING STEMPPERM ITEMPORARY BLDG PERiNII I IBUILDING BMITIGAT IHOUSING MITIGATION FEE JBU!LDING JBPLANCHK PLAN CHECK FEE BUILDING BPLANCKAOD PLAN CHECK ADO 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 ZADOCHG ADDRESS CHANGE BUILDING EPERMITFEE JELIEC PERMIT ISSUANCE ELECTRICAL BELEC1000 ELEC 600V —1000A ELECTRICAL BELEC1001 ELEC 600V >1000A ELECTRICAL BELEC200 ELECT SVCS 600V <=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 POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT . RCPTL• SWITCH &OUTLETS ELECTRICAL BREMRESAPP NELECTRICAL REMODEL RES APPUANCE ELECTRICAL BREMSIGNAO RMOL SIGNS ADO BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE & 2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER 11 BTEMPSVCS . TEMP DIST SVCS ELECTRICAL MPERMITFEE IMECH PERMIT ISSUANCEMECHANICAL BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER <= 100,000 STU MECHANICAL BBOILER2 BOILER>100KTO500KBTU MECHANICAL BBOILER3 BOILER>500KT01M BTU MECHANICAL BBOILER4 BOILER >1M TO 1.75M STU MECHANICAL BBOILERS BOILER > 1.7SM BTU MECHANICAL BREMAPPU BREMHEAT BREMVENFAN BMNEWMULTI APPLIANCE INSTALL HEATER INSTALLATION VENT FAN SINGLE DUCT NEW MULTI -FAMILY RES MECHANICAL MECHANICAL MECHANICAL MECHANICAL BMNEWSF&2F NEW SF&2F RES BLOGS MECHANICAL I aft Pniwd V 199 • •