000110106 (2) CITYnci mf o vt�iofaNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADURHSS: - PERMITNO.
WNlilt'S N3°. Iz13 Poppy WY BERNARD RONALD D .AND 7VUR 9"I"I"I 1JfCli[1011.01.0E
t'IIGNL. BERNARD RONALD D AND DORO 1'HY G SANITARY 10..1
q o ARCH]'1'EC'OHNGINIMR: - BUILDING PERMIT INFO
kC BLDG ELECT PLUMB MECH
(= t= 1=1 LU1
H i LICENSED CONTRACTOR'S DECLARATION ,106 Description
O Z hereby offirnt tom Ii
m I aremed under provisions of Chapter 9(commencing
Job
with Section 7Wfmf Division Sof,heBmsinesand Profession,Ced,,uMnry license
Y Is In bull force mJ effect.
License Class Lic,g
3 a N Due Contractor
ARCI IITECT'9 pItCLARA'I'ION
5 O S I undemundtny plum shut)be cud ax public mcmd,
gz � REMODEL TRELLIS
_p O Licensed Pmfessiunal ,
OWNER-BII1LDFR DI!CLARA'1'ION
1 hereby rtim,thin 1 an,exempt from he Comrsnor's Lirensc law for the
fralhoviu,reas.r.Section 7031.5,1l .'t e'. d l Reoinin,Cif Any city use county
0 which requires a permit t , et alter,improve. I li.sh repair any smucture
3� pr lormchpe ut to fit, igndsunemem
hit,he ishensNp l in dre mr,don,ofd ConareconeaL L (CMtmer9 S Ft. 1'IOOr.Area Valuation
Eco...emtgwd Section 70()0)of[)is Wen 3 of lire llmones vad Pndrs,tom Cade) q' _
or that he is exempt therefrom and,he knots for the alleged exetnption.Any violation
of Section 7131.5 by any applicant for a permi,subjects,he upplic,ot to a civil penalty
of not mod,than five hundred dollars(3100f APN Number - Occupancy Type
❑1,ae caner of the property,or my mnpdoyres with wages tx their side Fm,penxaion, r
will do,he work,and the mmamre is no,intended nr offered for sale(Sec.71144,
Bmim,,:rod PramO inn,Coda:Toe C9mranm's Lmcme raw dors ,at uppdy to an - Required Inspections'
.our of property Who M:iids or improve,thereon,and who does such work himself
F l rough hi,own engdoyers,provided Wa,such improvemmnis are not intended or 35E 1.50?7• X1(1
offered for sale.If,howele,,he building or improvement is sold within one year at
otnpde,ion,the awnerhudder will have the burden of proving,nm he did not build or
Zfor purpme of sale.). —
ronneprnprnramaxrwsiveycnntraemtgwith IFn.edcnatations 101 FOUNDATION
construct the project(See.71,14.Business and Professions CFI:)The Commens", 102 — PIERS
cremeLawdoe,not applymont urpmlmoy.1 Mtod,mnnFmvesd,emm, 303 — UFF_R
and who rsmmacts for such ts a prnjerwith enmmcmDa
ds)licensed mson, ,o the
ContFactors Li,emu Low, _
❑I cxemptunJcrS 13&I'Cfor his"a,nn 104 — REBAR
�re —
105 —ANCHOR BOLTS
WORK•It'S MI'IiN9 H DBC, RATIO,
Ihnrhy",I'm under pennl,y of perjury one of the following declarations:
1 �F SEWER & WATER
20c — UNDERFLOOR PLUMBING
D 1 hove and will mu ounin a Codlfed a of Consent ,o self-insure for Worker', '
compenamian, a, provided for by sertitm 3700 of the Labor Code, for the 203 — UNDERFLOOR MECHANICAL_
perfmmanre ol'thc work for which,nis permit is e,wed.
204 — UNDERFLOOR FRAME
❑00ofthedoff mnide hitchWorker'sCampenedanlmur:mrerwhuchodbysoutis 205 — UNDERFLOOR INSULATION
770(1 of fire i,nbor Codes r.n the perlbrnutncc of,he wink for which,Lis permi,i,
issued.My Worket'sContpensation Insurance tamer and Policy number arc: 301 — ROUGH PLUMBING
Cnmc —PolicFJIn11ICATIONOrI.XEMITIONFROM WORKERS' 302 — TUB R• OR SHOWER
COMPENSATION INSURANCE 303 — ROUGH MECHANICAL
(su0),ole "iamnerdnmhrrample,enir npern,ir.mrtmanandmndmnttr, 304 — ROUGH ELECTRICAL
1 certify that in the perfomwncc of the work for which,his permit is issued.1 305 — FRAME
snail on Fir day any persm,in wry nuum er.a,os m becmne subject to the Wmkcn' 306 — HOEDOWNS
Compensation Law.of Cdi b i Dine
Applicant 307 — INSULATION
N(MCEhe....Fe TO Alto flue WorIffkers
odermakingthis Cesion, ifof Labor,ion,youshould
forthwith om,ywitworkersCisionsrthis ruMimm�llhelalvr.,.ke . roam 3013 — SHEETROCK
Q O
forthwith comply with such provisions or P:rmit shall he Acenmd rcvnkcd.
m corvsTRucr1GNLENDING ncENcv 309 — EXTERIOR LATH
� ; Ihemby alfinn,hw,hcre is a conswmion lending agemy for the perfnmmnce 31.0 — INTERIOR LATH
E
of the work for which this permit is i,mmd iSm.3097,Civ.Cd
fy p Lendcr'sNume 311 — SCRATCH COAT
a z Lender',Addree,
p 313 — ROOF NAIL
I agree toot I have with thin city
anion vnd s,meances above lawsnaion is —
Ea owren.1aguel.comply with all autandcountyontalivesoandstaylow,relating 501 FINRL ELECTRICAL ENERGY
Q (� rebuilding eamm�ed pr.F ifperryFrimpeharlmrrdo,,inlulivrsof this city toenter Firm
y (k� ,he aM(WOeminned pm, tolenritup ndkeptono . SQ12 — FINAL FtLUMBING ENERGY '
[,t rys (We)agree to sive,inA<mni'eme,keep hon ty in m City of Cupertino agai,ut
rn liabilities,j91gmrms,cast,and expenus wkrn may n,any catty scenic ugwm„,aid 503 — FINAL MECHANICAL ENERGY
t) z City in conugnence it the gmming of this permi
API rp(ANTURD17RS'f SNpppSANA WILL �1PLY WITUALI,NO -POINT Issued by: 504 — FINAL. BUILDING Ed1FRGY
ZD
iss
Signaureof Applicl HAZARDOUS MAfER1AiS DISCLOSURE pat Re-roofs .506 — GAS ]'EST
•W511,he applicant mfmambuildingsccupmn more ormuddeh:naNnn,nuecriA Type of Roof S07 — FINAL_ PLUMBING
s JeGnud by toy Cupmino Municipal Code,Chapter 9.12,and due Health and Safety
Code,Section 25532m)7
❑Yes 0 N S0 — FIN I MEC ng material All roofs shall 4 spect l'o E N material being installed.
Will he applicant or frame buildingcacupim use equimamor devices which t(t('' I
a irhvaNaus air corimminon,redefined by the B,,,A,.Air puolay Munngcmen: If a roof is insta P wllh( l n61s77 Ins ectlon, I agree to remove
Di.lrirl^ all new materiahl&inspFcct�s l'Ap f�c �i iAtands and will comply with
Dyes , 0 N all non-points�tk4regulF{ifiMl_ �-UBLIC WORKS
01 have rcod,he hv:ndous materiels requirements under Chapter h.95 of,he
California Health A,Safety Cole.Sections 25505,25533 and 25534.1 understand,hut
if the bidding does not cumndy have a mnam.that it is my respumiblli,y to notify the
V.�.
upam of the rtyuben ems which must be me,pr' m issuance of n Ceri licn,c of
, icy
Signature of Applicant Date
raraa art<rd eat ume All roof coverings to be Class `B"or better
0FFICE "
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY 4 : 3
Sec: Twp: Rug: Sub: Blk: Lot:36615027.00
DATE ISSUED. ......: 11/20/2000
RECEIPT q. ........: 14060
REFERENCE ID q ...: 00110106
SITE ADDRESS .....: 1503 POPPY WY
SUBDIVISION . ......
CITY .. . . . . . ......: CUPERTINO
IMPACT AREA .......
OWNER .. . . . . . .....: BERNARD RONALD D AND DOROTHY G
ADDRESS . . . .......:
CITY/STATE/ZIP . ..: CUPERTINO CA, 95014-5306
RECEIVED FROM . ...: TIM 0
CONTRACTOR . . . . . . . : LIC q -
OWNER-COMPANY . . . .......: BERNARD RONALD D AND DOROTHY G
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5306
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ____ ---------- ----------
EE VALUATION 8,785.00 147.00 0.00 197.00 0.00
ICRE VALUATION 8,785.00 0.90 0.00 0.90 0.00
#1"
PERMIT : 147.90 0.00 147.90 0.00
METHOD OF PAYMENT AMOUNT NUMBER
-------- ------------ ------------------
CHECK 147.90 13648
m
TOTAL RECEIPT v147.90