00060092 CITY OF CUPERTINO
BUILDING otVISION PERMIT CONTRACTOR INFORMATION: .
Bun.Dm tlfrS1:90 ALDERBROOK LA , _ .' m:,RN1D Na0060092 .
OWNIIR'S
Z -A_LORRN TIMOTHY' P " .. APPLICATV66 S`YIVAV
?20
ONE: tD,a
SAN]FARYNO. CONTROL NO.
re0 ARCHITECT/ENGINEER BUILDING PFRMITINFO
rem— HLOG.J I:I.ECI' PLUMB MF.CII
-Fn Pd
LICENSED CONTRACTOR'S])I CLARAFION
�y? JIDescri lion
,Z'prglrrm thm I am licensed under pnrvl,Inns of Chapter 9 Rummenang P
pss J with Seruon]I(Nll ufDn,ian3ufNCBwine„and l'mfmwom Gdc,and my bccnm GAS LINE '
a 5g m of farce and effc,l
E as K 6 Licenm Class Lie,0 "
3 LL v Dam Contractor - • a - ' "
F,le
.S N ARCHITECTS DECLARATION O a I understand my plum,hall be used a,public records at
LL
w L 0 0 Licensed P...I a„lull,] r
OWNER
-BUILDER DECLARATION
Iyil= 1 hereby alarm Ihm 1 am e,emlm from he Conlr,emr's License Law for the '
allowing reason(Section 70315.Business and Professions Cale.Any city or county
F❑ which requires a permn m wnsmlet,allen mtprose,dnnubsh,or repair any structure
' ce '11111 mnsl„uunrc,also lag....r, appllcum lnr,amh permit to III,unigned,lutemenl
nlm he 1,licensed In..naoltolu7pnw,ma,of the Oaruwh,Lacco,,a Ww tCbalncr 9 Sq. Ft. Floor Area Valuattg�
Wunmencmg ulib Section 7000)of Division 3 of the Business end Professions Code) ,
or that he is exempt therefrom and the basis for the at lulled exemption.Any coalition
of Section 70315 by any apphcant for It perms subjects the apphcant to a co it penalty ---
,01 not mac titan fsc nllmtrcn dollars Is5no1 A3E9^f '0e�+2. as Occupancy Type
❑I,as m van's l the Property,no my c.pin)ec,with wages as Iheraole rompensmnso
will do the work,and the aructure is not amended sir robbed fur sale(Sec.7014,
Business and 11 fcsslon,Cale Tlic Cnnuacmr's Lcene law does not apply to an geq Irge��J tlons
ofpn„eny Arno badd„n inlpmve,meram,and who tome,o,Ir wmk nm,ed 1.06 — SEWER �' •W R
or through his awn employees pros Wed that such mtplovemenu Luc not intended ur
offered for sale.If,howevec the budding or Improvement Is sold within one year of 202 — UNDERFLOOR PLUMBING
Completion,the owner-builder will have the burden of pmvmg that he did not build or -
imp..eforPurpo,eofn1c). 301 — ROUGH PLUMBING
❑I,ad awoerod(be property,usehi,ncly eommedng with dcen,,doar,,u... o 302 — TUB & OR SHOWER
n,lroct the ouP,ct(Sea.7(44,Business and Profs„Ion,Cale:)The Coronacn,r, 502 — FINAL RLUMA I NG ENERGY
L,.a,e Law doe,Ism apply to an owner of property who bold,m ampmve,Iberron,
and win contracts for such pro)eas with a contmeto(s)licensed pursuant to the Sa6 — _GAS TEST ' -
Cnnl adorn Liccnee law. .
❑Iame,con,tond,,See B&PCfouthisemua 507 — FINAL PLUMBING
Done, ce—f,4—?!Jco
OR'ER'S COMPENSATION DECLARATION -
1 hereby affirm unJc1 penally of perjury one of the followmg declmavon, I -
I M1are and will mmmmn a Certificate of foment to,elf-imnre for Worker's
00callpin,stalf. as porn Wcd for by Secuml 370() of the labor Code, for the”
"ro mince nI he work far whsh n,'stow Is Isamd.. t .
❑1 ha,e and will mam,or Worker',Compensation la,uraam,as required by Sceuun
3]1X)of the Labor Code,far the performance of the\workpforr which his person IS I
Caiel_AfY Wnrkc/n Ganl n-`d A9bLcyNo y�1I-14}—N�
CERTIFICATION OF EXEMPTION FROM WORKERS'.
COMPENSATION INSURANCE
(This.xcuon need not IN cmnpleted If the permn Is for line hundred dllllul,
IS 1(10)sir lewd ,
I cemfy Ihat in the perfar ier,c of the wod,for which IIII,pertnn I,Issued,I -
shall not employ any perstm In any manner so as to become subject to the Workers '
Conapen,at n laws of Cahfnoda Date
Apdca t -
NOTICE TO APPLICANT:If.after making this Cemfcam of Ea.'mpuan,you should - -
become subject to the Worker's Compensation provisions of the LaMar Code,you must
fonhwnh simply with rich purr,,.a,nr do, .,],,bull he deemed revoked.
7 ti
F > hereby
CONS ilium is a ION LGNDI AOENCY
� ; w rkfor affirm this ilium is a am,wcee 097.C agency for the perfunneme
Lender's work for which this permn is issued(Sec 3U9].CIV C.)
Isnder's Namc
z Iw•nder's Addres,
1 aeon,that I have'cad this'P'Plieatinn and ante 0m the chose achousion n
[..m embed.I agree ,,comply with all city and county ordnance,end aim law,rclaung
0 C.7
to building amaructum,and herebyanthunre repm,maos,—fid,aym entenlpors
W amt abuvennentinned property for Inspection purpose,,
1 Wet agree lu save,mdcmmfy and keep barn I...the City al Cape,, ;i,i I,,
V] liabilities,jadgmrn,,C„,and espenw,which Ina,Ia anyway se..uc..ulna Beth
U z. Cuy In consequence s of the granting of this perm
APPLICANT UNDERSTANDS AND WAL COMPLY III ALL NON-POINT Issued b �/ Date
SOUR GREG ATIONS. �,_f�l y: I _
Star pPhembCon6ccto, Date Re-roof's
HAZARDOUS MATERIALS DISCLOSURE '
Will the applicant or future Wilding oceuµnt store or handle hazardous maenad Type of Roof
.. as defined by Ibc Cupenmo Mumupal Calc,Chapter 913,and the health and Safety
Cale,Section 255I21a1!
❑Ye, ISCNo All roofs shall be inspected prior to any roofing material being installed:
Will the applicant or future building occupant use equipment ord,sire,which If a roof is installed without firs( obtaining n inspection, I agree to.remove
at hazardous air romamiams m defined by the Buy Area Air Quality Management g P
mn,"i all new materials for inspection. Applicant understands and'will comply with
°'es FLN° 'all non-point source regulations.
I lime read the hazadous mom ud,regmrcmems under Chapter fi 95 of the
California Health&Safety Code,Sections 25505,25533 and 25534 1 and emamid that '
J ibe hwldmg dams lit currently have a len,in,Thal a is lay re,,on,IhlWy to nobly the
,ecupon of the actuni mcnts which lima be reel prim to osmtma lit is Ceulwal,of
Occupancy ,
• SignatureofApplicant Date
Owner am shun rdagcnt Date•. All roof coverings to be Class•B”or better ,
OFFICE .
CITY OF CUPERTINO
t. m 1 of/ 1 • BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY M 2 ,
Sec: Twp: Rng: Sub: Elk: Lot:36920042,00
DATE ISSUED.......: 06/14/2000
RECEIPT H.........: 12522
REFERENCE ID N ...: 00060092
t
SITE ADDRESS .....: 10780 ALDERBROOK LA
SUBDIVISION
CITY .............: CUPERTINO
IMPACT AREA
OWNER . . ..........: HALLORAN TIMOTHY P
ADDRESS
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4604
RECEIVED FROM ....: ALAN
CONTRACTOR .......: LIC k
COMPANY ..........: '
ADDRESS ..........:
CITY/STATE/ZIP ... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
_______ _______ __________ __________ ---_______ __________
BPGAS OULETS 1.00 4.44 0.00 4.44 0.00
C FLAT RATE 1400 90.00 0.00 90.00 0,00
ITFEE FLAT RATE 1.00 35.52 0_00 - 35.52 0.00
TOTAL PERMIT 129.96 0.00 129.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER i
_________________ ____________ __________________ .
CHECK 129.96 5145
TOTAL RECEIPT 6 6666129 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
6666 OCC6vv'i'vv==- 6=2 666
02 UNDERPLOOR PLUMBING
106 SEWER & WATER
301 ROUGH PLUMBING 302 TUB &`�OR 8HOWER
502 FINAL PLUMBING ENERGY 506 GAS TOOT, .]
507 FINAL PLUMBING F
4�
CITY OF CUPERTINO
m 1 OE/ 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY k 3
Sec: Twp: Rng: Sub: Blki Lot:36920042.00
DATE ISSUED.......: 06/14/2000
RECEIPT N.........: 12572
REFERENCE ID 0 ...: 00060092
SITE ADDRESS .....: 10780 ALDERBROOK LA
SUBDIVISION ... ')
CITY CUPERTINO
IMPACT AREA ..:....
OWNER ..:. ........: HALIORAN TIMOTHY P
ADDRESS ,� .
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4604
jl.
RECEIVED FROM ..: ALAN
CONTRACTOR .. ... LIC 4
COMPANY
ADDRESS ......:...:
CITY/STATE/ZIP!...: ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPGAS OULETS 1.00 4.44 0.00 4.44 0.00
C FLAT RATE 1.00 90.00 0.00 90.00 0.00
ITFEE FLAT RATE 1.00 35.52 0.00 75.52 0-00
_'
TOTAL PERMIT 129.96 O.OQ 129.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER -
CHECK 129.96 5145
TOTAL RECEIPT . 129.96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ......... ..............._.
106 SEWER & WATER 202 UNDERFLOO R PLUMBING
301 ROUGH PLUMBING 302 TUB 6�'OR SHOWER,
502 FINAL PLUMBING ENERGY 506 GAS TEET
507 FINAL PLUMBING