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,CITY OFCUPERTINO PERMIT NO.
BUILDING DIVISION PERMIT CONTRACTOR. INFORMATION:
RUIW?I NG ADDRESS: SANITARYNO. APPLICATI;gB�ALDAD
/U 2v Try V��Ok' 0�: ��IU w+'//��'4/ O
OWW'S NAME
l'oaiTs✓t SO�s+��
s NIC CONTROLp
yl2r-3 q ► J - vI el/J J C. PU43 zq El
17-11
ClirECIMNGINIiER /y__t^,BOL DING PERMIT INFO
9 � LJ_— I,.)
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I sm licensed under provisions of Chapter 9 (commencing
wim Samoa 7") of Division 3 of dr- Bu&inna atd Profesiom Code, and my licensee
in full farce and cIF a 7
[Loamm Cles
Date Canham&
ARCHnECTS DECLARATION
1 undeasace my pWu "I be used as public records
accessed Professional
OWNER -BUILDER DECLARATION
I hereby affirm, mos 1 am exempt from the Contractors License Lew fee me
follo nng &,acmes, (Section 7031.3, Bmincas aced Professions Code: MY city or county
which mqulm a mo cal or cmuWn, alar. Improve. demolish, Or repair my ne mure
From to its i.auance, also requires the applicant for such perand to file a signed su¢mem
mat he is licensed pursuant o the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business sed Professions Code) in
and he is exempt therefrom and the baa for the alleged exemption. Any, violation of
section 7031.3 by my ap meam for a permit subjects tae applicant to a civil penalty of
not mom d m Five hundred dollars ($500).
I,ax ewook, the on,aro mI.mcomajouleea withwadfor Wei(Sm. compemmuess
will dome work,aced the bin, Conoisroti Licaus Law
We(Sm.
to an BusWss
and Professional
Code: The Conaamri License Law d«s Iwo apply to lf awrcr of
hpon,myis own wow build, « improve thsuch i and who don such wars himself or through
his own employeese provided that such improvements thin net intended o Offered for
sale .If, however,the have
im burien of prnlem i, sold within caneildor completion,dr-
pwneof Weer will nave Nc burden of provin[ Out he did eras Wild or improve f« pro-
pose of role.).
1, in owner of ct propend, un exclusively coneadng with :) The Cromances to
constLi-
mom
Ott me project (Seeapply
, an weer Of p P, wino builds
Code:) The cal in ., nd
cense law don not apply m m owner of property who sed or improver marcors, and
whoseLancontracts for such projau with a conuacmr(s) licensed pursuant to the C.naaclMe
Licen
❑ I em <aemq under Sa. . B & P C f« this &croon
I Owner Data
WORKER'S COMPENSATION DECLARATION
1 harmy affirm under penally of perjury onc of the following0 k dalarstioru:
1 have aced will maintain a CeniOuse of Camenuo-if.insurc for Wtome-Compen-
cation, as provided for by Sectors 37W of the Labor Cade, for the performance of the
work for which this pemdt is issued.
❑ 1 have and will numb& n Wnrains Corn, aatton Ware«e. as required by Seninn
3700of to tater Cade, fm the perfomlance of de wort for which this Fermis Is ounce.
My Workers Compensation Insurance carrier and Policy number art:
Canter: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ucvo. madcad bccomplated hide, permit is forme hundred dollars(SIW)
Or lose)
1 Certify Nat in the performance of me work for which this pemil is issued, l shall
not employ any person in my manner eco as to become &Object to me Werkcr,i Compere
mil" Laws of Califemia. Data
Applicant
NOTICE TO APPLICANT: IC cher making this Certificate of Exemption. you tumid
become mbjal to me Workers Compensation provision, Of me Lebo, Code, you in
forthwith comply with such provisions w this permit shall W darned rooked.
CONSTRUCTION LENDING AGENCY
O O Ihereby affirm that mere is•mmorucdon lending egooey for the perfomamn of
Z y me work for which this permit is issued (Sm. 3097, Civ. C.)
F, Lenders Name
ya 7 CaMer, Address
ts7 C I certify that I have read Wer application and -Me WI she above information is
0. conal. l agra w comply with OR city sed county mdimnceo and sum laws relating to
U O building construction, and horebyinimmicerepesmossivn of this city to enter, upon me
above-memiaoed pmpm, for inspection purposes.
Lar [r (We) agree to save, indemnify and keep huml«s the City of Cupcnino against
O f.,) IiaMliticejmdgorm ,costs andeapames which may in my way ae.c.,miat said City
>. 1,x7 in mrimunnce of the granting of this permit.
r P- APPLICANT UNDERSTANDS AND WII,I, COMPLY WI TI I ALL NON -POINT
V Z SOURCE REGULATIONS.
Signatureof ApplicandConVect« Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant store or handle hoammous material
as defined by the Current.. Municipal Code. Chapter 9.12, and the Health and Safely
Code. Section 2 532(a)?
Dyes p+�
Will the applicant or future Wilding occupant use equipment or devices which
cwt hstaidous air conuminmu as defend by the Bay Arca Aa Quality Mm.,ramt
Diatr ct?
❑Yes
I lave read the hasssdma maria, reyui emorm. under Chapter 6.95 Of Ilia Cali.
fomite Health & Safely Cade, Smtiam 23505. 23533 ad 2553x. I understand Wt if the
Wilding does W cumusly have .1 u It is my— Potability a winfy she—Wt
ofthemquve�m plgybjp otswa«so a entryg}gJ�IJcpupemy�
owner or evmonace a ale
Job Description
Valuation
T "—>
LT -41 ou
— —,,—is
Re -roofs
Type of Roof
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
OFFICE
All roof coverings to be Class `B" or better
INVOICN INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Blk: Lot:36941005.00
INVOICE DATE......: 05/03/2000
REFERENCE ID # ...: 00050013
SITE ADDRESS .....: 10201 TORRE AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: PORTAL SOFTWARE
ADDRESS ..........:
CITY/STATE/ZIP .... CA 94404
CONTRACTOR .......:
BALL, ANDY LIC 4 19989
COMPANY ..........:
WEBCOR BUILDERS
ADDRESS ..........:
2755 CAMPUS DR
CITY/STATE/ZIP ...:
SAN MATEO, CA
94403
TELEPHONE ........:
(415)349-2727
FEE DESCRIPTION CNK TOTAL
FEE PAID -TO -DATE BALANCE DUE
---------------
BPERMFEE
___---------
P 200.00
------------
0.00
200.00
-----------
---------
200.00
------------
0.00
200.00
VOICE ID
DESCRIPTION
VOICE ID
DESCRIPTION
............................
.
40
............................
......_.
102
PIERS
3FOUNDATION
0
0 103
UPER
104
REBAR
105
ANCHOR BOLTS
106
SEWER & WATER
202
UNDERFLOOR PLUMBING
203
UNDERFLOOR MECHANICAL
204
UNDERFLOOR FRAME
205
UNDERFLOOR INSULATION
301
ROUGH PLUMBING
302
TUB & OR SHOWER
303
ROUGH MECHANICAL
304
ROUGH ELECTRICAL
305
FRAME
306
HOLDOWNS
307
INSULATION
308
SHEETROCK
309
EXTERIOR LATH
310
INTERIOR LATH
311
SCRATCH COAT
313
ROOF NAIL
501
FINAL ELECTRICAL ENERGY
502
FINAL PLUMBING ENERGY
503
FINAL MECHANICAL ENERGY
504
FINAL BUILDING ENERGY
505
FINAL ELECTRICAL
506
GAS TEST
507
FINAL PLUMBING
508
FINAL MECHANICAL
509
FINAL GRADE
510
FINAL PLANNING
514
FINAL PUBLIC WORKS