00090061 clTv of cuer xTINo, f CONTRACTOR INFORnATION:
BUILDING DIVISION PERMIT -
i .
BUILDING ADDRESS: - - PERMIT NO,
owrvER'S NAMg013 CRMINO •VISTA DR' , -i'' W AIlrii. PPLICATION. .. .
`HONE' SOHR I, OFF. JOHN W AND LI C I I L E 500 A"H'^aY"°' "a
,
C m Z ARCHITECT/ENGINEER. + -,-(415)p349-7Z ' - BUILDING PERMIT INFO
F4 O O " J'"'d "E" BLDG „ ELECT PLUMB MECH-
LICENSED D CONTRACTOR S DECL\RATION ' -
Z z y'm 1 hereby drrin That 1 a n IdenseJ and,,provisions of Chnpmrnr 9 moHere ng Job Description
°QoiI� with Secant,7GXtfDvsnn 3onhe Business and Pmmseln Code,and try license n r -
,Cxg is in fall facts and ffct -2
z rS¢
License Class L e M
iO Dal "' ." Con-anor
ad c.- AREA
CHIIECTSOECLARATION REPLACE WATERHTER <40 Gto
AL)
1 understood boy plans Mal be toed as public records
. toy 'r , a
wCO Li n dPrf:do,,al " - t' - '
OWNER BUILDER DECLARATION v i I'-
u7 'I hereby afford tl a r I care pl f the conar,pt 1' n Frfor the y ,
foil , (,Section 7031.5 B d 1'r f: C,ul AnY t(Y cordiality " - -
�j F m
which act,' pannitu, I"ItheI.burprove,isbaliko'o"c'sa,troy'r olure
•y13G
poor II ' ' I' 1 theRamona l I fl -b Il
d enteo s••. - "'
matM1 r ' dI tt o p n nl c I t 1 Ln (cM1apgr9 'Sl Ft. Floor Area Valuation
(a nenc'gwth Secfon 0000)of D'. 3 lith B : Iq f. C F) ,{ .
orthat he's exempt l eref d IN f [ (heIl ged pt ,Aye P i
- 'of
Section 7031.5 byY ppl' r r r im 'I uhE,t,the pu
pl ans u civ l.........
.
ernrtrdnmthan fveM1 dreddolls,($NXB) _ - - 'APNNumber - _ = Occypanc
❑I,as owner of the pmpery a boy erron,cer with wayus ar their saleknmpernation.
.;will iit,,the k a J the morelone in, intarded ,,oBeoI r _ iee 9 4. cRBune 1P f a Code,ThC t t o 1oes applyto air f 3421DScq@red,Inspections '
wone"Idporall Who hiiil&or aprowes therear,and who does sach work hi itself
or`;r
yh h' ply p ddth't. h p - toa tit intended or
olfoil .al Ifl rthe`wilding r'mprvn It id llh'n,a,ybaror k A
cunmlea' mthe ,sae n n vipbasethebader IIIpnwagmathedid antbald11 -'3 106 SEWER'..&, WATER, .
Itop tive for propose to f:l )' - - +-202 - UNDERFLOOR PLUMBING,
❑1,no.,no,Fmc pmpoaly.ain exclusively contrappoli with Linsed contraSori m '30.1 -- ROUGH ePLUMBING
the project(See.70,Ft'Businessd P ossi :Code T C t toe` '
constructInseLa does t (apply to an e fp (net, r builds unproved,a r. 302 — ,TI-IB R OR SHOWER
and h contracts f h p nrecs with antra,r(e)licensed t art no the - ., -
anlrcl r1' ,L - ;, e` 502` - FINAL . PLUMBING'' ENERGY,
'
❑Iaicaur,verlunJeLa e, B&PCRa lhis n -
Owner Dale '.506 — GAS =TESTv -
WORKER'S COMPENSATION,DECLARATION 507., FINAL PLUMBING, '
I herehy uffrat under,petuhy of.p Jury meat the following declarations: ' 4
b ,
CII havI and will patindain 6 Cenificale of Consent t 11 for Worker's
n - -
Conapentation, asprovided 1 by Suction 37ID li the L h C do li r In
oI",
pert no f IM1 k h h p tot J
. 1 - ' ' ' ;
O l base and will I or kC pit t Id by Seaport"
i r
tr h r Code,f thep f f thek f which ts
coned.MY Workcr>Cnmp,vnainn nu eranJ P Y h , - T
^
. yl.Cotm PolicyNo '.
!4I
I
n
f
CERTIFICATION OF EXEMPTION FROM WORKERS' - - -
COMPENSATION INSURANCE; f -
n (I his sectionneed niab mplmd if ole panct is for onehundred bullar- - -
1$100)orlet,
1 tfytlt @pH t ' fIM1 kf M1htM1 pr 'I's sroeJl '
that nor call,' y person iit any con,so as Io harms subject rn the Workers. ' ^
Coniteisepar,Laws of California,Dam - ,
NOTICE TO APPLICANT
Zr ' other
asking lh s C o f Ne of Economic,pyot lbald
z btheta k rC pe t provisions fiha LabaCtsfir,you nrs,
forthoviducturply with such provisions e bus pernit shell be dctred cooked.
,
M .« c
F fn
CONSTRUCT ION LENDING AGENCY
I Israel offiror delt there is peconlarileading dooli for the performance
W of Ih rk t h'ch O pe I s'sFue 1(S'c 309].C'v.C) _ s " -
LelrsNone )
'r7 Z Leader's Address - ;,. ,
,C
that
•'.eIW�rUa",CWC.yI
Terrify ihZI oit _hoplificatoriond
-,T
.l b ' r� correct.Ig t comply IM1all
city and 1Y d ancesda11relating.
tobg nui nadye hysudirep s ave fthnxelY neite pan
the above nproperty ' np rp e:
FIW) gr tid fyangk n y ECupertinoy'i
ifties,ibdg a, i led pence which mryin bystay accrue agumssaid
City inendoccuuaeof the granting If(Ir,permit t-
• . . n.
- _
-
-
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT r
SOURCE REGULATIONS. 'Issuedtby:, . ,.Date
Signature of AppticaMcnnnaconr ,. - "„r nude, « •» Re-roofs - • - ..
HAZARDOUS MATERIALS DISCLOSURE
Will me appuearnnt mmrebaua'ng t t ool d1 n a us mat 'a1: -,Type of Roof
as defined by the Capers nn Murc pot Code Chrpad,9J2.and the Health and Safety s
Code,Section 25532(a)1 -
❑ver rAll roofs,shall be inspected prior to an roofing Datenal being installed. r
P P Y S g
Will n it, I far.,,'h-1d' $ pant : ,y p I r wmm� If a roof is installed without first obtaining an inspections I agree to remove
emthrodivic,a Teri r,as refined by IN Bay Arco Air Quality M.nrgenent Diarist? all new'materials for inspection. Applicanrunderstands and-will comply with ,
oven 'D No ,, I , ,all non-poin[$sokl regulatiolis.
Forest, end the k d 1.1 l,onicitiocirroo, aide,Chapter 695 i f oho
Coldirraid Ho lk In Safety C Speow,25505 25533 E 125534,1 d soad tort'
if the building dcr act currentlyh 'e b laconic,Ilrt itis upy re,vandilityt bly par,
coarinperat of the requirements hich unnit be burbpriorinissuance f R Cerificatio or -
D w°`,' Signature of Applicant e Date "
-' - - -' All roof coverings to be'Class If or better ,I
Ownern amm�r zra agent � _ Date , .. g
n_•