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CITY
BUILDING DI SSIIONNOPERMdT
CONTRACTOR INFORMATION:
B�L8T t 3 LEWOOD DR
PERMIT NO. 02050112
° `1)'1TEPHEN S AND BARBARA O
AP� %T gs�al� 2
IPHONE:
SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r_J LJ
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(commencing
�ll�f,b Descrition
GARAGE SHEETROCK p
with Section 9000) of Division 3 of the Business and Professions Code, and my license
' ,m full force and effect.
License Clara Lic,p
Dae Contractor
ARCHITECT'S DECLARATION
1 undemmyd my plana shall he used as public records
Licensed Professional
OWNER BUILDER DECLARATION
I hereby off that I am exempt from the Conhacmr's License Law for the
following reason. (Section 1031.5. Business and Professions Code: Any city or county
$2000
which requires a prrmit to emmovet, oiler, improve, demolish, or repair any structure
prig t -'issuance, alsoq' _p, applicant for such permit to file a .'g ed statement
that he islicensed purtuaryl to the Provisions of the Contractor s License Law (Chapter936$.]F9;
(rommenc B 'thy fp)
ton 90of D' on 3 of the Business and P f Code)
Q'R3�e29t@a .. , r ,,
si. t
Vahlatlon-
or that be is exempt tM1erefrom and the bass for the alleged ,Xe npim. Any violation
0.t_
'
of Section 903 L5 by any applicant for a permit subjects the applicant to a civil penalty
of not mare than rive hundred dollars ($500),
pTa, n�S
_ 516,kl"Wli'U{Y$OLL4 BUILDIN._..
,'. „• Occupancy Type
❑ 1, as owner f the property, or my employees with wages as their sole compensation,
"will Jo the work. and'the swnno, is net 'intended 'or oRa<d for sale (Sec: 1014.
- -
Required Inspections
•Business and Professions Code The Conwcmr's License Law does not apply to as
0 caner of pmpeny Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are non intended or
.'Completiorule.ILhowever: Wildingo7 imvrovcmrniis within one ocurrof---
nsold
uilder w
the owner -builder will have me hueden of proving that he did not M1uild or
•' "
improvtiao,
improve for purpose of sola).
1 owner —cora---esc--cont—--
❑ i, as owner of the property, am contractingssi with licensed! contractors to
— — — -- MAY 2—. _. .
_ --- - - _' - -- - - - I' ;., -- coin
oo` 4 �. -
the project (Sec. 1In Business a
Business and Professions Code:) The Contraaor'x
T
,
`
License an
License Law docs not apply man owracy of property who builds or improves thereon,
"' '
.Cortes o comm..s for such projects calm a conoocmrts).liccnsm pursuant.ro.tbe
Cortisone, m e rs pttunde Sec.
Olam<x Sec. '• r' i,
._.._ ._. _. .__ _ ___.._.._ _ , p
'1 ��p�^
pt under Bffi PCfonhis reason�VG
qn.
; ' WORKER'SCOMPEIONDECf2ARAT10
-
I hereby affirm under penalty of pe jury ane ofthe following declarations:
I
O 1 havetand will maintain a Cenificiac of Consent to selfinsum for Worker's
Compensation, as provided for by Section 37M of the Labor Code, for the
performance of the work for which ..his permit is issued.
❑ 1 have and will maintain Workers Compensation' Insurance, as required by Section
3100 of the Labor Code, for the performance of the work for which this permit. is
issued. My Worker's Compenman
uon Insurance canner and Policy number arc -'
Cam h,1 ..f
8-.y t.
, Policy No
CERTIFICATION OF EXEMPTION FROM WORKERS
"
v."s ! ". `. r ," f,:
COMPENSATION INSURANCE'' "'
(Th. ton riet,d not be completed if nhe permit is for one hundred Julian
_,
�•'I'' . i"1(,1 tt"
Ic nfY th t in the pert 6f the w kf hob the pe 't siseued"1
shall t <mpl y any pe n n anY 1" 21�r t the Workers
"1'l—
s •' '
'
Compensaton lifami
Apple am
I E ' APPLICANT If after making this C r if m of E e pfo y u should
'
Mcory
m jecuothc Workers Compensate pm s .. of the l�rbor Cuda you'muit
fonM1 komply with such provisions or Nis permit shall he deemed revoked.
_.
"- - ''r CONSTRUCTION LENDING AGENCY
I h byth t the I d' g agency r m pert rinann
-
,.,i p.
"1
ofik f which this Permit "slued (Secc 3(191 'v. CC.)
d (S
Lensd Islamic
Lend Address•
r.
1 cenifY that 1 have W thisapplication d state thebo information s
c ere t I g w to comply with II y dd county ry d' nw o c oil supe
nt laws relating
-
.: ... .. .. /_///s• ....... _—._ ....
„-.
to building constryciina, and h by authorize represcmatives ofthi> city to enter upon
the above mentioned Rmpenr ter inspection purposes
agree to save,' a d had,
and kap h the Cita of Cm against
Is.
judgments. expi may in
costa and expenses which may in any way acerae against said
a agai
Cityinner, actin
City c 9 de of [be g i g fthis perms
nPPLICAq UYUERSTANDSACOMPLY WITH /.LL Is{`N PO)I nT
U
1 URC UI,AT10NS // /
S 2V o 2
Issued by: Date
gn at e, 1Applcant/C t cto Det ;,
Re -roofs "
HAZARDOUS MATERIALS DISCLOSURE ,:
Will the appliivnt fm bu lJng oc<uvatt or M1andlehazardou: matenal,
def
.-Type Roof.-,-..,.-,
.Type Of ROOf-
as ed bv. the Cupertino M erpal Cotl Chapter 9.12, and the Health and Safety
Code St on 255321)
.• ' _fit '
roofs shall be inspected to.any
-. W II d5 t, I r nt future building occupant use Yparso equipment e< < which
emit ha ab an corm ¢as defined by th Bay ArcaAir Q IryM n5gemcm
-.-..All prior roofing,materfa] being installed. _
If a roof is Installed without first obtaining an ins ectlon; Pagree'to remove
g p
°nam"
all new materials for inspection.. Applicant understands and will cornply, with
:. .,
all non-pointsourceregulatlons,_.(t,
I to d theass bdo mat Is q ¢mems unde Chaln 695 of the
Calif cora Health & Safety Curti, Sections 25505, 25533 and 25534 1 understand that
!fine building docs not conently have a rmunt. that it is,uy,1,ponsiI ili1, tonotifythe
O'cupant of the requircmntts which ..me me
..mai he prior m , issuance of s Cenifcac of
ecupa
�"
-
- � ^
tom- .. ._ C
Signature of Aale
pplicant _ _ D
2 - _
All roof coverings to be Class "B" or better '
Owneror...... iacaagent Date
............. _OFFICE ._. ..