02100078 CITY OF CUPEWHISO ' w - � �-'� '
BUILDING])]VISION PERMIT CONTRACTOR INFORMATI.ON .
BUR es : AV TONY ALVARADO CONSTRUCTIO PERMITN(02100078
OwrXHA*DRASHEKHAR APPANNA & SUM 3459 MARTEN AVE APPLICATIRI�IrL UV2002
ONE: 408 832-0206 SANITARY NO. r CONTROL NO,
ARC]IITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O
1-00 LICENSED CONT'RACTOR'S DECLARAI]ON
I thereby affirm that 1 am Licensed under provisions of Chapter 9(commencing Job Description
dad with Section 7000)of Divisb.n 3 of the moncssa Prolessin enda.ana my Limnm is TEMP POWER
in full inn d Ice ay
OZ G DaM Conaclnr /
F=�� A C CTS u A'r10N O
e< ders nd my a shall M used public records
OyU `J
uC n LiccnmJ Professional ^�
g OWNER-BUILDER DECLARATION V
aI I hereby affirm that 1 am exempt from the Contractor's Liceme Law for theal 5 O 0
we OO lidlowing mission,(Section 703 L5.Business and Professions Code:Any city m county
wm which requires a Permit to constrvet,alter,improve,demolish,or c pair any structure
prior to its immure,also requires the applicant]or such pemriun file a signed statement
�r'a that he is licenced pursuant m the provisions of the Contractor's License Law(Chopmr 9 3S1lM.ff9k4)OArU Valuation
,t-$ (commencing with Section 7000)of Division 3of the Business and Pondecions Code)or
WNat he is exempt therefrom and Be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars(S500). 102pN—NW
PIERS Occupancy Type
0 1,as owner of the property,or my employees with wages az their sole compensation,
will do the work.and me machine is not intended or offered for sale(See 7fW4.Business ±E)3 UFER
and Professions Code:The Conanors License Law does not apply m an owner of 104 - REBAR Required Inspections
property who builds or improves Bremen.and who does such work himself or through his
own employees.provided that such improvements arc not ntended or offered for sale.B. 105 — ANCHOR BOLTS
however.the Wilding or improvement is sold within one year of completion,the ve owner- 106 — SEWER & WATER
01e)'
builder will hathe, of proving mat he did not Wild or improve for purpose of
3202 - UNDERFLOOR PLUMBING
0 I,as owner of the property,am exclusively contracting with licensed contractors to 2 03 — UNDERFLOOR MECHANICAL
construct the project(sec.71004,Business and Professions Code:)The Contractor's Li-
LcerrteLaw does not apply toanowner ofpmpettywho Wilds orimpmwsthercon.and 204 — UNDERFLOOR FRAME
contracts
se Law.❑.r such projects with amomrazmrts7limcnsd pursuant to me Contracmr's' 205 — UNDERFLOOR INSULATION
0 l am exempt under Sec. ,B&P C for Bis rcaznn 301 - ROUGH PLUMBING
Owner Data 302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 — ROUGH MECHANICAL
T hereby allies under penalty of perjury one Or me following declaratory: 304 — ROUGH ELECTRICAL
I have and will maintain a Cenifcate of Consent m self-insure for Woherls Compete
stela,as provided for by Section 341X)of the Labor Code,for the performanm of the 3 05 - FRAME
work for which this Permit is issued. 306 — HOLDOWNS
0 1 have and will maintain Worker's Compensation Insurance,az required by Section 3 7 — INSULATION
3700 of me Labor Code,for the performance of me work f which this permit is issued.
My Workcrs ComNnsationimm�nacaie,and o1 Xcoa 308 — SHEETROCK
C , lip ,; —42U'U 309 EXTERIOR LATH
CERTIPICA OF �KEMPI'ION FROM WORKER ao
VlefvI'Qdj1C&OaY1['EN$^'rdoN llgsuRANCE 310 — INTERIOR LATH
(This sexism need not mo'/mapo1A�/,LflldiftMp mitisforonehundmddullac(SIU)I 311 — SCRATCH COAT
ar worry 313 — ROOF NAIL
emptyynypthat nthe oninanybannenffire restokfor wmrnthis
0theWPermit isissued,lanaunot 501 — FINAL ELECTRICAL ENERGY
employ any Person in any manner so as m Mttsme subject m the Workers'Compensation
Lawsol cafiromia.Data Applicant 502 - FINAL PLUMBING ENERGY
NOTICE TO APPUCANr:If.after making this Cenilicam of Exemption.you should 503 — FINAL MECHANICAL ENERGY
Mends comply with
Workerprovisions
or tis Permit
steal of themed Cldlmd.you min 504 - FINAL BUILDING ENERGY
z INcomm subject
with sucherroviompenrthis pproisions Mhe Laher Cnkcd.
zoCONSTRUTIONLENDINGAGENCV 505 — FINAL ELECTRICAL
F Iliterary affirm thatthcmisacuasactinnlending agencylot the perummanceof 506 - GAS TEST
R,> the Leede 4nwhich thispermitisicued(SeeJ1N7,Civ.C.) 507 - FINAL PLUMBING
Q Lender's Name
= z Lcnder'sAddress 508 - FINAL MECHANICAL
U O 1 vanity you 1 have read this application and stale that the above information is 509 — FINAL GRADE
H. cexact.I agree to comply with all city and county ordinances and state Taws relating m
OU building conWruaion,and hereby amhodrs mincrrvatives of this city to enteral+,n me 5 FINAL PLANNING
above.memiumd Property fur inspection fut"exs.
F y (We)agree m cave,indemnify and keep harmless me coy erca against said
against 14 F IN�RKS
V2 lintilito(We)grentoeasts and expenses yandkewhich may iusStheway avcmeaprtinoagCity (L C.FK/ /
U z APPLI consequence ormpgmnengunhfepeWI Issued by. Date
" APPLICANT F.RST DS AND WILL CpMPLV WITH ALL N NON-POINT
SOU CE RE .ATO
!/V w Re-roofs
nature at ApplicmWConm""S arc
HAZARDO SMATERIALSDISCLOSURE Type of Roof
Will the applicant fir nm a builJing occupant jmre ser hanJle hasardous material
az defined by the Cupenino Municipal Code.Chapter 9.12,and the Heath and Safety
code, 0 us x553z(ay' All roofs shall be inspected prior to any roofing material being installed.
❑Yes V'a
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
_mit the ardous air comaminana a defincd by the Bay Arca Air Quality Management all new materials for inspection.
District P
0Yes Nn
I have mad the haiardous malerials requirements under Chapter 6.95 oftM CaliGm
null 0&Safe Coble,Soctions 255115,2.5533 and 25534.1 undo x and that if the building
It cu 'nt1y have a tenant.thm it is my res nulbilay Y Be occupant of IM
s wblcn kewlpfimm on cpni acupanmy. Signature of Applicant Date
acre 0 l0
ow.rnrauthuriedago, D All roof coverings to be Class "B"or better