01010010 - CITYOF CUPE RTINO
BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRBSS: PERMIT NO. -
20967 FAIRWOODS CT 0101.0010
OWNIBUS NAME: APPLICATION SUB DATE -
GRELLI VINCENT S AND SANDRA L 01%03/001
IONS: SANITARY NO. CONTROL NO:
00 ARCHIT[CI'ICNGINIiER. BUILDING PERMIT INFO
w((- BLDG ELECT PLUMB MECH
yy`.i I_J L=1 1=I CI
Z y=E= LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby a(rm,mat 1 am licensed under previsions of chapter 9 amnmeneing
th S
FmC wiection 7030)of Do,o....duf the Ifminex.and Ruf—imry Code,nnd my license -
s;nhnuameaaae REMODEL
P
a is l.i«ttsn as a Lie.e
cm,tme�76-�
ARCIIITEe,.S o, LARA'I'IUN
—O S I unJentand my plan.shall M usN ax public records
Licoa.W P ..ional
ao
Oat I in v....DER m the RATION
Iasi' 1 herchy a1Rrm that 1 am exempt from she Commis Coi bice,,law fns,he
C which ire reason.fermi ]odor t.alneswmpr vet diainnr Ca de:Any chy,roomy
which requites a Pettit to amxwn,alter,improve,demolish,m repair tiny s,mmure
of
�t3 prior to its i.ssuance,also regoims the applicant for such pem,ino file a dilated stammer,
that to is licensed pursuant it)The provi,its"oche Cmer"I'a"license Law(Chapter 9 Sq. Ft. Floor Area Valuation
(varamem shut he is exam Section 700(o
and the basis for the al3 of the leged Business
on..tAn"n.Cade) $5000'
p ge P y vielady
or notion 70315 iv nny applicant ser v pemtit amjer,.the aPPlic:nn too dvil penuhy
m'not atomn,nnnveltn.dreddolmmiss,w). APN Number Occupancy Type -
❑1.mnwmern�nepropeny,oto,yempwrrr'wh�wagas asmebanme.m tuntmn,
3591,31 1.4. 00
will do the work.and the onalure Is not Intended m offered fns sale(Sec.7141,
Iru.iaess and Professions Code:The Communist,License Law does not apply b)an Required Inspections
owncr of pm,.,Who lmilds lir impmves them,,.,and who dors such work hi msclf —
mrmgn his own mnPloyces.p.wided that such intlnnvemrats.lin an,intended m 101 FOUNDATION
offered for sale.If,b.wnsia,the building or ince mmmrm s sold within nae year of '' — PIERS
completion.she owncrbuilder will have the burden a(pmving that he did not build or 102 _
ova mrpnre.se 103 — UFER
a L as owner of Property.am exclusively contracting w;m licensed sbmmtm,to 104 — REBAR
canwmm he project(see.70,4,Business and Pore:.inn.Came)The Cammemr's
Lice„se Law does not apply to;m ossm,of property won h ilks or hnpmves thereon. 105 — ANCHOR BOLTS -
and who contracts Ba such projects with a eontmemns)licensed pursuant m the
Contractors License low. 106 — SEWER & WATER
O 1 ant exempt under Sec. It&1'C R,nhla tea.nn -
Owner Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL
Ihereby ifism We,penahyof ,jury are of befwmwif,declarations: 204 — UNDERFLOOR FRAME
Id 13 l hoeBand will ntaintdn n Cemaume m .Consent , seH.irsure lot Weaker 205 — UNDERFLOOR INSULATION
Cmapemmson. as Pro%ideJ for by Section 37W of the Labor Code, for ,he
Performanceoftheworkforwhichthispernitisssued, 301 — ROUGH PLUMBING
❑I hove and wi 11 maintain Worker'.Compensation Insurance.as resimre)M1y Section 302 — TUB &• OR SHOWER
37011 of,he IaMa Code.for the performance of,he work for which,his permit is
issued.My workers C........malit mmrr.ce v;..."mad Poheymtmber am: 303 — ROUGH MECHANICAL
Caricr: Policy No: 304 — ROUGH ELECTRICAL_ '
CERTIFICATION COMPENSATIONTIN.URA(NCE OON FRM ItKLRS 305 — FRAME -
(This wedo.need ant he completed inite permi,is for one nuadmd dollars 306 — HOLDOWNS .
4Eul)"`less') 307 — INSULATION
1 certify ma,mite perfmmanm of she work far which tis panni,i.ismcd.1 308 — SHEETROCK
'hall not umploy any person In nny mnaorr,so a tc xahiect to the Wurkeri
Cmmpensmh,n L.wso1 C 1 P� 309 — EXTERIOR LATH
Applicant ,��uc
NOTICHTOAPPLICANT.e;unr's,'.Ielas mi.errtremenn?.xemprmn,ron.bhmd - 310 — INTERIOR LATH
hecnns subject m the Worker's ComPenwni.n pnrvieiam,,f the Lahar Cole,you nmst
�O forthwith comply.rith'arhprovid.morihoP<nnh.hall beaecmrdresulted. 311 — SCRATCH COAT
FV� CONSTRULTIONLENDINGACENCY 313 — ROOF NAIL
1 hereby oeirm that,hem is a construction lending agency performance
for the perfonce
CZ
nfheworkforwhirnmisper.hisissued(Site.3n97,eiv.C.) 501 — FINAL ELECTRICAL ENERGY
CLIQ Leader'.Nunn
p z Leader'Address 502 — FINAL PLUMBING ENERGY
U O keno"matlhmaread ],isapprrmianad,fatadhal dm.1ho,smnnali is 503 — FINAL MECHANICAL ENERGY
li. E.. correct.I agree to comply with all city and county ordinance'and state laws miming
O U
to building construction,and hemby authorize repoesentawes arms city in enter upon 504 — FINAL BUILDING ENERGY -
he:mm,e-mrnmonen popery for tro,caon parp..es. _
_ a (We)agree 1.sass,indenmifyaatkeep hermlessmecilyetCupeninaagainst - 505 — FINAL ELECTRICAL
V1 liabilities,judgments,cows and expenses which may in any way arae against said 506 — GAS TEST
U City in anmscd.,mc of the gm0fming this permit.
SOURCENgWTUtND�TI. SND.AND WILL COMPI %�N�ON�OINT [slued bySOl7 — GT[>LL 011IMF TnIFy Dale
sig.atnre of AprAmile':II''/Coriole f� '1% >at�/ Re-roofs 508 — FINAL MECHANICAL
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future buildingearupam woreor handle bvcomm,material Type of Rom9 — FINAL GRRDE
game°lei nt2553:;nm° pale,de,arlPter 9.Iz.Iced @r Health and Safety
510' r FINAL_ PLANNING .
❑Yes \Ino All roofs
being installed.
Will Ilicapplicart or future building vettatatin as.cocisaintant or device,.1tit,h If a roof is installed without first obtaining an inspection, I agree to remove
slIM emit hazardous aircentantin�^\Isa�r defined by the Bay Area Air Quality Management
Dtwr`o ser ;WNo all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read,he hazardous materials requirements under Chapter fi 95 of the
Culifemb;Health&Safety Code,Sermons 25505,25513 n 1255;4.1 wN...iand thus
if the building does no,currently have a tenant,that i,is my Rarx nsda ity to wady she
ace.pan,of the requimmems which ram,be me,prior to issuance of v Ccnifi,.w of
Signature of Applicant Date
Owner oru m.ri ee.,carr All roof coverings to be Class "B" or better
OFFICE