00080201 CITY DVSONO
IiINCONTRACTOR INFORMATION:
PERMIT '
BUILDING A DDRESS - -
PERMIT NO-
pmm � pZo
'ow15ER's
938 FERNGROVE DR WF_STHILL CONSTRUCTI LI�6FIj 3N
ONE: y
ARMSTRONG 5354 RLICKER DR SANITARY No
O za ARCHITECTIENGINEER.- LI.(7�B 1395,'-43�r 1 BUILDING PERMIT INFO
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F - _ BLDG ELECT PLUMB MUCH
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LICENSED CON
ICFNSEDCON'TRACTOR'SDECLARATION
g y J I v atros d,l I and fsunder prooknm' fOna 1e
r,9(,,,„menalns
JOb'DeSerl
tio[-n
wall Secio70gDof Divison 3 north,fkxnem call Pmfcxon,Code andmy licence
i
in full force and a act.
z ¢ 'Licens<Clus,_ .___
0 a u Dme Q Contrnctnr_--
a m F�j' —O' AkcxITECT•S DE, PAIR) REMODEL -
Coo 1ancestralmy pine.shall wsel phi a
ad
6ppce Lc 11 f.:
k ceOWNERBUILUTR DECLARATION
a I h ,ff that l pt f theC e
t l Lis 1[. for Inc
c< followingto.(Section90315 B 'n aP f:.' Ld y ' county
'�20
which ylr permit l consortia. It p d I' o P y.t oda,
3_ca
prior to itsalso q s the applicantl reedifitt tile a signell,l tenant
first he I,I 6Ipnsnn a thep ' a (if the Commerce's' L ,el '(Chapter9 Sq, F . FloorAreaIm n a Sum 7000 fDt ]Of P : as a IP f:. ,Code) � a tion '
-
nr Ih t pt th"Ifirour told the hlcs:f [tic alleged exemption Any violation
of Seelinn 70315 by any applicant fora permit dold n the uppl leant m a civil penally _
ur not more than five hundred al f5saB1. APN Number
❑I,ow owner of the propenyl or my employees with wrga,as lban,vole courEcro rind. -
will do the work,and the,fracture is not amended or olbled for sale(Sec.70o
11..hid„and Profceded,code:The Conmmadr,L,cn,e Law does'call apply tom, 375380 269sWred Inspections
owner of property Wild builds or improve,thereon,and who does wch work him,elf '
Or through his own employees,provided that such improvements are not immmded or _
offered for role.if,mWO'c',the building nr improvement a,sold within one year of
nmaplalon,'he,,,mar-builde, ,II have the burden of ptnvIng that he dad not build net 101 — FOUNDATION
hnpmvo for purposo Orono..).
102 — PIERS
❑Lloownerorte property,nmBluoreexclusively eomraLymgwan llemeTheoamrol 103 —_ UFER
LGns"ra the Fluods nl(Sce.7041,own r of,ad rd,so tiob ild, ,, Thr comroarr',
iaise Law does no,apply loon toner of property who)fins m improves thio the
ant who commas for stub mnJnms wim a enmmaor(,)Bhrn,ep pursuant m me 1-04 — REBAR
Camaro,od,Licea,cLaw. 105 — ANCHOR BOLTS
111 mm exempt under Sac. B&P C for rcmm�
Owner Data 110T6 — SEWER & WATER
WORKER'R COMPENSATION DECLARATION 202 — UNDERFLOOR PLUMBING
1.n<reby arc mdt,aer penally mhOrinry one Of n,uOwmg aeelaradOms: - 203 — UNDERFLOOR MECHANICAL
1 nava and Mll annular a CrrBBctde Of Consent so self d%dre for Workers 204 — UNDERFLOOR FRAME
.ampm„aaua: as prnvaed mar by Spca19m 3900 Or the Label arae. rnrtl" 205. -- UNDERFLOOR INSULATION
l_fluncmar an worAfor which ihls tisa2 ued.
111 halo and will m:aaah;Worker's Cumpersehrn himn a,,as re,irea by weds, 301 — ROUGH PLUMBING
370()of the Labor Code,for the periom,ana of the work let which this prom,is 302 -- TUB &• O R SHOWER'
issued.My Winter'slnm
�Compensation smicr carrier and Policy number are:
Carrier:_ nd POhcyNo. 1�10� _ 303 — ROUGH MECHANICAL
CEkI'oFICATION OF EXEMPTION FROM WORKERS' ROUGH ELECTRICAL
COMPENSATION INSURANCE
rThis,eeaan monitor rearm correlated if the 305 — FRAME
($100)orle,s.> - P pmmeisrorm,anarareaa°°am . I : -306 HOLDOWNS -
I candy that hi'he perflionm,ce of dna work To wnim,this perm l i,i„add,l 307 — INSULATION
snarl"Or employ ally person in any nrnnner so as to hcemoo ruder to the Workers' 308 - SHEETP,O
Compensation Laws of California.Date CR
Apphciall - 309 — 'EXTERIOR LATH
NOINCE TO APPLICANT If,oftermaking this CertiEcmeor Exemption,you should - 7 `
Z neomne,ahjea1.theWOtke.,CompensationpronnionsortheLaborCode,youmust 310 -' INTERIOR I_ATI'I
O O fonnwllncomplywimmtchprookion,or(hispennehaEheeenn,mlre,ok`d. 311 SCRATCH
_ COAT
E;y CONSere is a IONLF.NoINGAGF,NCY 313 — ROOF
a Therebyaliichthat ih.itmcsued(Se 097,hadingagemcyfor the perfonnanec NAIL
Lobo work me cam<n this pernn is "act csa.3097,cin.c.) 501 — FINAL NAL
y o Lctmer"Nand ELECTRICAL ENERGY
p z Leadcr',Address 502 — FINAL PLUMBING
U 1 certify that I have tend this a 1 503 — G ENERGY
w L city 504 FINAL MECHANICAL ENERGY
OF ret.1 ogre ho comply warn all shy ant<Ottnly nminamee' ,hi,rote lawn a alio F'I NAL B 1
U tohshe'ddealt.media,eproyfrIad to'hodaerep"'antahne,Ormm<itrlOantrapon I .ILD.ING ERG
�^ w n,e she'd necI pro pertyfrrh,spccdkeputpnm., 505' EPI J�2—
Ir CL (W) y I ,mJ fY oak ph smeary (Cpm agent„I _ FINAL ELECTRICAL
t V1 liabilities yon any u-y g nest sail
I ag I:,costs d p es car n 506 — GAS TEST
U ^ Cary q or granting s nil permit. k—o_ ”
SOURCE REGULATIONS.UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: s 507 — FIN Date
stgtrhtre Ot ApphcamAZARDOU Dale _ ANICAL
HAZARDOUS MATERIALS DISCLOSURE Reproofs 509 FINAL ADE-
Will the a Cupertino
-1 initial rad lCull ,apt store 2,Gant a Health..,material .Type of Roof GRAD
agnea t. me 32m)?nm Mrtm„p „ Chapter B Iz,and me xenhn ant safety YP 57.0 — F I NA
,ale.,ammo 25532(mp pp L PLANNING-
71 .
va, NO All roofs shall be nSpec—tetf-drWto aliyAdn rggtqW Ing installed.
Will eapplicantntmmmnwl grecttpaansoolmimemoreevi«,which If a roof is installed without first obtainin an ins ecUo ,l a Tee to remove
emit hnnmdons air cnntnminanty a,I ed by the 13ay Arm Air Quelity Managmmm� lar P g
Disttml0 yes to all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the n. rmous ala 'ah negulrement'ander ennptar fi 95 or the
Cabfomla Heahnk my So ut '255115,25533 and 25534.1 underlined(hit
rld"uildingdnm at a tl emir,that it is lay responsibility to notify the
Occupied,
of I rc, a m be met prior do.....died 01 n Coni(m¢of
Owupmcy,' -
Signature of Applicant Date
Owneraaddagain . Dae - All roof coverings to be Class "B” or better ,