02100186 CITY OF CUPER"11NOy
BUILDING DIVISION PERMIT bCONTRACTOR INFORMATION:••''
BUI 00DRFESTIVAL DR AMERICAN BRANDS CONSTRUCT ffl#AITN02100186
ADT.AIsjAhEDMUND W AND KAM-HAR Y 1145 HAWKS HILL ROAD APPLICATIP"TRg2002
PHONE. (408) 210-4945 SANITARY NO. CONTROL.NO,
ARCHI'IECIYENGINEER: BUILDING PERMIT INFO
BLDG ELLCF PLUMB MECII
0 0 0 0
ro, LICENSED CONTRACTOR'S DECLARATION T�hp
<u F I hereby affirm that l am licensed under provisions of chapter 9(commencing REVISION--IN HU U S c I�'n ONLY
N¢� with Section 7(XXp of Division 3 of the Business and Professions Code,and my license is
->< imm�Dneaweffect. ORIG. #02040045 , NO NEW PERMIT ISSUED
License Class Lie.#
oiFo Dme Commet., REVISION RO FOUNDATION
QQWj ARCHITECTSDECLARATION
a< I understand my plans shall M used as public mcurds
ti0ue
rLLLicensed Podcssinwl
OWNER-BUILDER DECLARATION
za Y 1 herchy afford that I am exempt lines the Comrnerus License Law lin the
W�o O following rentor.(Section 7031.5,Busing and Professions Code:Any city or county
w$ which squires a permit ht construct,alter.improw,demolah,or repair any structure
FZy P60T to its issuance.also retinues the applicant for such permtuo file a signed statement
s< that he is licensed pursuant to the provisions of the Contractor's License Law Chaplet 9 Sq. Ft. Floor Area $3851MOation
yF$ (commencing with Section 70(Xq of Division 3ofthe Business and Professions Code)or
y _
this,he u exempt therefrom and the basis for the alleged gumption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicanuo a civil penally of �+ O
not more than I,. CCUdnC w hundred dollars(55110). Occupancy Type
❑ L as owner of the property,or my employees with wages as their role compensation.
will do the work,and the structure is not intended oroffced for sale Doe.7044.Business 3:83: Febie
and Professions Code:The Conpactors License taw dors not apply to an owner of 102 - PIERS
squired Inspections
pmpeny who buildsor improves thereon,and who doessuch work himself orthmugh his
Win employees,provided that such improvements an,not intended or offered formic.If. 103 — UFER
however,the building or improvement is sold within one year ofcomplction,the owner- 104 — REBAR
builder will has the harden of proving that he did not build or impros for pugXae of
Silo')' 105 - ANCHOR BOLTS
❑ I,esnwne,of the proper,em exclusively contracting with licensed cmracana m 106 — SEWER & WATER
construct the pmjecl(Sec.7014.Business and Professions Code:)The Contractors Li-
mer Law does notapply toanowner ofproperty who Wilds;orimpmwsd¢snn,and. 202 - UNDERFLOOR PLUMBING
who contracts for such pmjecas with a contracmr(s)Iimnmd pursuant the Contractors
License Law. 203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. ,B&PC for this reason 204 - UNDERFLOOR FRAME
refDae 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
Ihereb from penalty r 301 - ROUGH PLUMBING
y pe yo Of Om, dallict's o 302 — TUB & OR SHOWER
❑I haw and will maintain aCerfificare of Consent to self-imam for erforma Compeer
cation.m provided for by Section 3700 or the L.Wn cMe.for the Pertortnanw of the 3 03 - ROUGH MECHANICAL
..,it for which this permit is issued. 304 - ROUGH ELECTRICAL
❑I ban and will maintain Workers Compenwtion Insurance,as equimd by Section 305 - FRAME
3711(1 of IW Labor Cttle,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy,number ate: 306 — HOLDOWNS
Caner Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not he completed iftW permit is intone hundred dollars 309 - EXTERIOR LATH
or1CS) 310 - INTERIOR LATH
1 terrify that in the performance of the weak for which do.permit is issued,1 shall not 3 11 — SCRATCH COAT
employ any person in any manner m m as become subject the Workers'Compmfsation
Laws of California Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.I1;after making this Ccnillcatc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
OzhecomesubjecttotheWorkeracompemationpmviamm,ofpactLm,Code.yoummt 502 - FINAL PLUMBING ENERGY
fmthwith comply with such provisions or this PeW merevoked,Permit shall Jccd ked.
zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Fes— 1 hereby affirm that there is a construction lending agency]or um aerformance of 504 - FINAL BUILDING ENERGY
awa > the work for which his pcnnilisissued(See 3W7,Civ.C.) 505 - FINAL ELECTRICAL
O Lender's Nano
P z Lenders Address 506 - GAS TEST
U 0 1 cenify that I have read this application and sue that IAC aWw information is 507 - FINAL PLUMBING
f` cortect.I agreemcomply with all oily and county ordinances and setae laws relatingm C, FINAL MECHANICAL
0 building construction,and lrrehy authorise mpmsenutiss of this city to enter upon the
above.mentioned property for inspection mrposes. 09 - FIN DE
H W (We)agree or amts,indemnify and keep hmml.ar.the City of Cupenin i against
h liabilities.judgments.costs and expenses which may in any way accrve against said City 5 N NN G �•1 ey+
of
U z APPLIC
APPLICANT of the AND WILT,COMPLY WITH ALL NON-POINT 51
SOURCE REGULATIONS. Issued by: WORKS Dale
If
m
Signare of ApplicanUContractor Dae Re-roos
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future building nwcupant sroe or handle miartlom material
s defined by the Cupcnino Municipal Code.Chapter 9.12,and the Health and Safety
.Section 25532(87
❑Yes ❑N., All roofs shall be inspected prior to any roofing material being installed.
I Will the applicant or future building ocvupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dire nigh
❑Yes No
I have read the havallous materials equiements under Chapter 6.95 of the Califor-
nia Health&Safety Cock,Seem.25505,25533 and!255M,1 u olimem d the if the Wilding
does but currently hate a tenant.dra it is my icspnmibility to notify the occupant of the
requirements which must he mel prior m issuance of a Cedifcmc of Occupancy Signature of Applicant Date
Owner or authorised agent Dae All roof coverings to be Class rB"or better