02090027 CI TY UOPERTINO
OPE ,I, CONTRACTOR INFORM ION:
BUILDING ADDRESS: PERMIT NO.
10490 FLORENCE DR DYCKMAN TERRY A AND BRENDA J 020ss��90027
B DA
o�I�V TERRY A AND BRENDA J APPLICATI 0 9/ 0 5/2002
HONE:
( SANITARY NO. CONTROL NO.
o O O ARCHITECT/ENGINEER: # BUILDING PERMIT INFO
le u U BLDG ELECT PLUMB MECH
y= LICENSED CONTRACLOR'S DECLARATION J�ti�bb DD
oz_o Ihereby aRirmlamlicensed under provisions ofChapter 9(commencing WINDOW REPLACEMENTeseription
pmt: wmth
lm se
Section 7")of Division 3 of the Busi aces and Professions Code,and my licen
=xs, Lcense force anQ effect. ���� ��
a O'c'u Date License Class Lit.M �i
Dam Cuotm<tor
r�r:a O aARCHITECr'S DECLARATION .
1 understand my plans shall be used as public records 3 AN 2 1 2003
N
._,0 c Licensed Professional
o� OWNER-BUILDER DECLARATION
w 1 M1meby a am,hat I am exempt from the Contractor's License Law for the
Cza fallowing reason.(Section 703 1.5,Business and Professions Code:Any city or countyconstruct. 15000
as tz-D which requires a permit to construct.alter,improve,demolish,or repair any structureBUILDING
ure
pn. l is romance.also t1 thepplcant fmmch permit file asigncd statement
,hat h! licensed pun mit,to the provisions of the Convenors License Law(Che .�,ra�5�s�s�l
(commencing with Sect ,law) fD -son 3 of the Business pad Professions Code `�.11-,.'3 Da- Valuation
Valuation
or that he if exempt Ihemfrom nnJ the basis for the alleged aemption Any viola on -" ` `' -
-of Section 90315 by any applicant fora permit subjects the call ma civil penalty
.of not mote than Five hundred dollars(s500). 10 1AP-N t4nODAT ION l- :r Occupancy Type
0 1,as mv netofthe property,°rasYemployees with wages a.their sole compensation, 102 - PIERS
'
will do work. ad'he structure is u.l intended'.,offered for sale(see:lata. 10 3 - UFER
t Busiacss'and Professions Cadc:TW w Contractor's License ladoes no,apply m sm Required Inspections-
own
r of property Who build or improves thereon,and who does such work himself 104 - REBAR
or ib gh his o ployecs provided that such improvements are not intended or
oRcred fo s le If,h ever the WJd ng.7improvemem rs sold within one Year of - - - _ - "'-' ------- - - --_._-..-_ _.._-"..._.._ ..._-
TO5" - ANCHOR" BOLTS
completion,the owner-builder will have,be burden of proving that head not Wild or 10 6 - SEWER & WATER
improve for purpose of sac.).
_..1."_..sine _se prop - ' 202-----UNDERFLOOR---PLUMBING- -----,., -- --------------
Ol:as.wnerp p(Secnpam Business and Professions
licensed Contractor's - - -----1 .
License
owthe project nsec. LoanowneroandenywhonsCode:)TheCommcmr', 203 - UNDERFLOOR MECHAN'T'CAL:i.It •. i •o Nc_
Licence law does no,apply,o on owner of progeny who build or improves Merton. - '
._and who contracts for.such.projects,with a commea fs)licensed pursuant.to,he" _..._ .
204-_._...UNDERFLOOR--FRAME
em t re.teL 205 - UNDERFLOORS' INSULATION
'
131 p, nder� � t ' i'''B& C for s reason
ovineos o'Iz 301 - ROUGH PLUMBING
"WORKER'S COMPENSATION DECLAR TION
302 - TUB & OR SHOWER
_ - IM1ereby affirm under gently qr petjpry,;one afore following declaration.: 303 - ROUGH MECHANICAL
a.c'am will mainmin lu CeuiBcaie'4 Conient�,o self-insure for Worker's 304 - ROUGH ELECTRICAL
Compensation,
as
spprovided for by Section 37x1 of ,he Labor Cade, for the
m
_ - Performance ar e work for which this permit is issued. 3 05 - FRAME
❑1 ba e and will info n Worker's Compensation ionce,as criared by Section 3 06 - HOLDOWNS
37W of the Lab'r Cale,fur the performance of,rte'work for which,his permit is 3 07 - INSULATION
w d My W k Ys Comps ,on Insum arae,ar PoI cy numbc
_1 308 - SHEETROCK
_ -=ware, A L".
ff - - ' ......
CEjTFICATION OF EXEMPr0WORKERSO9 � lEXTERIOR LATHYN FROM
„ COMFENSnnONINSURANCEs -310--; I'NT$RZ'OR--LA'TH -
..' (nn,secdmineed r;beconpleind'fthePerm, seronehundreddollars 311 - COAT
SCRATCH
rslwl le' )
313.: ROOK. AIL
"' 1 certify,h,' the perf ttti fine k(y hich,h pertlit u d I ; I.
shall , mplr Ypea any marine". Fkcome hltWideWorkr 501 - FINAL ELECTRICAL-ENERGY ' •
.AM' tt Lie cI °' ��z _ _._.. _ 502-_-_ FINAL....PLUMBING .ENERGY,. ..._-_-
. _.._.__ ....... -.
boric
TOAPPLICANTIf nk gm crit oe,rE- - 503 - FINAL MECHANICAL" ENERGY
pi y .ho la: ...
f beco b3ent the Worksp C pc t spec rth Labor Cod mus,
rn�nw mc.mply with etcn proa.a.ne o,miep ,shaux deemust rev°kd" 504 FINAL BUILDING ENERGY
_
F'� '�", CONSTRUCf10N LENDING AGENCYdi SOS - FINAL ELECTRICAL °',
p4.> In byrF,mmtme ton.tro,snlendtngagen,formeperrornance 506 - GAS TEST
�.r ofm work for which ms pe , bitted Sec 3097,Cr,C) ..-,"-
M tend .Name
..... _..-- ._ .. ._.
._.. .."... ._. .. .. ._ sees._•_ - _.. ___.".
p.z Ldtta vAdd " I 507 - FINAL PLUMBING :
U-_0 lertrymmlhee,cadthi,.pphcaionanasm,ethaimenWveinformationis 50 - FINAL MECHANICAL'.'.
torka 1 agree
comply with II city and ...ty,rd'runc s d ural refining 5 9 - INAL GRADE
U ,o W Id g s,wrings:and h by authorize p ,t of th':city to enter upon
y fx7 measmentionedproperty r pa purposes.. 5 0 - INAL NG
E., d (ed ) gree, v ode fy and kap harm). the City f C pen against
m 1'abil, judgments, t d pc me which y n any,w y ac against sad 5 - INAL B RKS
U Z City c nseriencs mare
gm, g of'his perm, _
APPLICANTUN'DERSASDSq\DWILLCOMPLYWITHALLNO IN 602 F IL
SOURCERE . Issued _ Date S
yAO I
S g f ppl PJ'7 i �r. p to Re-foo - -
a.
refinedlby he HAZARDOUS MATERIALS DISCLOSURE
applicant orf, Wilding«c p 't tore handle h rd to material .. Type of Roof_ _
Cogen M nc'phi Code Chapter 912 and the Health and Safety
Code Sldo 25538x1^ - 3
-- . All roofs shall be.inspected prior to any roofing.material being installed. --
-Will mcappl cam o armmM filed ache nt Bay useequipment lit Marta which If a roof is installed without first obtaining an-inspection;'I agree to remove
it h d i s nm an,. def ed by,h B y Area A Quality M Management
Go - ,. all new materials for inspection. A ltcantunderstands.and will comply_with ,
❑Ya ;" ❑N _" la ...
- all non-point source regulations.
1 havemad
,
the hazCtenon q irem"cn¢u'ng C�h per 6,95 of,ilb Health Safety Cod.Sections and 25534,Iaro
ifme Wildingdoes nmcunly has
a tenant,
ttitismYrniitym-milf,the-ccuP , requirementsmewhichmustW mci poor to
suaceof.Cerefr
--
- - --- _
OccupationS , f .. .. .. _ .
- Signature of Applicant._ _ Date
°oviner or°tm°n:ea agent 1 Date All roof coverings to be Class "B"or better
:: ..._ . OFFICE
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