01030023 CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERM IT NO.
GRANADA AV ADZICH HELEN AND R DOVAN V TRU01030023
OWNER'S NAME: APPLICATION SUB DATE
V TRU 03/06/2001.
IDNIi: - SANITARY NO. CONTROI,NO.
Mike a ARCHYTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PL H MEC11
a� I-i �i •' it , I_I
nlDenDECLARATION
IherenY afthtImIcsedunderprovisions ofChap or9(commencing Job Description -
F=h with Sidle ]Landefect. un3of the Business and Pmlessinn Code,and mylicensc
s� Lie�nmlclu: and effect. Lica ELECT METER
Mr,o u Date Caammnr
tth p Fir ARCHITECT'S DECLARATION
vo'g I understand my plats shall be used as public records
pO LirenseJ Professional
OWNER-BUILDER DECLARATION
I,many affnn Intl I con exemin,foto the enmmdnr'x Li[fna Law for theollinv .
3es which
hlrcson. ahonJan LAct.ainee.mpse.demolih, ,tend,
can mcoumy
F C whim,it,reclines...a meati)m ceras the alma,improve,demolish,or eepair coy umcmre
a3� dard hes(iuuan mmAregaibe rtvbovisiosof the Conon,mas mfile
cose,Lw(Cha mem
(contea li gwit pa ectiotla Mool'Dimmor3ofthe me o,ireme Law rcnnpterv- Sq. FL Floor Area Valuation
or lion
(criminal ng who Section]IKlflnof Division i none s es and Pr.,,, vi Code) OC 0 d V
or mol h i7 3 Ihcrclinm and Iba s s . It o exem lion, violosAa
t]Ill x. Ylandredd, $500).1 Je rho applicama oil menu, P yTyP
i art �nret ive,annrea a: am(sslxn. Y APN Number Occu auc e
r n, - rsoleamr,msatien, 7-;7IrrAiq MCA
will (P the work,and the stm a is not i to and for sale(See 704J,
Basinus and Profasinnn Gsde:l'he Cmttmcmr's I.iccn c Law does not apply la an Required Inspections
owner of property Who alilds a impmvra there.,an ho docs such walk himself
or through his own employ,,,.to..ided dna .a wmeau am nm immureda 304 — ROUGH ELECTRICAL
offered for sale.If,haaever•the building of movement i.s sold within one year of
completion,the uwneobuilder will have the burden of pmving that he did not build or 501. — FINAL ELECTRICAL ENERGY
improve for purpose of sale.). ,
505 — FINAL ELECTRICAL
°I,as nonce of the property,um exclusively contracting with Ilu)capsedTheYmb tract to
mens el the projoa Nov.(Seto an Business and er,who
Ccaills or The,anthema. r.
License law tact nm apply to an owner of property who builds or impmsei(hereon.
and who License
for wale p leets with a cnmmemgsl licensed punmm m the
El I to.km License Law.
°I am axemp under Sec. B de P C for This reason j
Owner Dote / �
WORKER'S COMPENSATION DECLARATION
• I hereby uBiunder penalty of pejury one of flue following dedamtiuns: O
mt
❑ I have and will maintain a Ccnilicae of Consent in xelf-insure tin Worker's v
Compena:dion, as provided for by Salton 3700 of Im LUM1nr Cndr, for the
performance of the work fin which thix,canal ix issued,
°1 have and will maintain Worker's Co npenmfion Insurance.as required by Section
37M or the Labor Cade,for he performance of the work(or which this permit is
sued.My Worker's Compensation Insurance carrier and Policy number art:
Carica Policy No.: '
CERTI ICCATION OF I XEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
This section need not be completed if the pemJt is for one hundred dollars
Ib l lin)or less.)
I ecoily that in I,e lwrfnmuame ol'the work for whichmi,pooh is issued,1
,hall 1101 employ any peon in any manner s,as to hoconm nth ca m the Workers'
Compan silmn Laws of Conflict Data
Applicant
Ny1'ICE'r0 APPLICANT,.If,alter making this Cenife a of Excmpfimu,you should
7 bca re mhica'I to Inc Woo me,Con,samiliom provision of the Labor Code,you nm,t
ZC fall"ill,cmnPly with such provisions or this permit shall he deemed rcvokcd,
EDill) CONSTRUCTION LENDING AGENCY
� 1 hereby.)Lunt dou there is a con Im"no lending agency for the performance
W ,of the work for which Ibis permit is ismed(Sec.3097.Civ.C.)
Q Lender's Name
d.endcr's Adana _
V 1 certify that 1 have read this implication and state foul the above information is
coma.I agree to comply with all city and county ordinaa:es and sate laws miming
Q [,) In,aboingco mmivgandherehy umM1odre mpmsenmtives n!)his cirymemer upon -�
r� Ina aM 1 0 honed propend for inspection puryoxs. ,as
(]t ( c) glee msove,Indemnifyand kecphannles'ole ilY o(Cupeon, room
Z) liahl 1 agmen nstx and expemes a n way accrue a a,aid
6.1 City i m eque a the granting oft '. perml
APP NT :RSTANDS AN ILI .O PI WITHALPOINT
LN P
so P ::R '.ONS. / Issued bye N70ti1/CC! Date
— Do attract — — Date Re-roofs
Do
MN117RIALS DISCI, .URE
Will me apVEcattl m mturcbudding ncupant stn a handle narnrdon material Type of Roof
m defined by the Cupeaim,Mmoripul Coda char .12.and the Health and Salary -
Code.Section 25532(u)]
°Yr All roofs shall be inspected prior to any roofing material being installed.
Will the eyplicmu ur)wore httlldin6l'ecltpanntse cyaipntent or devlcus which If a roof i installed without first obtaining an inspection, I agree to remove
Emil Invadous air mmmltimmtg ns defacJ by Wv Bay Arca Air Quality Martie nem
istdarr Xignature
rials for inspection. licant understands and will comply with
source reg on
I have l the ety Code.Section
narcosis re05,2 . is under 4,Chapter ama6 95(theCol ,colo 1 hh RSufay COJc.Sentinn ^ 115,2 and 2553J.I unslcrsvtildit CJs notntrruntly hav' cut it. t' my rasrymsill l momcult t o th gaircmants whi null he I p u,,isono, f t Rnib
t Applicant iteortnee gem Date All roof erings to be Class "Bor better
OFFICE
' I