00000160 MTY.OF CUPFRTINO
nt.l "nf .smN '• vt CONTRACTOR.t INFORMATION:PlikR^
BUILDING ADDRESS:
'
PERMIT NO.
' '. ..
168
r- OWNER'S NAN1672I JOHN - - - APPLICATION, -
IonE: WAYDEGEUS ,RICHARD AN - - e 10 ., SANITARY NO. -
•�0Z ARCIin-ECT/ENGINEER:,,; " - _ — 4_ - - -BUILDING PERMITINEO�
9LDr. ELECT o PLUMB MECH
z y z LICENSED CONTRACT'OR'S DECLARATION Job Description "
O z_ I hereby aBinn that 1 am IicenscA unser pnrvisiore of Chapter 9(commencing
pp winhS t n]pgq nfD . 3of the Bu. JVmfessions Csxle.and mylicen.,e
t-Wi is in full(nc unJ cites 9 •- •
�z Lice -
wo., Dal /Q-406 Cnl __y�e� KITCHEN REMODEL
ARCHITECT'S Ds 61fic TION ff
t'
1=O S I unJcrsmnA n,y plans shall bi used as pontic recoNsc.
O Licensed Professional -
OWNER-BUILDER DECLARATION
1 hereby e(Brm that 1eacmpl from the Contmno's licence Law for the
rea -
Y G following mn,(.Seaton]1131.1.5,B,alters and Vro,der fi W or Any city or county
ac x O ,air
require.i peal.:.re nirsrum,aper,improve,Demolish:nr repair any anamem -
i3� ha n , II I ' 0 Ipli .I ape rr fl L demmem _ a .
— man :dp . . r v nn < . I-cense (Chapter Scl, Ft..FI'oorArea Valuation
or but
hengwIb section]f1f10aofehivo,Snit the Bl..nenand,Pn.An,ss Cols) .- - -
nr.hm he is eacmpl mercfmm ana the haxit for the alleged exal.p,ian.Any vinlminn • '
ofStru 7031.5 by t apcm 'u oppl a asiv nub
fuel thanr e I 51.1 Iy{ APN Number _ Occup_ "
❑I a e flh p nY yen
will do thek e Is t 36927057
Bu e IP r nor :r a t RWired Inspections
owner fI p IyWI Id: arp, , nl ImJ . rkb 1 f
or through h' ,m Y c..pro, it u 1 np em Y r I Ica I , /
s ear , If In ag r meati . wt ore, 1.01. — FOUNDATION
completion,on,the owner 1 x the o f prminy 0 he not b
Improve for purpose of nate.). .•. , 1.02 — PIERS
13 1,as owner of the pmpeny.am exclusively contracting with licensed contractors in 103 — UFER
Lmswel heproject(Sec.]813,Business mal Professions Code:)The Contractor's
laeme Law does nor haly(a nnowaer of properly woo huuds or improve,'hmm'n' 104 - REBAR, .
:Intl he conanc.n fur such p jeeps,with n can0:¢ua(s) IiccnscA pursu:mt m the
Col am exempt
License Law. • , r. � � '1,05 — ANCHOR BOLTS, '
❑ mpt under Secn
: H k P C for this caon - '
Owner - Date 1 d 7 06 — S6JER & WATER -
WORKEk'SCOMVENSATIONUECLARATION 2202 — UNDERFLOOR PLUMBING
jharehy:annnunder penally nr„ following r203 = UNDERFLOOR MECHANICAL
0 I Faint, and wB Il.:dmain,rem.irctlla or Con,cal to:elf-manic for Worker, 204 — ''tUNDERFLOOR FRAME
Congtpaaa➢6n, a,, movalad far by Seaton 5700'of the Labor code, for tiro — UNDERFLOOR INSI-ILATION
•
.performance nr the work for which this penall is issued. : ., _ 005 UUNDERFLOORDy,-,
'01 have a adwill nommmaWorker"CompenwranInsurance,usobtained bySection 301 — ROUGFI' PLUMBING
37W of me Labor Cwc,for the per4,rmanec of me work rnr which mit permit is '• X02 — T'UI3. & OR. SHOWER
issued.My Workers Compensation Insurance currier Cad Policy rmnber ere: - ,
Carrier: 1'arcyNo.: 303 . — ROUGH MECHANICAL
CHH IFICATION OP EXEMI11'ION FROM WORKERS
COMPENSAIBN INSURANCE
- 304 — ROUGH ELECTRI CRI_
(This mittincest
amhecumplctedfine perminsfor nor hundred dougrs 305 — FRAME
(SIMmle.) 306 - HOLDOWNS'
I cert f,that in the performance of the work for which this pemnt is is,u d,) - 307 — INSULATION' -
-nn:dl not employ any Pe y mm a as I becomq�c� tom, Workers'
-
Coapemauo,Lawsdolr _ JJ�� ..77�r icai� 308,-- SHEETROCK .
nppl a.ma, - ,
Nrn ICEI OAppLICANIR,a.erni ,:CLrn stern xs,nplt, yst aI ind .'309- —' EXTERIOR LATH
zl bccowithCoectmnmWorkerss .,,.Granproall hal Kedec bor redaale,yaala,itl Jl0 — INTERIOR LATH
Q forthwith c c,l t xat mch provi,inns nr.hit„omni.shall tie esxmor revokes. ^. '
f^ � CONSTRUCTIONructio LENDING AGENCY 311 ' — SCRATCH COAT r`
.t a > 1 hereby for
of0nn that mere iss construction(Sec.
lensing agency for the performance
of n e work ror which mi.permit i,iasned LSeo.�(raz cin.r,., 31.3 .— ROOF NAIL
WM1I Q Lender's Name
1 r7 z Lender's ADdress - ' _ - •' . „ = r _.
501 FINAL ELECTRICAL ENERGY I
L) o 1 ffyn.tn ad m": Ppiw r d .t That dinaboveri oar nl, 502 FINIAL FI_LIMBLMC; ENIERGY
4T+ F.I correct. g .,comply with II city and lyordinances1 late laws mbling - '- -
o u buildingtoe .t eros and h by untorepresentatives nn city toenter upon 503 — FINAL MECHANICAL ENERGY
} rW the abnvc.mmntioned property for inspersion purposes.
0. (We)agree tosave.inaemnfyand keep harmless the City ofcuNitinnagaina 504 — FINIAL BUILDING ENERGY
In Iiobilities,judgments,rods and expenses which may in any way accrue against said
' v z eityineel.,esuaneconnagmrtmganni,,,armil. 505 /FINAL .ELECTRICAL
APPLICANT UND STANDS AND WILL COMPLY WITH ALI.NON-POINT 1 1. ,I,l^t1r TFRT Di1IC Z 'fie
souRCE REnONs,_c-
Issued by: 9ihF.
—�� a 507 FINAL PLUMBING.
Signature of Applia:I t mr Date Re-roofs
1 G\RDOUSMATERIALSDISreormaIi Type
, 508 = FINAL MECHANICAL
Will me applicant or furore building le.Chapter
score or and
the
hmaNnm material e of Roof
Code.Sednyme 32m)? dnwnieipalede.enapter9.lz.xndmeu hnanasare'y 509 — 'FINAL GRADE
' Code.Section 255321x1?
OY` All roofs shall h
og9plectedl{SII01(War)pIrt1AF7DtItN(1)rrial being installed.
Will the al,plieantar future nnildingocc.Il,.atn.aeyilipa,catordeeiceswhich If a roof isinstalk' 3yitlioutFfTy�AttallnLgyLn Eep(wtE 1W,6greetoremove
nail hnzun nm air coma amun,as dcfncd by mo Bay Amu An Qmd'ny Mam"crovit
D;,maY all new materials,for,inspection. Applicanttunderstands and will comply with
°YeS .kt4/ all non-point'souree"regulations. '
I have read the hamrdo.,mu eriab requirement,under Chapter 6.95 of the
Catifomia llcahh Ns Solely Cade,Section.,25505,25533 and 35534.1 understand thin -
ifle
hbuilding does not Onabnly have a l nnal,that it is my bcsnmxihility m)ratify the
"edam of.he rpyui arnem,which ants.he Incl prior to isenarre nl'a CeniB,me rf - -
`;"a"'a`y' ' Signature of Applicant Date
" ��� ;'All roof coverings to be Class `B"or better
(lwncr nr authorianl (fI � pent '