02080117 (2) OF
CI BUILD NG DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20595 MAPLETREE PL (LOT48) GB GROUP 02080117
OWNER'S NAME: APPLICATION SUR DATE
CUPERTINO COUNTRY WOOD HOA 8921 MURRAY AVE 08/21/2002
PHONE: SANITARY NO. CONTROL NO.
(800) 653-7172
O O ARCHF ECTENGINEER: g BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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0 z h Z LICENSED CONTRACTOR'S DECLARATION Job Description
oz-o Ihcreby affirmD, ,mt I 3liaheeBwimasd under provision,ofChapter 9 Caci.a(commencing REPLACE POOL FENCE
ay Cj with J00(pof Dyyy/// Sof the Business and Professions C�e,end myli<enu FINALE®
CYf inf]I folic ands O
C a�6 cc as Lhin
G 6 V eIIC GOnln[lor
3 �eu e DECLA TIO: - AUG 2 2. 2002
C ; 1 under and my plans shall W o.ad as publl cards
o.S p O LiceraseJ Professional 1 11 1
OWNER-BUILDER m the Contractor's
Y,I�D,gNG
1 reasoerebyn.
.affirm(Sect on 1 1. exempt from Ina Cocoons Co Liana taw for the RRR LLL 777 V U
C Z o following reason.(Secdon]onstr Business and we.Professions demolish.or Any<'n m county
E F o which rtq rt p,also, , , h r,improve, ittor upas any statement 3 m .prise t e missalso y In applicant of fur such perm mice ssignedsutemmb - - --- --Valuation,.
that hp sfin with
Section
intranets,son3 a the Buttons License taw(Chapter t��.1u�s�r,AA r�pp ae Valuation
(comma g ,th s«, ]000) fD ,ionJof the Busn,c{{s and Prof',curas Cafe) { {F,�� 1'�325314 V!r T.(VV,t�l�ri:�IIt)w4;
or Ihm ecis e,cmpl thcmB%mY and the basis for the alleged rJlimpdoh,Any violation '
..of Section 7031.5 by any applicant for a pend.subjects the applies.,toe civil Penalty-
of not male than me hundred call.(a500). 101AEN VTOMATI ON Occupancy Type
o Las ownerofthe gopi or my employees with wagaas noir sale compencaan. - TERS
will do work, the strucnre is not intended or offered for sale(sec:JIH6. 10 3 - UFER Required Inspections
Busiaeu and de:Professions CaThe Conuacmr's License law does no,apply a an Q p
owner of property Who huilit or impoi thereon,and who does such work himself 104 - REBAR
cur through his own employees.provided,hat such improvements are not intended or
-offered Torula If,however,the Wildin--r int t is sold within one f - -_ - "' --__.'..._"" ---- -' --
ge paofprn ria 105 - ANCHOR BOLTS '
cmprove(4ftheo'setv'ilc,rwill havelhebuNenofprovingthathediJnotWildor 106 - SEWER & WATER
improve pulprse o
- '— ----- - .._.. __. ..__...— - - - - -202- - UNDERFLOOR" PLUMBING,-.._..
❑I,es own«,oLlhc pmpcny,em exclusively cuntroaing with Iicen,eJ canvucmfa to "
_ - = construct the project(Sec.]DLL Business and Professions Code:)The Contractor, 2 03 - UNDERFLOOR MECHANICAL'
License Law does net apply to an owner of property who builds or inpaves thereon.
_,tow who contncs.for.mch projecn,with a contractional menned.paraaanl.a the . ._ .._..--2 04--- '-UNDERFLOOR--FRAME
nls pane Law
01 am . ..
- _ amexemunder IiaPefor msnax,n 205 - UNDERFLOOR' INSULATION
71 Dwn.,' Date' 301 - ROUGH PLUMBING
WORKER-SCOMI'ENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby affirin under Penalty of ixrjuq for of the following declarations: 303 - ROUGH MECHANICAL
❑ I have and will maintain a Certificate of consent to elf-insure for worker, 304 - ROUGH ELECTRICAL
Compenaalion, as powidad fm by Secdon 3700 of the Labor Cri forme
= 'perrom,ana cur me work mr whim this pem,ilI�a i,sand.
305 - FRAME
❑1 huve and will maintain Worker',Comi,rnsatinn Insurance,us required by Section 306 - HOLDOWNS
JJ00 f therah Cak forthe pe man f the work for which this remm 3 07 INSULATION
:,aeMy.�wkt,,c_a pe ton mmrancc canter and Pol cy m/�c15 ' 308.' - :SHEETROCK, "-�-`
CamerUiO(- .S.,l2P Ii YNo V/ / �j� _,s. - -' .__...._..
IITIFICATIONOFLXEMPI'10 F O WORKERS t J1} 1309 f'_'�EXTEWIOR•iiLATI-It
� �[ENSATIDN INSURE` 20� - 310 INTERIOR LATH
section d n�ol bfe`i s plain f Inc,cant is N no dad annaes 311 - SCRATCH COAT .
1$100)or[as,)
313 -- •ROOF- NAIL,... . w.
1 certify that in the per fo ce f the work for wn cru th pert.,is issued,)
nauna,empmyanyper,onnanymarine,.tooa,.nWame subject to 501 - FINAL ELECTRICAL ENERGY
campenwtinn Ww,of cahrnmia:time - 502.. - FINAL . PLUMBING.-ENERGY.. ...._..._ ..
.Applicant '. - ... -. ..
NOTICE TO APPLICANT Ipmter making this Certificate of Exemption:you should 503 - FINAL MECHANICAL"ENERGY '
become subject to the Workers Compensation provisions of the Labor Code,you must i
O fmhwithcomplywithsuchprovisionsorthispermitshaBxe«mednvaked. _504.,,-_ FINAL_._BUILDING ENERGY. -_-._. -
_. -... _ _ . - —
x > ON LENDING AGENCY 505 FINAL ELECTRICAL ,,, ,
E•^ m.mann rc Wit construction lending agency for the perfonnmux 506 _ -_ GAS TEST
T
s ark for which th pet' .tore(Ser.3097.Co,C.) _ ._.. ..-_. . . _.. .. . ...
o q ..IadersName -'-- -- - -. , _,_ ............ .. 507 - FINAL PLUMBING
- .U.O Lender',Address ,
1«reify Incl 1 have read This application and mute that the above information is 5 FINAL MECHAN I CAL •
correct.I agree to comply with all city and county ordinances and note law,riming 5Y9 - INAL G DE
itoWildingconstruction.andherebyauthorizerepresentativesofthiscitytoenterupon 5INAL NG
the above-mentioned property far,inspectionputpo.ua„'gt` a (`A'e)agreetosave.indemnityandkeepharmlcnstheCityofCueninougainid 5INAL RKS
Lto liabilities,judgments,costs tow expense' Inch may in any way aceme against aid- Ctyin con aofthe tingofhis cantrss � tPld-P El Issued bDate
/ / e
,gwmm of ApplicandCom r —vJote Z Re-roofs
` = HAZARDOUS MATERIALS DISCLOSURF. , ,
Will lltergllcat or future Wading occupant stme or handle narardous material Type Of ROOF . . - . . ••.••'
as defined b5,he C peRn.Municipal Coda Chapnr 9.12,and the Health and Safety tede, y a 3 g
CScciion 25532151 ! j"e : " 1';./ t i ,
oyes' ;❑No Tei ';' All roofs shall be inspected prior-to-any roofing.material.being installed._ _ ...,.
will me applicantorfutu;e building occupant ase equipment of devices which If a roof is installedwithout first obtaining an inspection,'I'agree to.remove
into haz:{rdous air contaminant as defined by the Bay Area Air Quality Management
D motor .. all new materials for inspection. Applicant understands and will comply with -
oret, ON. all non-point source regulations.
I huvercad the hoaeNous material;requir ents under Chapter 6.95 of the
California Health&Safny Cade.Section,25505,25577 and 25534.1 understand that -
"ifihebuildingdac nm currently h:rve sten LIM1m' is my usponsibili,ymnotify the
occuant the uiume 'eh muse and onoissuancc of Ceni-care of
.,
�ao'�'
Signature of Applicant Daten,aama�iamagenl - •• ata, All roof coverings to be Class "B"•or better','
OFFICE