01030173 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRPSS: PERMIT NO.
7940 MC CLELLAN RD # ' PSG FENCING INC 010301.73
OWNER'S NAMII: APPLICA'r10N Suit DATE
CAMPBELL ASSOCIATES 1133 N 10TH ST 03/9/2001
HONE: SANITARY NO. CONTROL NO.
4089953397
O ]. ARCBI'IECT/ENGINI1711 'BUILDING 13I7RMI'1'.INFO
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w❑ BhI IiLECI' PLUMB MECII
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I.ICHNSCDCONTRACIURNDECLARATION i7 JobDescrip n ❑
mw 1 hereby affirm that I am liveried under provisions of Chapter 9(commencing
!,f-a with Section 700(h of I) !on 3 or the itusines.and f I o Colt,,aryl m r license
is imm�larecand
cf 11QQ" —� 2ND FLOOR BALCONY REPAIRS/RESIDENTI
st 0 d U License�p _! laic.1, �7 �
11
w 3 e.� Unm `!` L_ 1 -S DECcvar
Am.ons ILLI SDECLAIc mo,ol
r_1=°�' I mmmrswmJ my Plans,bol be Ilea:,.poria,e,oaa, .
:moi. a F Licensed Professional
as ao°
OWNER-BUILDER DECLARATION
to 1 hereby affirm that 1 am entrain from the Contractor's Licence Law for the
wp z following reason.(Section 70315.Business and Professions Code:Any city ar county
N O which requires aIvonit Its n n alter.r. demolish, repair any structure
65�
prior to its 'L,mLImmS the III t bor inchWord 111 6 d.flmenl
- matm 11 hario'dI I t, tire Is into IIInhe c t I Law(Chain,,9 Sq. Ft. Floor Are Valuation
monnocticia,with section 7000)oI lr 1 t he linoam,,aad Irrole,o' q Caro)
(or mat he„exempt mmelrom and the basis for the alleged exemption Any,oral on $3500
of Section 7031.5 by any applicant fur a Penni,subjects,he applicant no a civil venolly .
of inn more edam me hundred dollar.(55()B). APN Number Occupancy Type
01.as owner of the propedy or my employees with wages a,their sole compensation. 362101
will do the work,and the.structure In not intended Lir offered for.sale(Sec.70W.
Critics, ml 11..m .Code:Tim Corr:mlor,License L:tw are rot apply la Required Inspections
,wharf prolan,Who tbuilds or improve,emnor.dad who doss,Lia,work Inim,e
,through his own nnployce, pn,mdcd that.men.............coos are Dol intended or 101 - FOUNDATION
offevl for sale.II:howeve,the building nr lnnpmvmmad Ix"old within are year of
Onodefim. he mwmm.twilde,wit have the burden of Proving that he did not f,uild or 102 — PIERS
improve farpnpo,eofoile.). 103 — UFER
ED 1.as ownerof the property,amt exclusively contracting with licensed contractors or 104 — REBAR
iwOnset the projctt se 7t .Business and Pmfcastons Code:) nm Convector's
jocm,e Law Joe,red apply a.in.owner of rvorory wno build, ,,im ,o,r,thereon. 105 — ANCHOR BOLTS
and who eontmns for ouch p tens wins m m�tmnor(I)hearted Pm,mod m the
Contr"a"s I-mensa Let. — SEWER 8• WATER
❑lain c,cnnp,unacf Scc. ,BR PCliu nhix rca,rn
Owner Bane 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL
I hereby nlTm mule,peCaIt,of,,ja,mm mrtne muowingd«Iarnmr,: 204 — UNDERFLOOR FRAME
❑ I have and will totlnnin a Cernre:,ta mf Consent m self.in,ma rat worker, 205 - UNDERFLOOR INSULATION
Compen,aaon, to Provided fur by Sec,lon 3700 of the Labor coda. tor the
pe,room,mecormeworkto,which hispenmilisissued, 301 — ROUGH PLUMBING
have and will maintain worker's Compensation ln,umncc,to re,nel by Section 302 — TUB & OR SHOWER
7(q of the Lahr Care,for the performance of the work for which this permit is
issued,MyWorker's ComK�o�atmninsurance carrier and Policy nmmneram: 303 — ROUGH MECHANICAL
Caorct-4 X—'- 'rN ���i�34Q 'j �>�® 304 — ROUGH ELECTRICAL_ .
Chltl'1'( C NOF LAI IO PI'1(INPROM WORKIiRS' �e 305 — FRAME
COMPIiNSA'I'ION INSURANCE' Y
(Tnix,eentn need ma be completed it the wmot is It 'I'm It tndrm dolor, 306 - HOLDOWNS
($10(narle,,.) ,i o 307 — INSULATION
I certify,Iran In he pe,romame of the work far which this Permit i,isect . 308 — SHEET ROCK
,hal or employ any pe"Im in any nine,so a,to become wbjeo to the wa,kers'
Com pmuation Law,of CsfiforaW'Date u�LD,N 309 — EXTERIOR LATH
A,lilard
NOI'ICITOAIIIRAF"r It lfrvl alAkingthisCCridleare ofl:5enm,t n.IIn,"a"lw 31.0 — I-NTERIOR LATH
hc,,vorc,,ubjvci Ih N k C 1 t'ul p _of ll,Lh,rc de you nn,,
O Ibnhwmeomplyisth,nehp ,n Permit is 11be'I.Inedrevokd 311 - SCRATCH COAT
F zI CONSTRUCTION LENDING AG1iNCY 313 — ROOF NAIL
I hereby alliin that there is a construction leading agency f the perfmmance
of the work frwlm
dch thin Pend is Issued(Sec.3097.Civ.C.) 501 — FINAL ELECTRICAL ENERGY
(] Leaders Name
z i.cnrer',AJJrexx 502 — FINAL PLUMBING ENERGY
U O 1"oddy tha(d l,rme mad mis aPpitmitto 1 d"a[,that 111, 'Not,imrnmmdaii, 503 — FINAL MECHANICAL ENERGY
Ii i• lancet.I once to comply with all city rid"manly oMin:mcc,tad,nue laws miming
O U tabuJamgcordmniam.andheren,anhmirareprexmmivesofndxdtyloeme—fron 504 — FINAL BUILDING ENERGY
the above-mentioned property lila in"ci..n purpmes.
F„ a (We)agree to. mor
indemniryandkeeptho,theCityofcuper —
imoagam^" 505 FINAL ELECTRICAL
Ud liabilities.Nd,mmm.coxa and expense,wh'nn Indy in any way secret,aguimo said
U Z Rilffic
ilm.mor
MCI gmmmg onnix l+nna. - GAS TEST ��_
RSTANI D WILL COMPLY,WIT`I ALL ON- K Issued by: Date
TIO y'
Comeit,Coramcto, ^+� Dat= Re-roofs 508 — FINAL MECHANICAL
AZAkDOGS MA'IIikIAI,S DISCLOS RE
fume Umilding mtceupant,lion m handle hwallohs maerim Type of Roof 509 — FINAL GARDE
a,defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safe',
Code.Section 25532(a)? / 510 — FINAL PLANNING
❑Yes No All roofs shall bet,�'PIeclQ Frf an � ft�Lrn.l t kbting installed.
Will'he ap"I"mamfuture bokdingma,parr ce,Inipmen,o,Jcvlceswhi,h If a roof is installed without first o taming an inspection, agree to remove
nail harmluuuur ono inatus a deto ed by the Buy AmuAir Qoality Managcmcn,
p;pr;�,P all new materials for inspection. Applicant understands and will comply with
❑Ye.. INo all non-point source regulations.
I have mad the hmmdou,materials requirement,under Chapter 6.95 of the
California Nails k Safety Code.Section,25505.25533 and 25534.1 understand thm
if the building does nm currently have a Icon,,that i,i,my respmm,ibiliny to notify the
Aof dt euirnnem,whcha he nu,prior n n,u:mec of s Cenificane el
y' �-`ZSignature of Applicant Date
aad,od, tlgem�— Date All roof coverings to be Class "B" or better
OFFICE