01030182 ct U off cul'E
BUILDING CONTRACTOR INFORMATION:
tst.nwc DIVISIONSION st°n PERMIT
BUILDING ADDRESS: PERMIT NO.
7942 MC CLELLAN RD # 4 PSG FENCING INC 01030182
OWNER'S NAMH: AI'PLICAI'ION SOI{DATE.
CAMPBELL ASSOCIATES 1133 N 10TH ST 03/2
'HUNG: SANITARY NO. CONTROL NO.
4171899-9-3-397
OW O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
Fa p D ICLI'CT PLUMB MECH
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Z F N p hICI;NSHD CONTBAC'nOk'S DECLAof hof Job Descripti ❑
J Z_ 1 hereby a0inn thm 1 am licensed b nines provisions nl Chapter 9 and
in I Ging
F_,C J with Seainn](NNllnf o 1nf,hc business and de..it Cs,Jc.anal myE e
�x °fid
I'y"°d, I'v°� lic.x_ 2ND FLOOR BALCONY REPAIRS/RESIDENTIAL
a Lieenxe`cGrx
X o w Dmc 2_ Contm.um
W 3 W G n CHI❑!C'r'SOI!eLAkA71
AA-
F''�v,O� I undcmmnd my Pl:un.hall be u.aJ a,public ttcolaa
o, a b
uE y c,�O LiccmeJ Vmlcsinnal
OatNEWBUELUT:R DECLARATION
W= 1 m.ws gro that 1 am elhvin front due Contractor',Co Lkeom Law fur the
L " whicfolloh ngISmat ,mis tam,a3 1 ,, her..and P e,dearomh,m Any shy ur county
I F O airar ,.am, Iw r E t , , h p d mut
t rep r say t man,
aa. prof, 1 I. y m ��I11a of hoc 'tl IIs A Los.
moll I,.rru- n, d nn " ft i. moor, -, 1 ten ode) Sy. FL Floor Arca Valuation.
(en enu igwm Sewe ]IaIand the
n3orealeg ipi'r.A sCnne)
Jc
nr Ihm n nI, 31.5 b,na.,a,pIi and...h m rnr me v,fhd pdiCT iI to Any violation
of nasion-tha 5 iv a hundred
doll Tor a pennin whjcm,me upblicam n,v coil penalty
(if not mart than live nnitared m,uar.(ss(lol. APN Number Occupancy Type
❑1......ernf,M poison,ormyemployee,with wage...their.nlecnmpenm,inn. 3621 O
will a the work,and the ode *1 e C nm inn',L or o fu v.l SI (Se>:.],QI a "
Broin.,.nod Prorcmniltn emE.:Tne cammnnr,Lm.t,e eR R�1„Ma.6�f1'4(y1,,,8RA 17e9 Required Inspections
,;tTor pmpeny Who beildn of improves thereon,anal% lu r 1
ihlengl,m,wa mn,dnyr,, noewed than inch in,pmwmei,l,are ao,inmmhel a, 101 — FOUNDATION
otfcred To,ah,.II,hnw.ver,the hlilding nr impmvcmen(o solYtj�' 1. y. nl'
im..p led...theownc+.builder will have Om huNennfpmving flh9AY 1,`ir or 01 102 — PIERS
prov.for pagmwnfmle.). 103 — UFER
O I,uv owner or the property.am exclusively eo umering with licensed commaarr om to
mstmct he prose,(Sec.7044,RnQnes,and Isofevion,CialZ pi .� G` 1.04 — REBRR
Lmen,e Law does not apply to:m owner nl pminny%no build.: MM''�!
ad own„eantrass n.,....h pmieet.with a ena,mc,orc)Roomed por,aam m the 105 — ANCHOR BOLTS
C.:m,racmr.Lieense Law.
lame.cay,haaae,s,<. R&Pcbado,mT.m 106 — SEWER R. 14ATER
O%mer Date 202 — UNDERFLOOR PLUMBING
WORK12H S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL_
Ihereby aninnunder penahyofperjury one ofthefollowing declaration 204 — UNDERFLOOR FRAME
❑ 1 have and %'dl tanotain a Ceraaca,c of Cnnaem m.en-imam tor Worker's 20S — UNDERFLOOR INSULATION
Cn I.......I as provided Tor by S,xum, 3700 of the Lahr Code. Tor the
„erm,llraneeofawvoa ro,,lhehflo,,,oaf `i—ad 301. — ROUGH PLUMBING
❑Ihaveaodw0l lmnlnuln wmker',camp.n.aann Lnaumnce,a.,equiredby SCeann 302 — TUB & OR SHOWER
3708 of the Lahr Chale,fm the perfmmaoce or,he work far whish his permit is
issued.My I '.Cnan, no
nI . mom,comer and policy number arc: 303 — ROUGH MECHANICAL
carver PnfiIIgI, U 304 — ROUGH ELECTRICAL
ON )I IiPolmyNo, M o Klik.
COMPENSATION INSURANCE 305 — FRAME
(Da,mction need not M;completed if he Droit is for one lOndreJ dollars 306 ' — HOLDOWNS -
ISlgry
I eenir)that in hm
The perforance of the work for%hien this permit is issued.I 307 — INSULATION
shall no,employ any penin in any manner so as to become auhject to me Worker: 308 — SHEET ROCK
Contpvma,lon Law,of C.hromia.Date
Apph...1 309 — EXTERIOR LATH
NOTICE I0 APPLICANT:If.afer making this Ccnilicam of l7searpfmn.Y m ehuuId
bConna,.uniceh In m.Workera cmpeaan��
n .opiovtsimum the Luho.GMC. ,,alnllah 310 -- INTERIOR LATH
O O h,nhwiih oar,ly with s,,,[I p,I,kimis ,, his pm,nh shall be deemed nivoked.
SCRATCH COAT
CONSTRUC`DONLPNDINGAG17NCY 311 —
_m -
F" 1 hereby amort that pert i,a construction lauding ageney fair de,perrom ms. 313 — ROOF It
I_
� > IofffirsmdTNamwmenmi,pmltisi„ued(sa.3o].civ.e.) 501 — FINAL ELECTRICAL ENERGY
A Erack,',Naim
a z ''"'d"`Ai1dri" 502 — FINAL PLUMBING ENERGY
U0 Iccnirymmna,v.madthi..ppli.nrmnnml,tmctra,Hmabmcll'f,nnatEn'tia50, — FINRL MECHRNICRL ENERGY
Lw F.. correct I agre.tn.mnply with all City and eot adio mr,and slate Its,relmins s
O U ,Ihildi.sena.,means.aadh.r.byaamm,ae,m,volure,of1111,earinrole,mon 504 — FINAL BUILDING ENERGY
ry2 he abo e-mmmtioned p a,m,for in,pce,ion puryoms.
E a (We)agreao%mr,indemnify and keep hvmle,sthe City of Cupertinoagalm, 505 — FINAL ELECTRICAL
to liabilities Judgmcnu,a w,,and expcmea whish may in any way tus me agaimt said
U 2 Ciy m ,meyucncc nrthe gmnung nl min I<rmit.
APPI ANT DERSTANDSAND WILL COMPIyµ1T11ALL NON-POINT Issued by: 506 — Gefi��E I— ' Date �`-0 r
SO 7LATION '6y'✓Ll '-'C��(-t{ —
s:ammnfn— moth Dat. Rc-roof's 508 — FINAL MECHANICAL ,
1�,1%dkUOUS MATIik LALs DISCLOSURE Type
` wtll me a , cart In fair"holding traurym share in handle haaudom mamd.I Type of Roof 509 — FINAL GRADE
asdefinedbytho upcnim Municipal Cs,Jc.Chapter 9.12.anal the Health and Safety
Calc.Section 255)2(.1! — s
Y,,, 570 FINAL FLAlNIN �
All roofs shall be�t�s erred {u{Ljr'jQ an i {' ng installed.
Will lie apph.atn nr mnura nhhildntg,w.n�nt rose cy,dplmnnr dcvic..wn'len If a roof is insta1XFit`hout`fih't"CENtaillT 4rkpe gree«a remove
monh"adnur al......I rinuntx n. caecalby,he Bay Area Air Vnullny Munagcnmm
oigdall new materials for inspection. Applicant understands and will comply with
le all non-point source regulations.
I have mad the ha mous materials requirements under Chapter 6.95 of the
,dammin I leahh R Safety Code.Sestiun.]5505,25531 and 25534.1 vankmand that
if the building J,,.not currently have a tenant,that it is my responsibility to notify the
n of th cyma enu hich must be met prior u,issuance of a Certificate of
Oso an.y nt //11 Signature of Applicant Date
„anmm ng.ltt Date roof coverings to be Class"B” or better
OFFICE