01030165 CITY OF CU13ERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMITNO.
7944 MC CLELLAN RD # 2 PSG FENCING INC 01030165
OWNER'S NAME APPLICATION SIM DATII
CAMPBELL ASSOCIATES 1133 N 10TH ST 03/29/2001
'IIONII SANITARY NO. CONrRoL NO.
4089953397
MOO ARCHITECUENOINEER: BUILDING PERMIT INFO
W F I ,1 r ELECT PLUMB MECH
i I. _I
S N j LICENSED CONTRACTOR'S DECLARAI'[ON Job Description
O Z I O I hea'cl"after thin I jun lwou,,d umlur provi,iun,of Chapter 4(commencing P
GH^F,N wimsmtinnl00(bol D'misiun 3a1 11e Runinexxund It les,umr Coate,Lind mylic""c
ue,: i,Inrdlmmeanden '' ( 2ND FLOOR BALCONY REPAIR. '
K z 6 I.iccn.se['}/s � Lice p y_ e—
W 3 ti u nate U. �_ Cunnnnnr�
b iHClll"I'f:Cl"S DECLARATION
F undcrsmnd my plum shall Ic used as public ...rd,
zLLrE
it.
p x Licensed I'rnikvional
e aOWNER-I UILDER IICCLARAI ION
I hetes,eltlam than I n mpt run.the C( fra 's License Ltw lin the
1_Z� fnllnxing re.on. (Serino 7031.5.lbo and Profcs ns C+dc A.,ci,o jury
i M which require.a Manilla construe,alum improve demolish,or repair any strvnare
tare prior it)its issuance.algin requires the applicant for such permit in file a signed statement
m3� mar he is lie«oed Pur cnn¢,the provisionsof the Conductor's License Law(Chapter q S FI. Floor Area Valuation
tee Ing with Se, 70po ol'Dn 9 of the Ra. and PmEIs ..Cn le) q'
m in'a'ne 1,eaearpd mermmm rad the basis t me"ucgoe pplar .in Air fol 43500
trisection 7031.5 by any applicarn for a permit nabjc¢s dhe applicant H+a cavil M
of ern manmaa fete haunted dnnars(s5filb, A Number Occupancy Type
❑I,a.owner of if,po,of,,or my employee,w!,If wase,a,Inen,ole emape—don. AAY 10 3621217101. 00
will do the work.and the structure is not innnJed or nllerod for sale(see.IRI _
In,.ines.and Profession,Code:The Contractor's License law doe,not apply to an Required Inspections
,;w r of property Who build,it improves lfmreon,and who teas such work himself
t 11 ..aFh hi ,nice employee........ edjut suit intprovema ns are ilei amended ear 51.6 — FINAL BUILDING
interim ter sale.IL however.the building or iinPmvement in sold within one year of BUILDING
nmplelio f.the owner-builder still have me burden illi proving the he did not build or
nprove or par,ew ef.ale.).
❑1,us owner of the property,.,it exclusively coolusen g who licensed contractors H+
construct the project Ism.7044.[usiness and Professions Cade:)'Ile Courtrai
Llmn,e Law due,nor apply to an owner of property who builds or improves mernm.
and who enmructs lir such Projects with " onnrauerp) licensed pursuant it,the
Conuanor's Le«t.1)Law.
01 an+exceild tinder Sec. ,li&1'C fir this reason
Owner Dare
WORKER'S COMPENSAI[ON DECLARATION
I hereby thea under penahy of pe jury one of the liJlowing declarations:
❑ 1 have and will maintain a Certificate or Consent b+self-iroum for Worker's
Comprn.alaui, u. provided lin by Section 3701) of the Latin, Cade, tar life
IadirmancI of We work dor which I...Mnnit is i...ed.
VI hate and will mainwin WorAds C'ompennmion Insurance,as required by Stenon
370()of rhe Lubin Cole,lir the Mrhmnance of the work for which this Pannit is
i....d.M�i'Wor 1)'s Cowetion Insurance carrier and Pnlicy nnmher urs.
Gamer:V_q. - 1 a mil]R/.,SR�UA& o0
Ii T IL•11(lN(Pli'EMI'1'IUN Fk 1 OR EHS--'�
COMPENSATION INSURANCE
1'Ed,sc kia need not be completed if fbe Mnnir is for one hundred dollar
CS100)nr les,.)
I comfy mar in the pertinannce of the work lin which this peranit it Issued,I
'shall not employ any Mann in any manner so as to bmome subject la the Workers'
Compensation Limos of Califnmia.Date
A,11caju
NOrIC1;TO APPLICAN'e If,alter making this Ccnlfcam of Exch plaar.you should
Z hecmnesnblat at in,tiock"'s C.... enation pauvini mud the Labor Code.yor'a nue '
O O Forthwith conq,ly with such Pn ...is in this Manu Shull be deemed re,okeJ.
F ^ CONSTRUCTION LENDING AGENCY
I hereby alien lhi.mere I.a m.owaian 097.ng agency for the Mrlbrmunce
la the stork lin which Ih a permit is issued(tiro,7119].Civ.CJ
6. Q Lender's Nan¢
7 Z Lender:Address .
U O l certily mut I lAVC lend tbisapplicalinn and state that the above lnlimmnhm i,
W [.. correct.I agate to emndy asith all city and county ordinances and edam Taws«dating
O U a,building Con,weien.and hereby amboria represcntmives ofthi,city to enter upon
dte alnwe.mentioned property Int inspection pnrMocs. _
�.t LS0 dA)a,.to e. admnnifynnd keep harmlevenu+City of Cnnenano al, t,f
La Vi Ihmilitir,jail garnl..ensu and exp«nes whieb may In any way accrue again,t said
U Z City in cy treyucntt I the gaming til Ihi,Irnent.
APIUN SIH NSNDS AN .L COMPLY WITH NON POINT Issued by: �—� Date — - �
gi magi n A .nu(;"o=—','
"o=—', - Dare — Re-roofs
AHDOUS lATEHccup U15CIA5 P
Will the aPPl' mer lame Wilding Cg le.Chapter
,tenor handle h eaNrw,material Type of Roof
as dulinm ny me c peniao bbanmip:rl axle,cnapmr xlz.amt me Emldn and Safety
Code,Swollen 2553210rr
OYa "" All roofs shall be inspected prior to any roofing material being installed
Will the applicant ar Inonce building nvcepant use equipownt or devices which If a roof is installed without first obtaining an inspection, I agree to remove
if hv.ardam air conla ninants as aclin,d by the Bay Arca Aar Qualify Mana,nncnt
Di,hier� _/ `all new materials for inspection. Applicant understands and will comply with
°Yes R"i all non-point source regulations.
I have ead rho I...da. i
otheral.«qol m
es order Chapter hos it the
Health&
it dI'Wddrn,doc,aulery Crh I...a ater25905,,if , yre,n Eaulityl+,army lfuti
il'rM1c building J«snot curmnJy have a anent,that it is nay resgamihlllly¢+nobly the
cup" t el th te
quirennn wma
hich Insist be prior in issuance of o Cor iliewe of
°C "y' 4 {I Signature of Applicant Date
r tirenethnd. I' 4 `� All roof coverings to be Class"B" or better
2
OFFICE