01030185 CITY OF CUPERTINO
nuII.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
4 PSG FENCING INC 01.030185
OWN17R'S NAME: APPLICATION SUB DACE
11.33 N 1.01-H ST 03/29/2001
IIUNI!: - SAM'IARV NO, CONTROL NO,
53397
M C 7.ARCHITECDENGINDEiR: _ BUII.DING VERMI l'INFO
❑ BI I ELECT PLUMB' NIEClf
FEW C _l CI LI CI
Qa
z 5 N- LI i that!U CONTRA ind R'S DECLARAOON
s I nercby;,crop dr:.r 1.rrn uaewd under prosistruistic clhrmtcr 9(�,r.nner,ang Job Description
ONO
w wllnfu llioree7000).odoll '';xin; 3..1nc,lluuim:an pori l' tcsn un la Iic� u
Is in full lorce and cl y�
,zap LicerwC _ r � LieM �� / 2ND FLOOR BALCONY REPAIR.
O a V Dom _KI_II Cnnvecnn
F au. V ARC1111[Cf'S UECLAHAIIU
'j 1 undcrmmed my plans shall IN avid as public rceoNa
z�¢5
s p p Liccnwd Prof sionrl
a�j—
OWNER-BUILDER UfihcA RAf10N
to 1 hereby cit rpm u.n cwn.nr!rcpt the Cn;,uuu, ...hiccnw low B,r the _
h7
which
re"cure,,.(Seellnt 9'L5,liudnunsare I...lcxei . Codc:Aprcity or corny
s S D which rcquirca u Penni)m ronxlmet,alNq Ingm.ve.Ao.nullxh.m repair ed t;,(c cut
Co chat he i,xceerna.rlsaregnitheurprP...it for C thrrrniuulllca,1,.(Chapterm
dam tom he in cing it prumurnn in the povlsmns t 3 ofCt,R.onek Ldccrne law on,Ce
.)
a..mrnenemg sedan seeao.,70ro0 of Dissdon3onhe Ruxir.exx:,r,d profession,cite) Sy. Ft. Floor Area Valuation
or that he is exempr,there!,,and,he basis for tire alleged!e,e,nn,irn.Any violation $3500
of section 9031.5 by any applicant for a permit subjects Be applicant to a civil penalty
or an,tnourc than rise hundred dopa,.n500). APN Number Occupancy Type
O 1.u,owner of the p,,,,nr.or...y e,ploycex with wase,a.uheirsnlc anmvirolon. 2
j 2001 M L71
will d ,h I I rh , , r intended Ir d d f sale(Set.744. -,
rax and c I c t t r- l d t 1 t,:o, /� Required Inspections
o
x tp peay vin h ld 1 sd LED
1 n l ' A t tho,yh his own u gluyus lavdedLow.,di i ter t tet /'� GC{�J 101. — FOUNDATION
offered lar vale.If, uu c,.,clic bmWing or impmvenutru is,old within rote yen,of
omicron.the owner.nodder will have the buNan or proving that he did no,b�f 1 � 2��� 1.02' — PIERS
impovo fpr Parini ol'sale). IYI�.{
G1,-own.,afine pmpen,.mexdsixdycon,mernswith licensed contract to 103 — UFER
;urdconstruct the project(See.7044.Basin—dad proves s code:)The Cord...... 104 — REBAR
w1 Ecwdoes nf apply manownenda care who licemimprovcpair,rcuth ILDING 105 — ANCHOR BOLTS
and wM1n cnnmmh Inc ply Pon euv with r ,d,who n) ild,or "ttv.,
Cantrnctoh License Luw.
❑tern caentpr Door,sec. .nmrc E„n.de reoor. ].06 — SEWER & WATER
Oorer D.Ic 202 — UNDERFLOOR PLUMBING
WORKUR'SCOMPENSMKIN DECI.ARA1[ON
203 — UNDERFLOOR MECHANICAL
Ihereby amm.undetD:nal,y of per)uryone of the following decmrali... 204 — UNDERFLOOR FRAME
0 I have and will nminmin a CeniOcam of Consent to wif-imum for Worker',
Con,pen.ation. as pnnided for by Sec,mn 3700 or the labor codefor the 205 — UNDERFLOOR INSULATION
pred,lin,aoea ofthe work for which this Knott is issued 301 — ROUGH PLUMBING
IIvia:mdwdlrnamr:..tworkerec,nprensaro.hms,rn,nau.axreq,drcdnys"'i"" 302 — TUB & OR SHOWER
1 o1 the Lahor coda.1,, the p,rl'urmnnce of oro work Ihr hi i this pc ndr ie
issue I My Wor/k,er,co.,.pe., 1 1, puce n,nic/r�.,.Ld yP�o'y`y' i ane: 303 — ROUGH MECHANICAL
turner 39 Na:f�J_/ 304 — ROUGH ELECTRICAL
CER I'111 A ON OPE%EA1pIlON 1Ohl WORKFiRS'
C(IMI'ENSATION INSURANCE 305 — FRAME
(This xecthnnneed volbecorepinedache l.crunir.Intone hundred dollars 306 — 1101—DOWNS
(SBM)oneav '
1 eroily root in etc nedun,a:n«of he work for which this pend,is issued.1 _ 307 — INSULATION
,ham mor nrprloy arty nc,wou irr;,ity n,aooe,,o as,o bnvntc armies,ro roe Worker, 308 . SHEET ROCK
Compcn,arou I.aw.of Cold..,ni;;.Dare
Applicant 309 — EXTERIOR LATH
NORCE-1O APPI.ICAN'I':11,aflcr nuking rhix Ccnllicmc of Iixen,pion,you should
ne"'n,subject to the Workc/n Coropensrton provisions of the l.aM„Code.youmun 310 — INTERIOR LATH
Q 2 fo,Ihaim currency with such provision,a,this peon,led be deemed revoked.
Z
311 — SCRATCH COAT
FCONsere is.ION LENDING AGENCY —
7 construction 313 ROOF NAIL
O i,cuder,SottLwhimhmienmtilin waa(s .3 7,ei..e.> 501 — FINAL ELECTRICAL ENERGY
Lendcr'a Address
U O «naythaurxcrc
n; :,nnhi,appe.aaonand nmmthalthe:mos<mOmmnlonlx 502 — FINAL PLUMBING ENERGYo-. ,ren.Iagree tocorid,with all city odcounty ardio;meesand,iticlaw,relating 503 — FINAL MECHANICAL ENERGY
Ov mbuilding conxrrucdon,and hereby authorize repro:en,:,r.�e.onniscity toenter upon 504 — FINAL BUILDING ENERGY
,be aNt,c-nemioned p..p,.y for inspection p.,we,.
F y
(We)agme m sass,indenmify and keen banniess the City of Cupertino against —
rn liabilities,judgments.cost%and enpcnws which.nay in any way acerae against mid 505 FINAL ELECTRICAL
UzCity inenwyucneeofthe grarngofchi,pem,n. CR��GRS TEST �7` T—�/
APPLI N'f DERS'rANDS AND WILL COMPLY WIT�}�ALL UON-i'O�NT Issued by: 5 , Date
Sou P RE A ONS,— [/,�-5 lJ y'
sig. aeJA,,,h ni uaoror D�ale�— Re-roofs 508 — FINAL MECHRNICAL
IIA%AIRDOIIS MATERIALS DISCLOSURE
Wdll1a,, plicaut o.future building,<oupam,mrc o,lu dm acca,dona rm,te,i;u Type of Roof 509 — FINAL GRADE
as defined by the Cnl,cnina Municipal Code,Chapter 9.12.and the Health mW Solely
nwe,Sccron255a2ro9 510 FI. HL PLANNING.
O Yes <No All roofs shall bet�IsTpyquteri p/�.jQf�rNq{{Q-���_nylj�' {.j. ��J�" g installed.
Will the applicant or I not building occupant use equipment or de5ces which If a roof is in$talleQ Wl[hOUt flrll l)Olill nl ll 111 ec'II VI,';1'gree to remove
noir hNnus air cnnrnminnnn as de 3ned by the Bay Amar Quality hlmmgemen,
Is 2,aaae all new materials for inspection. Applicant understands and will comply with
❑vex ' o all non-point source regulations.
I have ead rhe hnundaux,moods nciluircuiculs under Chapier G 95 el he
Cubit n.to Health k Safety Code.S.arinn.s 25505,25533 and 25534.1 undcnnand that
it the bud Wing dues our...really neve o,corm,Iha,it bony responsibility n,fi ify Ibe
ncce"tan ere tittle; ,crux which m net prior e,.....nue of a cer fr m at
(J Signature of Applicant Date
ow tho,i.e agent Dam All roof coverings to be Class`B” or better
OFFICE