01030186 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUILDINGADUKHn48 MC CLELLAN RD # 4 PSG FENCING INC PERMIT No 01.0 301.86
OWNER'SNAME
'CAMPBELL ASSOCIATES 1.133 N 10TH ST nrvLlcnrION
sub fY29/2001
HONE: 4089953397 SANITAKYNO. CONTROL NO.
CatARCHI'ri!Cf/ENOINEER.. - BUILDING PHRMI'I'INFO
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n iH' ELECT PLUM❑ MEC11
F U
u j LICENSED CONTRACTOR'S DECIARA'rION
V 1 hershy anion mat 1 mil nacn,ca slider pmvi>n,a,of enawer v m��e,nmyeoins Job Deseripti
F ° isihsectmaegann 'aien�onhentt,inenaaay,rOix �7 2ND FLOOR BALCONY REPAIR.
,,..JJ in nal ion?amt '�,r C(oy, `J
S l"suite Lu.«
X 0 6 0 Date Cnntne
iy 3 u y ARCHI'rEI"S DCCLARAI'IO
1 understand my plan.hall he used as public mann
OLiacrcd Proleninral
i° a
OWNER-BUILDER DF.CLARAIION
I hereby uftian that 1 am exmnp,Iron,file L'nmmctor',Lacre Law h,r the
bAkWing rcavm.(Scaion 711.31.5.Rumme and Pmfesiurs Co,lu Any city w'county
3F F M which y iscritil tof t I,r,i prW,damolikh,or repairy,trucure
y,p p,I.,too, . fey ' the lipplimill f h it ifile 'g eJ stamina,
than he is liclarleripurmant, dela n, ftlc , t r,L Ise (chapters Sq. Ft. Floor Area Valuat k
(commn
anngxth Section 71X10) lDi )of the businessJPm .fe- ns Code) h500
or th:d m he is excitpt,hercfrnand the basis for the alleged ®mp,iun.Any%within
of Section 7031.5 by any applicant fin a permit subjects the applicant a,a civil Penalty
of not marc,hat fisc Iterated Jul L,d($500) APN lyllEf2001. 00
1 C Occupancy Type
tc .
❑1,m owns%of d,c protean,a my I% o t in Wit It wxgea to mobaam safe
(S ermien.
will Jn the work,and the structure is not intended or nlTereJ far sale(lee.71N4,
Iirine,s and Professions Code:The Co anientr's License law J«s ant apply It,on Ze tions
61 pro,n,Who build,or impmw,tbercua,ail who me.: grpyltgd y C® 101 - Fb1.14 AT
14��
owner
�mroash hN awn employee,.pro„del mm such impnwdnem,aroih0 R9 L G
onemd for%lie,If.however.the building a impro.emcm i,,old within ane year of 1.02 - PIERS
1 �ompletion,me owner.hnddc,will haw the burden of pro,-ing that he did nm baud or
mpnwclb,,a , cot,ale,. MAY 0 2001 103 — uFER
Cl.as ownerof the property,ran cxchulvcly contracting wiat licensed commdors to 1.04 - REBAR
un sumer the project See,744.Ifusines,and Pmfession.s Cut The Contractor's p�
consumer the
doe.,not d,i,m an,amer,d property Who Hood.orimpm 1Fryy 1. �p,^ 1.05 - ANCHOR BOLTS
and vsho counters for such project,with a commctnd,l Iicened pars W9' NG 106 - SEWER & WATER
Coags,.....,License Law.
0 lam campt:mder Sec. .H er r C for this,reason 202 - UNDERFLOOR PLUMBING
Owner Dric 203 - UNDERFLOOR MECHANICAL
WORKER'S COMI'I7NSAI ION DECLARATION
I heahy affirm under pemaltyol Petjary nae of he adlawing declaration,: 204 - UNDERFLOOR FRAME
0 1 hale and Will ntammin a Cenmemc of coilwa,to .ell-irate for Worker, 205 - UNDERFLOOR INSULATION
Compcn,aron, r hnoided liar by Section 37N) of the Labor Code. for the 301 - ROUGH PLUMBING
perfe, nnncu of the w,ak for which this puna”,is issue([ -
dmdwulmainmmWmker,Compca,itioninumaa,asreyuircebySection
302 - TUR 8 OR SHOWER
e 1 or the lana Cale,li„Ne pdrionniance of the work for which this Prerrml i, -303 - ROUGH MECHANICAL
isaed.My Wake',Compen' on Inwtanee currier una Polies number arc:
jj lieu L� 304 - ROUGH ELECTRICAL
Carrier {_�l_qa �, r,o.: T It 305 - FRAME
ffC NO Ea Icy No.. , MWOR CRS' „t
COMI'ENS AT ION IN SURANCIz
306 - FIDLDOWNS
(Thi,section need net be e:n,tlJema if he Penna i,nor rate nnaanea anlCtta 307 - INSULATION
(SI UIIIa len.)
1 certify that in the Perfnnm n,,of the work far which this permit in i,,awd.1 308 - SHEET ROCK
,hall not employ any person in any manner so as in become subject m the Workers' 309 - EXTERIOR LATH
com'-wion law.of California.Dare
Applicant
NOTICE 10A'PLICANr:IL:ntcn.,,king mi,cerldieam on:xempaon.lino,heard 310 - INTERIOR LATH
hecome,uhjcet to tire p
e Worker's Canpcnwtion rovision,of the Lubar Colic.you a nav
0 roanwimconiplyWith,achpwi,ioo-,this�mm,haum
bedenedrecoked, 31.1 - SCRATCH COAT
w CONSTRUCrwNLENDING AG17NCY 313 - ROOF NAIL
a 7Iherchyuf(nnthathere isamnwction[coding agencyfor the peirfnrmance 501 - FINAL ELECTRICAL ENERGY
of the work far which this permit i,issued(Sec.3097.Civ.C.)
y 'p larder,Name 502 - FINAL PLUMBING ENERGY
D 7 Lender.Address
U O I early that I base neat tlti,apprcatioa ane ,are that f tit alro,e informatics i, 503 - FINAL MECHANICAL ENERGY
W. P correct.I agree m comply with all city mid county ordinance,and,tate law,renting 504 - FINAL BUILDING ENERGY
O U rebuilding coytraction.and hereby aumm -`
onu pwcmmi.c,ofihis wm yenter upon
y L,, ,healm,<.mntiomedpbapertyfminPectmnlmDto,ex. 505 - FINAL ELECTRICAL
e, (We)agreen,rase.induala fy and kap harmless the City of Cupenino ugeirt
m lianuitia,,jadgmenr,case,and c,,,aW,whmh may in any way aecmc a,.last,aid 5 6 - GAS TEST
U Ci,r in<oa e,u-,uof me grm I of his Womt. Q
APPhIC I'lt OCRSTANOS AND WILL COMPLY WI'I'[I NON POINT' ISSUedb � FINAL PLUMBINGDate
SOU H IATIv.,' �( /.. .1—J/ y' —
si f, as VARDOit [1/>at�e\ //- Re-roofs `I
HA%ARuture MATERIALSer,constore DISCLOSURE 509 - FINAL GRADE
Will the applicant or furore "pal o a,Chant amen.handle Health an]Stent Type of Roof
a,dunned by the 32d)'no Municipal Cale,Chapter 9.12,sena the Health and lakry' r-"P 1.0 — FINAL PLANNING
Ctxlu.Scc,inn 2553P[al'
O ye, I*e All roofs shall be I�laocted Fri1fll96yRtAT?4njGatWQR�&g installed.
Will the arpiicmitor Rnurc building occupant a,,cyuipmctaord:wicaswbiah If a roof is installed without first obtaining an inspection, I agree to remove
roarDbunelmconcontaminants:ur contaminants us JdineJ M1Y the Hay Area Air Unality hfonagenmm
hrnlall new materials for inspection. Applicant understands and will comply with
nye, jj�No all non-point source regulations.
ILave read the haaardou,nt:aedw,left ti,cman,under Chapter 6.95 of the
Cullfnndn l Icahh M Satery Cod,Sadion,255115.25533 and 25534,1 undepli dthat
lythe buildingdue not<mr ally hoseu,mtnm.that it my.ppnribllity mnotify the
"U" t ,ha u mento which rasa M ran prior,o i„Dance of a Rnilicat�of
"rca� -1 Signature of Applicant Date
o era slice f scat - b — All roof coverings to be Class 'B”or better
_ OFFICE