00110137 CITYBUIOFNCUP DIVISION
O PERMIT CONTRACTOR INFORMATION:
IRRIANNGAI➢)ltdiSfi�O MINETTE DRIVE SUNBORO COIVSTRI.ICTIO ""'8'49''001. 10137
OWNER'SN 144 APPLICAlION SUI"DA'IIT
gbhlBORO COhISTRUCTTON 13.07 S MARY AVE #208 1. 1/29/2000
PHONE; (408)810-6122 SANITARY NO. CONTROL NO.
P0OO AIiCI11T[C3'/IiNOINIiIiR:
BUILDING PHRMI"r INTO
au BLDG EI.ECIPLUMB MECH
k' IJ I_ I= 1=J
r¢i
Zg2i I...it tNS ED C011owdarfe,, OF.CLARATION lob Description
_p Ili i7(X)).f thin am Ilcfhe Bonder pmvlsimsx uT..Code. 0.nnummaeng
Cyt is
Seaian]INMI)of Division3nl the Nosiness unJ Prol'rssimn,C,xyl. nJ my license TEMPORARY ELECTRIC
x i is in full force and effeu 7357 !
ex in
fullt�r _ Lic.a_L r
�. comm".,.
' ARCf iT CI"S DECLARAI'[ON
1 understand my plans shall he used as public records
Y
gp Licensed Prul ......ltl
OWNER-((MILDER OLCe Contractor
ION
uai Q—'v I hcrchY aRnn thin I u exempt from Inc Cnmmcv,r License law lire the
t z a ttdlieving mason.(Section 7031.5.Business and Professions Cade:Any city fir county
5 p which.".tutu.a permit to construct.alter,iniprove.demolish.or repair any%mature
3m prior Tons i...more,uLn re,mal.,the apphanuu to, ch perm it n,file neignedx.nenlant
thin he is licensed pynuau m ole p,.vi.ion.r the Cmmeachn,License Uwvchupl..9 Sq. Ft. Floor Area Valuatl011
(commencing with Section 7000)of Division 3 of me Business and professions Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any striation
of Sceion YID 1.5 by any Igplle:un Iia a rennin"'flax the aphlleml to a civil Pcnsmy
of not mom than five hundred dollars 65101. APN Number Occupancy Type
01.a..owner Time n.rrm loees,ithw,c,retmeir�nleemn a..n. 375,31037. 00
prrpe s rrnsP r h penia
will d tl k t t t " I t J B d l 'a (See71W1.
Bas, 11 I : .Cwt I lie Contractor s License Law does are
work
hi an Required InspectionsIC
liw . fp penrWn nolo -. at and n d n kn ,ru 304 — ROUGH ELECTRICAL
r eed through h' ply provided Ihnt h improvements t intended J fir
offered d,o'n"wmsT.mendave It tdenofian x.daw'th tnmyetrof 501 — FINAL ELECTRICAL ENERGY
mnnarmc list thcpose al ilAer will have the bnnlcnt of Proving that he did nm build or
,pm,<fnr pytposem,am.). 505 — FINAL ELECTRICAL
01.a owner of the property,am exclusively contracting with licensed cummaors to
m,lm,l do,pm
j,,O Sr,ISr, 7044,11 ti u% nn
d Vrflessiras Code:l' ,e Conti ar
em's
License I-aw oxis inn apply ,,an owner ol'propeny wen nada,To hupreve,tIn rcon.
and who contracts for such projects with a contmctimst licensed pu meed m he
Commeor5 Liecnx law.
O I ora e,maud under See. .B A P C for his Tension
Owner Dma
WORKER'S COMPENSATION DECLARATION
I hemhy alfinu under pen ally of perjury soared the Ihlluwing Jeclunuiunw: ��
❑ I have and will maimed.f Ry Seat of 3700 of m¢Laborm for Worker's
the
Col have a d m providedintai far Certificate
is Section Cons nl Inc Loner Calc, I'or the \�
perfourmer of the work fur which Ihi,permil i.in,tod
01 have and will,m,inmin Worker's Compenmtinn Insurance.e,rleained by Seaton a
3710 of the I.men Cale,for We performance of the work for which this permit i.
issued.M Wn ker's Cwnpe�n.mion�Insurmnee currier�and Policy in her arc
Currie Policy Nu.: IrOO'R7� •��
CERTIFICATION OP RXEMIMON FROM W ORKIF[Rt
COMPENSATION INSURANCE
(('his.solom need hat be emnpincd it IT.permil Is for art,handed dollars
(8100)...he".)
I rcnlfy Ih a is it,,q',fiirinallccol the work he vdech this prnnil is issued,I
,hall inn employ any person in any intoner mso as to become subjectm the Workers' -
Compensation Www of Cnlifomim Dale
Applicant
NOTICE TO APPLICANT:It,alio making this Cenlliette of Ewelptine.you should
became s..NeO to the Worker's Co npu,satlon provisions of the I,aM,.Code,you tnmt
O Q for th comply with such pnwisiun.or this permit shall he dermed revoked.
z _
F y C'UNSTm is it ON LENDINGAGENCYagency
I hereby which thin Ihmu isitc..ed(See
Iendlnp mgcney for the Pcdumuntt
of the work I'm which this permil in iaucd(Scc.3097.Civ.CJ
6x z Lcndnr's Nume
.z 1<ndrr's Address
U O I ccnity that l have read ddsim,ficalii and snttm mat air nhrve iolloruntian lx
lis F. enol t.I agree a,comply with.11 city Tend county oNinue,cs and ,all lax,mlaing
O fes) to building construction.and hereby authurim representatives of this city to enter upon
W the n sol-menmencul property for inspection pu.pows.
[r 6. IWcOgre"Io suva,iademnllynnd keep hued-,lbs Coyot Cupertlnn against
W liabilities, a,casts and expenses which may In any way accrue ii imt.said
U z City is comryuc ' 'of / _ 25—
At'
4— s11Y
AY .(CANT UNDb ,NDS AND WI CO .Y WITH ALLN POI IStiIICdb DatC
50 B REGUL " r/,/ W y'
Signawrc nl App te:m✓Gmtmnor _ I at— Re_rOors
HAlr\RDOU'. A'I ERIAL.S DISCLOSURE
Wul thea ed,; .lir tonere building,icapant woreor nmmdlc hazardous neacnal Type of Roof
as defined by the Cupertlnn Municipal Cafe,Chapter,).12.a,I the Ilctlth and Safety
Cade.SeOin i 25532(e):'
O Yew 0N All roofs shall be inspected prior to any roofing material being installed.
Will the aprdcammmmmbuildne,necnpnotowc,lnipanmltor m:virr,wnirn If a roof is installed without first obtaining an inspection, I agree to remove
emit hmafder,air cunmmin:nn,as dc6ned by the Boy Arco Air Quality Management
District^, all new materials for inspection. Applicant understands and will comply with
0 Yes CNo all non-point source regulations.
1 hove real the hamrJau,material%myuimmrnts under Chapter 0.95 of the
California IR.hh k Safety Code.Seeders 25505.25533 and 25534.1 undersand that
ifinehuil adol.nntc�ead me a tanam.thm it is my mspe.sihility m mnGfy the
le, a ,•lits who It must be act prior hi i,,onnac d n C,y wwag of
Cketp:n¢y.
Signature of Applicant Date
ow a agrn cmc All roof coverings to be Class "B" or better
OFFICE