00110139 CITYOF DIVISION
N
RTNO
BUILDING PERMIT CONTRACTOR INFORMATION:
RUILOING ADDRESS PFRMn'N( 13
1079 PRI_0 VISTA RD F;ALLIO CONSTRUCT-ION- OO-0 -0
OWNER'S NAME: APPLICIOW /b �20@0
ROBENOT, JAMES 165E ENGLISH DR r� "
• PHONE: (408) 873-9777 SANITARY NO, CONTROLNO.
❑p� ARCHITF.CrMNGINEER: BUILDING PERMIT INFO
k 0 HLDG ELECIPI,UNtl h1ECH
,,5
ZW
6 y
IF— LICENSH)CON'1'RACI'UIt'S UECLNil Chapter
Job Description
y0 Z 1 hereby allinn,nol am licenmd under provmm�,of CM1C,il 9l I I ting
F_'=� wan 1.111 cxeunn,midonsof me en.,mes sena yrnre.an .enJe, ylice BATH REMODEL
Y in In full lin'ec r
C„ Lamont Lic.X_
H Date ••� s Comraaor p
a �` I IIs,i S ., I hhe V
1 underuand mY plane J,oll be useA us public rcund.
2'i
w O O Liecnmd 11 tv"iunol
c w r H OWNER-BUIL)ER DECIARATION
1 hereby IRmn the'I am eaempl from the Conaercmr's License Law for,he
F A i hollowing eeown.(Sccnun 7031.1.Imine,,and 11-fir,sin I,Codi:Any city lir county
Owhich re4uires a permit to eonvWct.alter,improve,demolish.or repair any.oure ur,
ia� Prior to its issuance.also"uims the applicant for such Perotto file a signed danment
that he is fieen.Wponnam some Po,,W n,ofine Cortin 's License Law(Chupmr9 !Sq. Area Va IaUJ 10
(commencing with Scot I901)(0)m Divown 2of the Eosin„anti profes,ions code)
co hat he d,mennpt,hcrelmm and the nasi,for IM alleged excnnpti.a.Any violutinn
nrsaaon soul s ny any.y,pfim.n,airs p,rma.,.nie,w ma Ippo,:.nt m a dvn pen:dty N %169_8.
n�
arm„none than live handled A,Imn(S51X) A a,9�/p�169_8. 00 Occupancy Type
❑L it%owner of the property,or my e,nphoyas with viruses their sole co.npctionon,
will do the work,and the orucmre o nn.Intended or fl Loed fn,sole(Sm.7144.
SpCCtlonN
Boor,',and PmleWinn.Cody.The Connector,Locove Law docs not apply to an
nouvr of pmpeny Who builds or improves thereon,and who dues such work hin.«If 101 — FOU&V
or Ihrnugb his own entploycos,pro,ided that such imprfrvancms.nc non Inhendcd or PIERS -
uttered for sale im
If.however.the building or prm
loveent is old within line year of 102 — F I E R 5
�mpintimn.the owne,budder will or have the hur proving milt he did not build lir 103 — UFER
❑I,as owner of the pmpeny,ani e,clusively contracting with licensed contractor,to 7.04 — REBAR
i.nvweet the protect sec.7144,Boon,and I'rolle,or, ed,rou Cort mclof, 105 — ANCHOR BOLTS
mcnse Law does not apply to an owner lir property who builds or improves thereon.
and wan contracts for such pmims with a camtricmrly)hcemed punu3111 to the 106 — SEWER R WATER
Conua,mr',License Law
❑I.,,1 e,empt order See. .E Ft P C ha this rat s"'n 202 — UNDERFLOOR PLUMBING
owner Dole 203 — UNDERFLOOR MECHANICALWORKER S CONIPENSAI'[ON DECLAIM[f 1N
I herdry.dnr.n under pce,ilty of Actio,oic of Lire following dedmathms: 204 — UNDERFLOOR FRAME
0 1 have and will maintain a Certificate of Consent m aIf-imam for Worker's 205 — UNDERFLOOR I NSLILAT 7 ON
Con.pen,.tlinn, :. nmdded for by se.dou 3710 of me Law„ Cedr, for he 301 — ROUGH PLUMBING
,,unmoor of the work Ior which This his,rn..I is Iou,d.
302 — TUB 8 OR SHOWER
❑I have"Cline
will mnimain n do,I..penance oon se walk I.hos hich hi by ound 1,
i...e of lite cork r cele,Inersab pertonnonuc lir.hc work her wind,this per.nil is 303 — ROUGH MECHANICAL
avioid.Mr rker,�cm�npen�.ad7nn ln.mm�ee"diet a pnRey�n,am�x�r,-tr7e,�q 304 — ROUGH ELECTRICAL
c.,ndre {/f- ��pnllnrN":I (7 305 — FRAME
CEKHFICA'1'ION 111n CSIiMPn(I pROM0.OR K-1 RS' :,
COtdIPIiNSXHON INSURANCE 306 — HOI._DOWNS
fairs section need not he complmad if the permit i.,lin one handled dollar �.07 — INSULATION
ISIO(d or lesa)
I certify that do the Knouniancc of the work for which this pinnal is issued.1 308 —• SHEET ROCII
.mm not employ any ,,a in try manner.n a,m become,.nice'to the worker. 309 — EXTERIOR LATH
mn.Low.ufcalimmf
Coln"n,. a.Dale
Applicant 310 — INTERIOR LATH
N(ll IcE'to APPI.ICAN'I':If,Into,making this Certificate of Fsxcn,ption,you should
Z b,,oua,ao,e11,,the Wotke,.C......al-niltionpow'.von,ofbeLabor cod"you alad 311 — SCRATCH COAT
Q Q lothwat,c...nplywant suds p—Won,of thi,Pennil shill l b,accred mvokvd,
F (n CONS'I'RUCI'[ONI.PNDINGAG1:NCY 313 — ROOF NAIL
� ; I hitter,art rn„hn,then,is;,com¢ucI I londingngcncy fm the,,bnnenive 501 — FINAL NAL ELECTRICAL ENERGY
If the work for which his permit.s ts..ed(Sec.3097•Civ.C.)
W o Isntle,nNam= 512 — FINAL PLUMBING ENERGY
7 7 Linde,,Addn...
U O Lertifyth,dIhave read this.,li,niceand.ourda dbealhaveofonnatimni, 503 — FINAL MECHANICAL ENERGY
rz F. con,,,.Iagree ,,emn,lywith.11citytell,I.....1,mdi..ame,and seamInw.Id.ai"g 504 — FINAL BUILDING ENERGY
Q f,) .)h.ilding construction.and hereby authorial ecprexnt.ave,of this city m enter upon
y
he awwe.mendontp
,d pn,peny fill ino'd on poo-,. 505 — FINAL ELECTRICAL
OW. (We)agice nn otos.indcnndry and keep humlcs,the Gly of Cupntinn ug..in„
fin liabilities.iudgncnl..coo,and expenses which I,.,in any way name again.,.add ti a, �—eo
SS TEST
Q Z cityin...... uen,cefthe emitting orthis pernit.
A• NTUNDE .DS AND WILLCQMPLYWITHALL ON.P NT ^ Issued b 5674— Fd NAL PLUMBING Date ( O Oe2
5 EREGULA7 S /s/ y'
� _ C CL a
5igaa' Idic. lcoanerlor I e Re-roofs
HALARooUSMArERIALN DIJCL,5UR1i 509 — FINAL GRADE
Will the applicant or thluna beildiag.e,upnnt,m,eor handle ha.ado.,matenal Type of Roof
.t,defined by,he Cupntino Munieipm Code,ChILp,er 9.12,amt net Heald,and safe,, 510 — FIINl.��(Af��L. [PLANNING
Code.Satins 255,2(a)'i - p ff F* `lt .1 f� g
❑res ❑No - All roofs shall CL•te o•n �of� I�iFiY�ein a installed.
Will the applicant ormmne building acupamuweyuipnncntordevices which If a roof is installed without first obtaining an inspection. 1 agree to remove
emit hmmofous air contaminants as defined by the Hay Area Air Quality Management
Di,.ti,n _ all new materials for inspection. Applicant understands and will comply with
El ye, 0 N all non-point source regulations.
I have mod the humrdmm
on. a.crials re9uircenu under Chap¢r fi 95 of the
California Health k Sale,,Code.Section.25505,25533 and 25534.1 undcnland,hal
if the building docs no,currently have a union,that i,is my msptmxibility to nn'ify the
e . the rcyuir,ou ,s wjh nool be nun ono,to n.unnc,lit a Ccni¢ale ll
Q A Signature of Applicant Date
iwn,r or um mrircd ng o. - 5 7e All roof coverings to be Class"B"or better
OFFICE