02060194 CI sin OF GUnPER�NNO CONTRACTOR INFORMATION:
PERMIT
NRAVE GREAT LAND CONSTRUCTION ColP�1`MIT�o2060194
: OE� GJAST
G 1019 S DE ANZA BLVD APPLICApG.N9
/1 ''2002
PHONE: (408) 865-0562 SANITARY
INJO. LO/ CONTROL NO.
f
nmO ARCHITECT/F.NGINCIiR: BUILDING PERMIT INFO
0❑ BLDG ELECT PLUME MFCH
N a i C_-1 I= L-:1 L:1
iZn= LICENSED CONTRACTOR'S DECLARATION �,hS7�
f2 I hereby affirm that l am licensed,Mer to,man,of Outpace 9(commencing EVISION SUBMIT7-E17 escription
with Section)U00)of Division 3 of the Basincai and Professions Code,and my'license
;'4f1ismfull r"ccaraeffect. NO NEW P RMIT ISSUED, ORIGINAL #01120100 .
:w"6 License Class Lie.a
O c t-' Date Car
3 G,
ARCHITECT'SI ;CLARATION
1 undcnla ril try- a i,x6,11 be
used jt. able rcmMx
OWNER-BUILDER DFO.A 01,1
Dna
c
w=',,, 1 hcrt affirm an I am exempt from the Contractor's Liceme Law for the
T o following ,t
.(Sectio 7031.5,Business and Professions Cede:Any city or mumy
"rich requires permit ur consumer,alter,imprma,demolish.or"pair any structure 5 94 0 5
i 3 prion t .fi once l+ requires theapplicant Poi
r such Permit fl gtmm
.' dseent ... _. . ._._.._. _
that he is licensedp ria tt the po i. ari of the Conametor s License Le (Chapter9 y ,Sq. Ft F1oor-Area „ Valuation
¢o dngutn recto vogE)nr oivli on3onne Eu.n,.a pr r. rolls coon e -;1,'j.- Ts.1, is-rl
or that he is exempt then fmmi and the basis for the alleged excmpuon.Any violation 3 7 5 3'7 0 4 6'. 0 0'
-of Section 9031.5 by any applicant for a Merit subjectsthe a.. . mtoacivil penalty
of not mo"than five hundred dollars S5w). APN Number Occupancy Type
DL as owner ofthepropepry.or my employees with wages as their solecompemation, 101 - FOUNDATION
will do the work.and he'.amctum is not intended orarfemd for side(Sri.7044, 102 - Required Inspections:
Business and Professions Code:The Contractor's License Low docs not apply to an -
owner of pmpeny WW builds or implants thereon,and who vies such work himself 103 - OF ER
or through his own employees.t, handed that such improvements wi net intended or
-ante a r r If.however.-m b-loins o 'improvement is m 'tri node year or -' ... - 104- -- REBAR
iamply theWold 'Bnvetnebua fprvingthtn de not Wild or 105 - ANCHOR BOLTS
mprove far purpose
. .. . ..- . . _ . - . . _
_ —D l:asmvneH;nnep.mpo.ny..ann..ex.m..us.mayeom"e. .doewim...namsea.eanu.an.,tato. SEWER & -WATER
.
construct the project(So .7041.Businesi and professions cove:)no Contractors 2 02 - UNDERFLOOR PLUMBING
- - Lid h Law aces mot apply man owner lh property who builds or improves thereon. -•. .
.Co mitt esLicns for xueh prtjans wdh.a.eom"nnr(x)Gmrsed.p,r„tams".the ..... 203_.-. UNDERFLOOR._MECHANICAL ....._._..
Committees m exempt
License Low. 204 — UNDERFLOOR.vFRAME, ,
❑l em exempt under Sec. ,B @ P C for miz rtaxon
_ ow Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
'✓ IherecyarrmtuMerpe,rghy0,"iaDone onnefollowing dena"tions: 302 - TUB & OR SHOWER
F D 1 have and will maintain a certificate of Consent m self insum for workers 303 - ROUGH MECHANICAL
Compensation, as provided for by section 37W or the Labor Cede, for the 304 - ROUGH ELECTRICAL
performance of the work for which this permit is issued.
' - 305 — FRAME
D 1 have and will maintainWorkds compensation Insurance.as requited by section 306 - HOEDOWNS
37W of the Labor Code,for th�performance of the work for which this permit is
ttsved.MyWorkertltn
sComperxaImamatecarrierandPolicyanotherare 307.--. .INSULATION-
.. .. •riser. -r, � ,. ,of '.f3 r.-Policy No:'
. ..... ... . ..
...CERT IFICATION OF EXEMPTION FROM WORKERS' - ( , c 308-,=t!SHEETROCKJ'It;,t .
. ..t _ COMPENsnnDNINSURANCE::._ � ___ __309--= EXTERIOR_LATH-_-`-.-_..___.__.- '----'------._._.._._._ .
nisecctiod need not eeenmpletm itfas,rmit I,Trete nand"ad.11. 310 '- I'NTERIOR LATH , -' ^'` 'C.
spot...mss.)
311. -- SCRATCH_,COAT .
deal int m nm dreeofI okr n nip permit s'a,( 313 - ROOF NAIL -_ ' ' 4—
Ishall t�rtLawsy-{IL elv manner so ft twomp b t. Wo k rs T
Co t L I b Date l0 V� 501 — FINAL ELECTRICAL ENERGY _
A°til t -- - ` sn Io 502 — FINAL PLUMBING- ENERGY
Z IC OA LICA k C fir
Isrif o y.twnr-y,
may' . ns ofm Imb CWe,you must
O Q £Dalt Tfior, ywilh nchp ionsntth pe lstaff befo e eked, 503 — FINAL MECHANICAL ENERGY
Z i .,�.. - CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY''
a: d hereby am mat inert is a ctninuedon lending agency for tha performance 505 - FINAL ELECTRICAL
ed
the a work fru
or which oris permit is issued ser.3097.Civ.C.)
Landers Name.- . _ _... ... .,_.. .. 506 — GAS TEST- -
aD ZL"eMersAdpresq„ 507 — FINAL PLUMBING
U.O Icer(y(barIhavemadthisapplicationandstatedortheabineinform:inim 508 — FINAL MECHANICAL
fsf E.. Darren.I agree to comply with ell city and county ordinances and state laws mining
O:O m building eonseunion;ard hereby aamori:a representatives or mix city,.emerapon 509 - FINAL GRADE
';;s, W I the above-memlmod property for inspection purposes. . .
p...G: (we)og em to save,iodm
enify anml
d keep baress the City of Cupenino against 510 - FINAL PLANNING
UZ liabilities.judged" ns ane expenses which ay in any war accme vgainxt win +
.Z ctyinu eneetnneg nnm<Farmi. e 514 rs F A WORKS
SOURL ARE.0 DERSTANDS'AN - ILL CO P 'WITH ALL NO)
b NT - Issued by: Date
,orereo Applac uccouranor "' tare"" ',Dat Re-roofs •�
_- W MATERIALS DISCLOSURE' '
I:
will me applicant f” but ng oc p iw "b MI nsuchadr,mterial 'type Of Roof
ax defnod by he Cupen M 0 Cod Ch p" all 1,a e th Halm one Safety
f
Cede,Section 15531(e) ! . . }
°Yai ' - r All roofs-shall be inspect1ed ripti i
i, mg,material being installed,-
Willme pNie t orator b I.Ilrs n use equ p t cedar wmrn, If a roof is installed without first obtaining an inspection, 1 agree to remove
T , cm t h do s-it cont nail o+ fin<J by theBay Area Air Quality ManagementDist n all new materials for inspection. Applicant understands and will comply with
G1 °Ye all non-point source regulations.
I have read the hamrdous materials requirements under Chapter 695 of me
if do,mo att,ca scut co e.5«ii m8505,15533end 1553J.1,eye.notify
that
Calif rni at,cases nm cutrtmly atal25 mats is and
itymntand the
oimupt t of life requiremcros whiche and be t He,to schance o Ccnificac of
_ Oee -amy. Signature of Applicant Date
w aumataea o .. _ bDkm
� All roof coverings to be Class"B's or better
.. t : : t, . OFFICE- ..