02060043CITY OF cIJe
INEURM�ATION:
sulLotrvc DIVISION
tstory PERMIT
,CONTRACTOR
...,�_._.
umgDD(3Ap4REV PORTAL AV
ALLEN & LYDIA DUGAN
PERMIrN92060043
AUbEK & LYDIA DUGAN
APPLICATt9`16SNUTY 2002
/
ONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
p� cripiion
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
ADDITION
469 Sjdb y'
r
with Sedion ](MA))of Division 3 of me Business and Piummoipns Code and my license is
in full unsound effccl.
License Class Lie#
Dace Connector
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Pmmsslnnal
OWNER -BUILDER DECLARATION
I hereby station that 1 am exempt from the Contractor's License Law for the
$45736
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit m construct, altos, improve, dentniich, or repair any stmetme
prier m ILi issuance, Skit regpires the applicant Iko weh pem,lt to file a signed m prompt
39g6Bt]IF1t�1 A@a
Valuation
that he is licensed pursuant the provisions of the Connector's License law(Chapter 9
(commencing w1), Section 7000) of Division 3 of the Business and Professlnn4 Code) or
Nat he is exempt therefrom and the basis for Ne alleged exemption. Any violation of
iUAPl%7NFRRFUATiUN
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($50T.
102
— PIERS
❑ 1, as owner of the progeny, or my employees with wages as their sole compensation,
Required Inspections
will do Ne work, and the structure is not intended or offered for sale (Sec. 7(100, Business
and Professions Code: The Conuacmrs License Law does not apply to an owner of
104
- REBAR
property who builds or improves thereon, and who docs such work himself or through his
own employees, provided thatsuch improvements are not intended or olrercd for aide If,
105
— ANCHOR BOLTS
however, the building or improvement is sold within one year of completion, me comer-
106
— SEWER & WATER
builder will have me burden of proving that he did not build or improve for purpose of
sale.).
202
- UNDERFLOOR PLUMBING
❑1, as owner of the property, am exclusively contracting with licensed comracmrs to
203
- UNDERFLOOR MECHANICAL
consumer the project (Sec. 7004, Business and Professions Code:) The Contractor's Li-
censeLaw does not apply toanowner of property who builds or improves merengand,
204
- UNDERFLOOR FRAME
r
who commets for such projects with a coranur(s) licensed pursuant to the Connector's
205
— UNDERFLOOR INSULATION
License Law.
❑ l am exem t under Sec. ,B& P Cfurmis reason
301
- ROUGH PLUMBING
to
Z-- 302
- TUB & OR SHOWER
O K' R'S 1PENSATIONDECL no
303
— ROUGH MECHANICAL
I mody"Fors ode, n ty of locimy one of me hillizing declarations:
304
— ROUGH ELECTRICAL
El have and will maiman a clumateofeunsentmselLmsmemr. worker's Cnmpen-
3O5
— FRAME-,
saticn, as provided for by Sectio 37118 of the labor Code, for the performance of me
work for which this permit is issued.
306
— HOLDOWNS
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3 07
- INSULATION
37011 of the Labor Code, for me performance of the work for which this permit is issued.
My Workers Cumpensation Insurance carrier and Policy number am:
308
— SHEETROCK
Carrier: Policy No.:
309
- EXTERIOR LATH
CERTIFICATECOMPENSATION IINSURON ANCEORKERS'
310
— INTERIOR LATH
(This section need not he completed ifthe permit is furore hundred delta. (11M)
311
— SCRATCH COAT
or less.) %%
313
- ROOF NAIL
(certify thm inthc perym,encc of the work far wh¢h cels portents issucd,Ishan not
501
- FINAL ELECTRICAL ENERGY
employ any persoymanner us esmhecomc hjccuo me Wnrkeri Compensation
Lawa orcafie,rnm. Dat
502
503
- FINAL PLUMBING ENERGY
- FINAL MECHANICAL ENERGY
pl nt ouahnulJ
E TO APP h ter mak' g his Ccniticatc of Excmptinn, y
come subjemm ¢worker's Compen atin prnv cions of the labor Cnde, you mum
504
- FINAL BUILDING ENERGY
forthwith comply wi@such pnrvisionsn w pprmhshall nc dcemr4 mvpkad.
505
- FINAL ELECTRICAL
CONSTRUCTION LENDING AGENCY
506
- GAS TEST
I Mmny alarm that more is acunswninn lending agency li,T me performance of
the work for which this Fermi t is iamrd(Set. 3037. Cil. C.)
Lender's Name
507
508
- FINAL PLUMBING
- FINAL MECHANICAL
Lender's Address
I certify mat 1 have read this applicminn and sate that the above information is
509
- FINAL GRADE
coma. l agree to comply with all city and county ordinances and state laws reining to
5
FINAL PLANNING
building construction, and hereby narrowrepresentatives of this city m curerupon the
above mentioned propmty for impectinn Partners.
14
— FIN AIn PUBLIC11WORKS
(We) agree to save, indemnify and keep harmless me City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accme against said City
in comequc ofthe gr anti ng fib )mit.
APPLICA UNDERST ND WILL COMPLY WITH ALL NON -POINT
Issued III
Dale
SOURC G
O S
Type of Roof
Signa rc of ApplicaH)li, amu Datc
H" RD S MATERIALS DISCLOSURE
Will me applicant rfut building occupant store or handle havartles,material
defined by me Cupc nc owipal Cum, Chapter 9.12, and the Health and Safety
le. Section 25532nd
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
two
If a roof is installed
without firs[ obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials
for inspection.
Dimrin?
❑ Yen ro
1 have read the hazardous materials requirements under Chapter 6.95 of the CShf,,,
ria Health & Safety Code, Sections 25. 5533 and25530.I un imscro thm if the budding
fres nm cu have a tenant, ma it is my respunsihiliIy m to,me rccupant of me
qu •m is uthe melt n thececraCrNOcamn ay�y.
Signature of Applicant
Date
�/
All roof coverings to be Class "B" or better
Owne , apm9d,ed agent Date
V
I
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