01070149 TY OF
CI
BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19111 PRUNERIDGE AVE DYMOND CONSTRUCTION GROUP 01070149
WNER'S NAME: APPLICATION SUB DATE
9EWLETT PACKARD CO 1705 RUSSELL AVENUE 07/31/2001
PHONE: SANITARY NO. CONTROL NO.
(4 08) 4 92—1007
O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
L_j
z w- 1 hereby affirm the ED a ONT licensed ad,,
poev DECLARATION
ONer9(commencing Job Description
iy L:° with Section7")of Division 3 of the Business and Professions Code.and my Iilene AC REPLACEMENT.
i Y lE,� is in full force end effect.
;,.6 Licenu ClassLic,x
-O W U Date Connector
I �+ ARCHITECT'S DECLARATION
}6j 1 undersivnd my plans shall be uud as public recoNs
i
ic,O Littnud Rofessional
vas OWNER-BUILDER DECLARATION
= I hereby.mein thin 1 inn exempt from the C License Law for the
following reason.(Section 7031.5.Business and Profession,
Code:Any city or county $500000
S O which rcquisu o permit reconstruct,vier,improve,demolish, file
earepair sigany movement
3 use 06s moted!a..-also requites the applicant for such pemot tlJoee me Law(Chtcnrm - -- ----- - -- - -
-----
tbatidencingsed Sectiotto the 7")ofDinnsn3o the
eBContrusines andPrtawonesCde)apter 9 p, {,�i gr-Q,rga { Valuation
(c that He H exempt
Section 7") the basis o the
eleged Business and Pmfeanyvi Code) t�l�'+y 1 �rO, p'�I/I(1 U•;ftjr4 j� ,.l.:•L'�j.�'A. '
or that He is eaempi tharefrdm and the basis for the allpgeE ekeid'ptiod.Any violation `
-of notoion4 thanfieerundred coUlarsvpermit anbjmnhc applicam mvcivil penity- Typ
'of not inure 1..n Bvo hundred douars(ss00>. lO�kpN DATION ••"' � � Occupancye
°I.as owner of the property,or my employees with wages as their sole compenmion,
-will do the wok-and the'structure H not intended or offered for sale(Sec.9844: Required Inspections— tit c'
Business and Professions Code:The Contractor's License Law does nit apply to an 103 - UFER Cl
owner of pmpmy Who Wilds or improves thereon,and who does such work himself
or through his own employees provided that such improver t arc not intended or 104 — REBAR. _ ,,,___
-olrend for wile'If however,the Wilding or improvcme n i sold unto one year of - --' '_ _. ..... _-_... ._ ...__ ..._..._.
105 - ANCHOR BOLTS
completion,the owner-Wilder will have the burden of proving that he did not build or
improve for purpose of sale.), 106 - SEWER & WATER _ _
---. . ..__ .._ ._- --.. . . -- Ii --_... - - - -
_ as owncr,of the property,vin exduxively commning with IicensW ronorutors m 2 0 2 - UNDERFLOOR B G P 1 .t•"r; .•„I t i• :.
conswct the project(Sec.]044,Business and Professions Colli The Contractor's
Lmmse Law iota not apply to an owner of property who builds or improves thermn, 2 03 - UNDERF LO . HAN, CAL' •
M who-cmuazt.foa such.projass.wioh acomranortq littissed.pursoanl.to.thc. .. _._-_--2
_-
C atraetoa License law. 2"0 4-' — '-UND F E—�j. '-
- _ ❑IvmexemptunderSec. 'B&PCfmthisrcamn 205 — L S bN
o. ,- 'Dole t 301 i IN .
WORKER S COMPENSATION DECLARATION 301
& R
1 hereby alum under penalty of pe juryone of the follow ng declaration:
EC I CAL
° 1 have and will maintain a Cmifieate of Consent to self-insure for Worku's .'�' •' 3'04 - OUG ECTRI CAL
Compensation, as provided for by Section 3700 of the labor Code, for the
paannume.of the work for which this permit is issued.' ,,3 0�5\�V`at-may M
❑I have and will'mainmih Worker's Compensation Iniumhce,as required by Section 3 O,6 'V LDOWNS
3900 of the Labor Code,for the performance of the work for which this permit is
lased My Workers Compensation Insurance carrier and Poly ender are: 3 0 7 INSULATION
ca PahavNd. . . t 30,8. SJ�EETI�OC Kr,
'r CERTIFICATIONOFEXEMPT IONFROM WOR�1(ERS - f 309'(' 11 EXT'ERIOR"LAT'H'
COMPENSATION INSURANCE_a- • _
0-i-�IINTERI OR
Cl acctlon•mrd not becompleteA if the permit is for one hundred dollars — -- 9 •• •'I.:li:.
(SI00)nr lesw.> 311 SCRATCH COAT
T' rn fy thin m the Ferrmromee of the walk I. which this pemus Li
t imedl. _ . . 31-3 ` - ROOF R00 F' NAIL..',
'shahs of employ any perms to any normal an as to become subject to me Workms 5 01 - FINAL ELBCTRI CAL''ENERGY
Corilpensat on Laws of California Data
Applcat ' . . ..._.. 502...-"--FINAL PLUMBING ENERGY....._.. _ . . -.. .. _, ... .
NOTICE TO AP LICAM If,after making'th,Crtficme (Exemption;you should
Z becomtbjecnotheWorkehCompensatonpro °ns°fthelaWrCodayoamusi 503 - FINAL MECHANICAL ENERGY
n chp iaromanrNaPenrnnshtll ec1 . itai' 504 .- . FINAL BUILDING- ENERGY -
Q _ . _ . . . . -- - - ._.. .._
w comply wi
;f ;CONSTRUCTIONLENDINGAGENCY 505 - FINAL ELECTRICAL
a (hereby eflim that there is'.cmatroin.ir lending.,a.,for the penfcomme, -
bah over° wmcnNtpermRtislnmfsec3o99,CH,C) 506 _GAS TEST
ap Land.,.Nme 507 FINAL PLUM)3ING .._ . ..
s7,zLenders Address
O 508 - FINAL MECHANICAL
U',i„ 1 certify N't I have read Nrs applicmimt�i si 11.11 He, he above information is
law- ebrrem:I agree m comply with all city and county,ardimnces and nate laws elating 509 - FINAL GRADE
to Wilding conswciion,and hereby authorize repreamenives of Nil city to enter upon
,rte the above-mentioned property for inspection,Fairest,,, 510 — FINAL PLANNING
G' (We)9greeoo save.indemnify iind keep harmlesatim City'of Cupetifto against
'M liabilities,ji dgrtiems,cost end expenxs which may in any way acerae against said 514 - FINALI, PU IC WORKS
U,,Z City in consequence of the granting of Nii pamdt.
APPLICANT UNDERSTANDS AND WILL COMPLY wrm ALL'NON:POINT Issued by: Date
SOURCE REGULATIONS:'. '' Y
Signamseof ApplicvnVContmctbr ^'r" ” ' - `;Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE �'
Will the appbcros or f tare Wildejoceirparnatirembandialsonandmes entanidSafety .Type Of ROOF_ ..
` as Befit by Ne Cupertino M n c pal C d Ch pt 9 12,and theHealth and Safety - -- '
Code gest on 25532(a)e r t. t i ♦ - . 1 i.' I 1) e - -, ,.
°Y °No u 1 All roofs shall be mspectgd prior to anyroofing material being installed._-__,,._._.
Wn mo applicant at oimra building occupant use equip meal°;devices which If a roof is installedlwithout first obtaining an inspection,'I'agreeao remove
r it feesout;car 6o tmmant.as defin d by the Bay Area Air Q uhty Management
Di trctr all new materials for inspection. Applicant understands and will comply.with_ -
+l ❑Yea ❑Nn all non-point source regulations,
I haveiread the hamrdow:mamdels rcquircment'under Chapur 6.95'of Ne
Celifdmia Hall l &Safety Cade,Sections 25505;25533 and 25534.1 understand that
Wiltling does not cum only have a tenant,that it is my rcsponsibilly to notify the
amdporit of Ne rent
equirems which must be mei prior msu
issuance of a Cerilficam of
Octupancj. .....
C - - '•' - - Signature_of Applicant Date _
owrierorauthoriud agent Date All roof coverings to be Class B'or better '
4) , - . .OFFICE
CITYILDING ppERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO. '
19111 PRONERIDGE AVE DYMOND CONSTRUCTION GROU 01070s1�49
D MffT PACKARD CO 1911 B PLYMOUTH ST A07G/31/2001
PHONE: (650) 968-8311 SANITARY NO. CONTROL NO.
q O z0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E�'+ ❑❑ BLDG ELECT PLUMB MECH
Z O?Z� LICENSED CONTRACT'OR'S DECLARATION Job Description
O Z—C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing AC REPLACEMENT.
s•y�`u with Section]000)of Division3afthe Bminessand Professions Cole and my license
m y is in full force and eRea.
s z< License Class Lic.p
a O Dom Contracro
aoto ti ARCHITECT'S DELL RA
4 1 undemand my plans shall be Dud m public rccaNs
dp p Licensed Professional
°' OWNER-BUILDER DECLARATION
1 hebuby M.Nat 1 am exempt from the Contractor's License Law for the
C Zs a following burned.(Section 7031.5,Russians and Professions Cade:Any city at county' $500000
F F o which requires a permit to construct.alcor,improve,demolish,or repair any structure
atx
304 prior m its issuance,also requites the applicant for such fist to rile a signed statement - - - '--
thatheislicensedpurso tmNeprovisions ofthe Contowns'sLicense Law(Chapter 931$9OF/O TV-"a �. Valuation
(commencing with Section 7004,of Division 3 of the Business and Professions Code)
or Nat he is exempt therefrodi mil the basis for she alleged.exemption.Any violation
of Section 7031:5 by any npplianlfor a permit subjects the applicant to a civil penalty 101 C9P�P6DATION
.r at mare than rise hundred dollar.S50u). APN Occupancy Type
El vs owner of the pmperty,nr my employees with verges uuhcir sole compensation, lO —
will do the work,and the structure'is not intended or offered for sale(see.70,14, 10 3 - UFER Required Inspections
Business and Professions Code:The Commctor s a
License Law Js not apply loan q p
owner of property Who builds or improves thereon,red who does such work himself _ _ _ __ 104 - REBAR
or through his awn employees.provided that such improvements ate not intended or .,.. ..... . ... ....... .. . . .. ..
-oHertd(or sale.If.however,Ne building or improvement is sold within ane year of 105 — ANCHOR BOLTS
completion,the owner-builder will have the When of proving that he did not Wild or
improve for purpose ofsile.). 106 - SEWER & WATER
— .-..... . .. _ -202__.- UNDERFLOOR "'PLUMBING
O 1,es owner of the propcny,o xduxisely contracting with littnscd convacmrs to
consumer she project(Sec.70aW,Hosanna and Professions Code:?The Condon'. 203 - UNDERFLOOR MECHANICAL' "
andwho
Law does not apply m an owner of a conty who) lids s improves thto the
dna who es contracts U., h projects with.cantsactensl3menud pursuant to abu 204 -— UNDERFLOOR FRAME ._ . .. ._ . . ._ _ .. .... --
Co1amorsvt<enseLaw. 205 - UNDERFLOOR INSULATION
❑I am exam t under Sec. .B&P C for Nis rcmon
Owner ' Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
-..�' Iharry affirm under pialtya(pdrjptyone ofthe following declarations: 303 — ROUGH MECHANICAL
❑ 1 have and will maintain a Certificate of Consent ui selbinsum for worker's 304 - ROUGH ELECTRICAL
Compcnsntion, as provided for by Section 37W of the Later Code, for the
pefarntunce none work rar which Nix peord is iaued, 305 — FRAME
ID.I have and will maimm.Worker's Compensation Insurance,as requirtd by Section 306 — HOLDOWNS
+-?: 37M of the Labs Cale,for the peoormmrce of the work for which Nis permit i.s
C. s warlr CompcnwiionlnsumricecvrierrnJPaicy' antberabu: 307 INSULATION
./T/�. �eou<rNb.: 308 SHE TROCK._. .
d.My
G turve 1.
(<4b L� .
CERTIFICATIONOF COMPENSATION INSURANCION FROME WORKERS' 3
COMPENSATION INSURANCE --- O'FF
E I O -� TH - "-
1CH C
(D,n see uun need t W completed f th permit for n hundred doll -
.•(51001 I.ss.) - i
I ttnify that the ps mrmanee r to k In which this permit t sued,l 3w'
hall not employ any Person in any manne w a; to becomesubject to the Warkui NA E ` "'Z'RI; sL lIERGY
Comicard onlnwsafC.hfomin.Daae � *'- .SD NA .PL BING ENERGY .
Applicata " . •. .. .
NOTICE TO APPLICANT It aOer maA ng chi c<ruraat rE pr'p,you should 503 — FINAL MECHANICAL ENERGY
s
Wcome subject to the Workers Compenstatioin provisions of the Labor Code,you most
O fnhwnhcomply with such p senna or this Permit shall hedeenedrevoked. ,504. FINAL BUILDING ENERGY.
cor+sTRucrIGN LENDING ncepfce 505 — FINAL ELECTRICAL
toI h relay allons that there s a 1moracfon lending agency for the perfommnce 506 — GAS TEST
"he
th 'work l r which this promit is issued S 3097,Civ C) -
a=q
Less 507 - FINAL PLUMBING
O Z Lenders Address
U O Ittnify thnlhave read this application and scam then the above infnrmnion is 508 - FINAL MECHANI CAf4
$,E^ 'cornu.I agree to comply with all city and county ordinances and state laws reining 509 - FINAL GRADE
O U to boddingcansuuaian,aM healthy authorize rcprcserawisesnf thiscitymen¢rupon 510 - FINAL PLANNING
} fay the above-mentioned property for inspection purposes.
ps lWelrgrtetowvc,indemnifyandkttphartnlesxNcCiryofCupeninoagainn 514 - FINAL PUBLIC WORKS '
y ludoli' - mems cons an xpen hich may in ray way acerae.gains,sold
' .U.Z Cit i
on,
see a the ginti gof is }mit.
AP 11 UN TAMS ND s'1 CO!• LY 'ITHALLNSONP0I,YT Issued by: Date
OR
•GU II N.' ` Y'
Signature bf Apphean iC tartar Date Re-roofs
'HA", GUS MATERIA SCLOSURE
,Will the pppl c m f cure build t accup,m store or handle haaallous matedvl Type Of ROOF - - - - _• ^ _-... .. ,-
as dented by the Calsiman-Municipal Code,Chapter 9.12.and the Health and Safety
Cod Sc Don 255321u1 • s ,,� '�
i ❑Yes ❑No " ' ' All roofs shall be inspected prior to,any.roofing material.being installed., .._..
WN the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove
,.it hamnlnua air coater inane as defined by the Bay Area Air Quality Management
District? all new materials for inspection..Applicant understands and will comply with
Gres - 0o all non-point source regulations.
I hm✓ and,he hoonsims mmensls requirements under Chapter 6.95 of the
California Health At Safety Code.Sections 25505,25533 and 25539.1 understand that
if the Wilding does not eterently ve a tenant,that it is my responsibility to notify the ,
occupy the quire w c must met Poulin issumortals Ceni icate of
p n
Signature of Applicant Date
owner 4,r uathonua agent nate All roof coverings to be Class "B"or better
OFFICE _ ._