00070145�b ow inns i (VISION PERMIT I CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWNER'S
C K Y ARCHI TE(T-AiNGINEUR:
�O
ul C
U
Gla
I.ICI!NSED licensed
underS❑ision, of TION
m t 1 hereby infirm bat I .tot herb undo f Chapter 9 (commencin
pnnisioma p b
F��� with Seri faucc act of Dlvision3nftheliusineaxand l'ndnsinns CnJc, wW leylicense
^t In IiJI litaa and cllccl.
a
On.
6 U Date c Clnss 1 ic. n
Dam Conpmcmr
ARCHITECT'S DECLARATION
1 understand my pluos shall he used as public records
Fqvqe
F p LiccnneA Pndcvionnl
EE OW pt a. e,,ar,k R DECLARATION ..
m I naso aHimt mal 1 am exusin film the fissions o Any cry
Law far the
F"2+ follin
which requires
Startpermit
Il]anso r. altess rand mdozioli Col AnYdn err
O whichit,a permit ar ransomer. he alcor, improve, demolish, file
repine any xI m
a. ce prig Ins creed ara,anato rhelM1e applicant tin wch"ba" fileusi aw(Chad"l
malbeis Ilecnseit Seetua to he ptt Ovinsof the[tic Business
usters Llrenvo Lawwums Cor)
9.
fcomnuneis a with Sccdmt ]m a nl a basis I of the leged x and ion. Any vi Endo)
or that he is exempt taercfmm and the boars for the allege, exemption. Any l violation
of Section a than
LS iv any applicant for a permit whjeas the affliction m a civil penalty
of not bort than live hundred dollars (S50)6
❑ I. ns owner of the property, truly nnpl,re, ,,It wages m their suite eompcmatinn.
will do Ibe work• unA the ..o-acn:re is nm inucndM m ofrered Ib1 sale (Sol 7614,
Husmess and line cxnimn Cole: The Commcmr's Lmenxe law does not apply m an
.or, of property Who builds or impnrves broom, and who does such wd ohimself
or through his own employees. provided that such impravemenu art not intended or
of! d for sale. It, however, the building or improvement is sold within one year of
Imtplainn, the ownenhuilder will Lave tlic mad t oI paining but he old not I Ili nr
ntpmve li,r purpose at sac.),
❑ 1. an not of triped, am eenaskely convecting with licensed commattrs to
consumer the pmjer (Sec. 7(l Holiness and procession. Cede:) the Contractor's.
License Law does not apply to an owner of property is ho builds or improves thereon,
and who contracts for such p oJecs with a contractor(s) licemed pumuem to the
corn "lnr's Lice e Law,
❑Icon cxyyyyyyrrm���ggpt set r s c. .B & 1'C /Iyp tI .nn
WORKER'S COMI'IiNSAT1ON DECLARATION
I bemhy uflilln unMrpenully at penury one of the following declarations
0 1 have and will annular, a C'cnificare of Consent to self-insuac for Worker's
Compenmtion, os pouided for by Section 3700 of the Labor Cole, for be
perfnumare of bgwork foramen this permit is illand.
❑1 have and will marindn Workers Cantpcnwlion Insurance, 'as myaireJ by Solan
3700 01the labor Calc, for the perornmnce of the wark for which Ibis permit is
issued. My W'oder's Compensation Insurance caner mill Policy nutnhr are:
Carrier. Policy No
CEK'I'IPICATION OP EXEMPTION PROM WORK17RS
COMPIiNSAIION INSURANCE
obi, section need not he cmnpleled if the penult is fm our handled! dollars
O Nd or less.)
I certify that in the Ncrammaa mine walk Inc which this permit is issued. 1
shall not employ any Person in any nrnnner m as to hcconm subjwl to the Workers
Cnmpcaxatlon Law, of Carmenia. Date
Applicant
NOTICE TO APPLICANT: If. at.. making this Cri ifiene of Exemption, you should
become mhution
jeco the Worker s Compensaprovisions of the Labormull
Cade, you
Q O Gmhw'nh comply with such provisions or this pemtit shall he deemed revoked.
CONS 'I'RUM ION LENDING AGVNCY
I hereby offi nn that there is a umgmctim lending agency for the performance
of the work for which this penitil is IsmeJ (Sec. 300 Civ. C.)
d A Iwndcr's Name
.5 z I<ndcr',. Address _
U 0 1 ecnifY flint I have read this nPPlicni i hill state that the above Inrornmtio 11,
LY P conecl.I agree to comply with all city and county ordinances and stale laws rclming
C) U :a Will construction. and hereby authorise mpmsenmtives of this city to enter upon
iW the above mentiaml property Gtr inspection pmfmse.v.
0. (We) agree rat save indemnify and keep harmless the City of CupertinoagurN
h liuhilhics, pulgnmms, costs and expenws which cony in any -a,accrue against said
U z Cl��ln enmeyura" nfthe graining of this ner:tdl.
e nr•ev nunn12creeskc ANn Wei COMPLY WITH ALL Mro-ist
Will the upplult I or comae. imadidlny ae,a a aum ar handl,, b:v.al kol mmadm
an drained by the Cupenimo Municipal Cade. Chapter Y, 12. and Ibe Health and surly
C,Jc. Seem. 25532('+)'
0Ycx 0 No
Will the pream nr furore building rwaupanl u�c a m,a artur devices which
emit W,andnur air ao..tic m... us Jclined by Ibe pay Ali At, Quality Mara len enl
Ilisldcl'I
❑Yes No
1 have acid the narrators materials requiremenu under Chance 695 of the
California [bahh & Safety Code, Serious 25505.25533 and 25534, 1 undersmnd that
il'Ihe building docs mol cu"ally have:tenant, that 11 luny mapnnsihllllym nnnly Ito
occnpanl of the rSquirenn� which oa mbe :mel prt 1'ito i..uantt of �ertifir/nl'
I'I' NO,
ELDG ELECT
Job Description
PATIO TRELLIS
Inspections
101
— FOUNDATION
102 —
PIERS
103
— UFER
1.04 —
REBAR
105
— ANCHOR BOLTS
106
— SEWER & WATER
202
— UNDERFLOOR PLUMBING
203
— UNDERFLOOR MECHANICAL_
204
— UNDERFLOOR FRAME
205 —
UNDERFLOOR INSULATION
301
— ROUGH PLUMBING
302 —
TUB & OR SHOWER
303 —
ROUGH MECHANICAL
304 —
ROUGH ELECTRICAL
305
— FRAME
306
— HOLDOWNS
307
— INSOLATION
308
— SHEETROCK
PLUMB MECH
309
— EXTERIOR LATH
310
— INTERIOR LATH
311
— SCRATCH COAT
313
— ROOF NAIL
501
— FINAL ELECTRICAL ENERGY
502
— FINAL PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
504
— FINAL BUILDING ENERGY
505
— FINAL ELECTRICAL
Issued by: SOF
— coq TEST Date
Re -roofs 507 — FINAL PLUMBING
TypeofRoof508 - FINAL MECHANICAL
509 — FINAL GRADE
All roofs shalRe0n.VcL 0Ilol Apr I¢tlinANNIINOnaterial being installed.
If a roof is in$II14d witipg0mit oofig[Lar uW[MI, I agree to remove
all new materials for inspection. Applicant understahi(}'Is and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class 'B'• or better