00070006CI Run,gI CUP6RT�ENIC B
7 @fic'*F0 p��MIT
CONTRAI� WIFNIPORMATION:
00070006
BUILDING ADDRESS:
T AND ELAINE
L 1495 S WINCHESTER BL
ERMIT NO ,
07/05/20
CULVER STEPHEN
OWNER'S NAM17
(408)866-68133
APPLICATION SUR DATE
r
SANITARY N(l. CON IROIL NO.
Z ARCIII'FITC17ENGINEER:
BUILDING PERM..INP(1
PLUG ELEC I' I'i.UMIR MECH
w
Pool
I_J—I r_.I CI
LICENSED COM1TRACI OR'S DECLARATION
Job Description
I haehy a15nn that 1 am licensed under provisions of Chapter 9l commencing
al with Suction 7000)of Divixion 3 of the Ru.inti,s and l'mfessi... Code.andmyliceme
is in full fares and ffn e•,
Liccnec
Use �lass ( Si Lic.M � !
�$.�mR L'nnlmfml
F RAIIO
ARCHITECT'S DECLARA
5 I undcmunA my plans.,hnll be uxJ nr puhllc rensNs
.
'
OL'acn.w l Profcsiomd
FP OWNER�IIOILDER DI:CI.ARAI'ION
I hereby affirm slim 1 am ex nila limn .he CunI racer', Liceme Law for the
$28000
T fohor,in,reason.(Section 7031S,..wins,, and1'rok,,ian,Codc:Anydtyorearmy
'
'
Owhich requlms a permit to constrain, altar, innpmve, demolish, or repair any slmcsar.
prior toils issuance, also requires the applicant for such pcnnin) file a signed statement
Sq. F'Lri^^�Aypa
OQ
Valuation
_ that he i%bacr.edpunuam to dr, prowunm of the Contractors Licence Law (Chapter 9
Business Prnfconum Corel
(eommemuing with Serof mon 700 Davirion Sof the and
Lir that he is exempt therefrom and the basis for the alRgcd exemption. Any riulution
5/rQ(j1�G�2.
of Section 7031.5 by any applicant for a permit subjects the applicant Lir a civil penalty
A P
Occupancy Type
lot is.,marc than Eve hundred dollar. Who)).
103nber UFE R
❑ 1, as owner of the property, Lir Illy omployccx with wages as their sole compensation,
—
a tions
will do the work, and the gmnure is not intended or offered for sale (Sec. 7O4,
Ilu,inuar load Professions Codc: The Contractor's License Law docs am apply m to
107 — PO / a+ `r+• •`•' '
r of propoc
ary Who bullus or impnner thercon, land who) rtes such work h.nlf
n lhnn.gh los own employees, pmveed dim roan iniprnv ems are nm intended a
7� 1 — ROUGH PLUMBING
nffcrcd for sole. 11, howcvcr. the hui.dne, n ripen concis sold with.....a yea of
�n�,boc..fo�r do,Nirwilnos�..hannldennf�mvingfour nedid nmmlJdm
v
304 — ROUGH ELECTRICAL
mt�ol
502 — FINAL PLUMBING ENERGY
❑ 1, as owner of the property, am e.cm,avdy contracting with lice..sed commmma to
conamcl he project (See. nua. Busher and 11 1 ..sun, Caso me Com lief r'1
503 — FINAL MECHANICAL ENERGY
Licenx I.uw discs not appy ns an owner al property who builds or improves berem.
_
and he correct, for such pnject, with acomments) licensed pursuant In the
506 — GAS TEST
Contractor, License Law,
❑ Ism exempt anti., See. . B.e PC for tai,..at
510 — FINAL PLANNING
Owner Date
511 — FINAL POOL
WORKER'S COMPENSATION DECLARATION
516 — FINAL BUILDING '
Ihemtry all y.nn awe, pmnallyol,,ary mncol Inc pd.owing dc<lomtie,o:
i0 I nova and will main.ah: a Co,fireme of Cmuem to s,If-insure fm Wmke,:c
Conpmnwlion, a, provided for by Section 3700 of the Labor Code, Iur flue
pedumianu o.'lhe work forwhiah thin per nal i, nand.
and will maintain Worker's Cmnlenunlion Insurance, a, required by Section
KI
. of .he [,No Calc, for the performance of the work lit which this permit is
i,wr My Worker'. Compensation Instu:uice eurtie'r numbero
}and rPGolicy
S'�'�__ I,olicy Ne, 1 0 � � 0
Cam
CERTIPICAI'ION OF EKEMPI ION FROM WORKERS'
7
COMPENSATION INSURANCE
' (rh lum need notli completed it the fernot'. for one hundred dIP r.
- • L/
IS 100) or fc,)
v /
I o,rtit that in the p forucarae if0he oaklor is torch this armilsisseJI
s, ns become sable., a the Wt.ke',
sl.all nu ....ploy n , Pennn'n : y no a
g/
C oau,ation Law, of Calif.. a, D,,I,nrte
Applicant
NOIICE'1 O APPLICANT l.; aper making this Ccnitica.e of Exennption, you should
become suhjem m.he Wnrkors Cn.npcn.aGoa pmvLion, of the Labs Code. you must
forthwith comply with such poesions or this permit shall he deemed freeload.
A CONSTRUCTION LENDING AGENCY
j1 hereby difrso the there i, a construction lending agency for the perfonname
of the work far which this permit is issued (Sec. 7097. Civ. C.)
,
Lender's Name
Z lender', Address
I ttnily that I has. read Ibis app.intinn and state that the above information n
niiii net. I agree .o comply w 11 n1l city and canny ordinance and ams laws retain,
!Jwhcoming .unune.ion, arm hereby aubta m epre native, of this city to enter upon
, .Neal t l pio,cryt' 'l I p
�
:6, (We) agt unted, urd IOU, . I.:ILCty oilC prrt ,'last
W fialahner. al,roar, .and p on . n .... way uwme on, mid
City n comegne ce mom, gaining of th c per sit.
�—
DZ
S _!"\ o%1
'•� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
by: Dat
SOURCE REGULATIONS.
Issued
Re -roofs
Signature ofnpphcan✓Cnmtmctor Dme
HAZARDOUS MATERIALS DISCLOSURE
Will the oppliend of fume building cccupam store m handle hateaNnu, mad of
Type of Roof
as defined by the Collation Municipal Code, Chapter 9.12, and the Health and Safety
Cdlc. coon 25.132(a)?❑pIJMs
All roofs shall be inspected prior to any rooting material being installed.
Wdl heapph,antmfulnrebuilding occupant are a,mirmantordevice%which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hmwdnl.s .dr conmmmare, as defined by the Bay Ana Nr Quality Managenmm
all new materials for inspection. Applicant understands and will comply with
...rule'?
oyer El No
all non -point Source regulations.
1 bervic read the bacardous mmeda., ro{uimnan6, ander Chapter 695 of the
and 25534.1 ty I."atI ,he
boil ingnocdhft Safe, Cod,See,a .rem, that it
il'1hebuildingencslimeomount, itis mryssuancsihilityermuni., the
iI
/`J/�/ ( %/►I
lo`/�%%��,I,I'�
The not
mnt,currently w
let
«'cupanl of the rcquiremens which moa be and prior m issuance n(a Ceniticuta at
Oce.......
Signature of Applicant Date
All roof -coverings to be Class "B•' or better
Date
Owner or authorized agent
OFFICE