00100215 CITYOF DIVISION
CUPERTNO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRISS: PIiRMIT NO. ,
7547 SI,UIRF_WOOD WY 001.00215
OWNER'S NAMfi: APPI.ICA'1'ION SUI{DATE
POOLE JOHN E AND MARGARF1 .T 10/31./2000
DINE: SANITARY NO. CONTROL.NO.
BUILDING PERn11T'INFO
O PO ARCHITECT/IiNGINIiIiR: BLDG ELECT PLUMB MECH
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1.10ENSPI)CON]RACIER S DECLARATION
�' 1nembrmrmmslatIamhcemwdunderprovisionsofchapter9aom,nencing Job Description
0 eu ,id,Sell a7O10)o.fnivolml3aforeB14asSu,d Pmfeolons Cale,and Illy hooToo
M n funr force and"ricer.
z a Lilco,Class Lic.p
sOawO [)am Contractor ` REPLACE EXISTING FURNANCE AND FLUE PIPE
3 to
ARC111TIiC1"S DECI.ARA'I ION
=' ; I I haround my plan.shall he mad m public n<ord,
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i d pp O I:mcnsel Pndmvinnul
��ff o ff G,'I mi BUILDER DECLARATION
hcraso ul Erm o nl 1 1. u.,i from the Cosign,C s A Leena,Law for rho
t Z a 'Itching reason.(Section 7rnlor Retinas,and ue,de Profession,h,or Any city or color, s
2 p whim reyuirs.permit In cun.aruat.:Jler,iinpinve,Acnmish,or repair any ntm<Wrc
prior to its issuance.also requires the applicanl for such 131 to file a sigred statement
mut he t.uccmedpursuant romeprovikionvmthe e,m..ae.o.ancerveLaw(Cha,Ier9 Sy. Ft. Floor Area Valuation
mmmn"ncing with Sarson 70())01 Dividon J of the Ilusims and Profcoian,Crile)
or that he ix exnnPI them(more and the basis for Tho at leged exempt tun.Any vlobnion
of fiction 71315 by any applicant fire a permit st,bjcc,,the apps imam no a civil penalty
ofao,mom,banlive handled dollars(SSW). APN Number Occupatr"rType
C 1,z%owner of the pmpcdy,or my employees with wage%as their sole cmmpomxation,
will do the w,,,I.and the.taco,.is num Inland d ar ol'loorl far sale 15ce.7IP4,
Business and Profession.Code:The Commctor License lax does not apply to an 3622701 Is 0&luired Inspections
owircir or property Who builds or nupm aro thn'con,and who Joe,ranch work anooll
or through his own cmpinyas.provided that such impmvcments am not interact or
offered for.ale.It.lmwever,me buddiagof in,prov"nual Ix.,dd wlmm one Year or 301 — ROUGH PLUMPING
comrvlerlon,the owncrbuilh,will have the harden of proving Thal he did oat buil)Lir
improve far purpose 1""'" 303 — ROUGH MECHANICAL_
01.moxno,ITT the pmpeny.n,n cmhrlivdy contracting wire rcelxed cataract a"I" 304 — ROUGH ELECTRICAL
Lim,l...I the Project(See.7WL n,oinec and['rnkreonns C,Ac:)The Counamor's
cense Law does not apply it)anno,nor(it propertywhohard%orimprom%thom""' 505 — FINAL ELECTRICAL
rid who conloactr for soch projects whh n umWaor(a)reared pursuant to the
nntr="m;a Lice.,°Lau'' 507 — FINAL PLUMBING
❑I am Lir mpl order See. .B&I'C or ml:mullet
508 — FINAL MECHANICAL
Owner [)am
W(IRKFR'S COMPENSAnON DECLARATION
1 hereby ani rin under p<•nalty of Nrlury one of the fel lowing declarations:
111 I rl r o, C t1 t fC Ire II' t W kers
Compo r provided f by.Section 3700 f m M Code.d I r me
turf III d I 9 'I th', p� I J.
C I h I wild 'rat Work,, C rip s 1 y d by 5 u'm Q
1710 of the Labor Cods,for the performance of the work dor soh ch this perm I a /
awed.My worker's Con.peovnlon lnmrance cam"and pulley lmllhl me:
Cm ac Policy Na:
CEFRI'117ICAFION OF MEMPfION FROM WORKERS'
COMPINSAI'[ON INSURANCE
(This section need not b"completed if the Penni,is for one hundred dollars
(SIW)or lets.) '
I easily that in she perfume nce III(be work fur whwh this permit is issued,I
shall not cnpmy any person in any manner ar it,m become subject to the Workers'
Compenvtiun laws of California.Doc
Applinml
NUI IC'E'I'O APPLICANT:If,afier making this C'el ilicme of Exemption,you should -
Z ocon...... sero me W..re,Computation powi,loo,offive LUNrCod,yen mmr
Q Q Amhwilh comply with such provisions or this permit shall he deemed revoked.
r 4 CONS'T'RUCTION LENDING AGENCY
a > 1Lcr for affirm thus lhemisac..cil e, 097. gagmmy lbrlh"pcdirmmn¢
of me work for whim this permit is rued"see.3fM)7.Ci,C.)
0. Q Ixrvdcr'x Name
Z Lender's Adana
U Q I a+my rent I have read mis:ippreatimt and cmc mar the above information is
4. E.. coram.I agree to ennpty with all city and county ordinances and state laws relating
Q U to build nIT coa,mcron,and hervhy numorive wgrcsennnives orthr,city to ante upon
the aMmcnentioned poverty for im,coign purposes.
L (We)agree to save,iadcmniry and keep lmonlexs the Cil,of Cupan'ma agoimt
Z Iiabillties,judgments,costs and eevem"s which may in any way accrue against said
U Z City in conttyuenec of the"ounng of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MINT Issued by: Date
SOURCE REGULATIONS. y'
Smgnamm of Appficandcoommor Dale Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding acupam sane nr luaus humping,material Type of Roof
us defined by the Culmnim Municipal Code.Choptt7 9.12,Lind the Ilcnhh and safely
Code.Sector 2553200?
q vcs 0N All root's shall be inspected prior to any roofing material being installed.
Will the applicant t'm mlarebuimmgoccupamawcyuipmemordesraswhich If a roof is installed without first obtaining an inspection, I agree to remove
emit norr& air conmntinuntsasd"Bnen
d by rhe I{ay Are.Air M.na,lelmm
rain,I all new materials for inspection. Applicant understands and will comply with
❑vex oNo . - all non-point source regulations.
I h.vu red the havardona I natcHA, ,Pon,nctns under Chtmmr 495 of rhe
Cali tunia neuhh&Safety CWe,Scctiom 25505,2553)and 25534.1 undmmnd that
It the building docs nut cuvcndy have a mnum,IL;u it Ix are msry aollilal ,,mnify the
cupant of she nommmane which must be mel prior to is,uana of a Cenilicale of
Occupancy.
Signature of Applicant Date
Owmr,oz Iho.;,alamend ram All roof coverings to be Class "B"or better
OFFICE