00080175 CITY OF CUPER•rINO
BUILDuac DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, VERMI r NO,
00090175
OWNER'S N8e.9 STENDHAL LA AIVVIACNI ION SUB ONIE
1:7r,4 lc-ATInliclol AVE 08/24/2000
IONS: MOTOYAMA SANITARY NO. CONTROL NO.
a ARC'{ITECIENGINEER: (510) 29;3 9901 BUILDING PERMIT INTO
�00
�m_ BLDG ELECT PLUMB MECH
t<�
0 S HN LIC'?lhaa iUCONnsed anO,no,im LARAIWN lob Description
= I...ruby ullirm shut I nate licensed ander Proviaions of b,Crteryln 0.'o,nmcncine .
t—w este sertorn Bohm ommi.l \Drone Isminea,amt rrom.,io,n„code,na,d array hnenw
<y^- i1
in full liorce Un f
Licence Clam Lic.M
d ce0a0
Uahe enntmet REPLACE WATERHEATER
w ,I"i, �I NF AItCf{ITIiC'i"S DEChr\11
(_ O undecuand my"luno shell M.tail a.puhlic recd 514ce ` Licensed Pr..c,,mral
n a c a OWNER-BUILDER DECLARATION
ce
1 1111h,natural Ilan I ane earmpl Irma tin Continent,Licensa Law for the
'L¢ 111141.1a,reason,(Section 711.315.Basins,and Processions Codc Any city or n,anty 7
M which requite,o perit m mOac,rn
u ,alley.imprnve.'denmlich,or repair aa,structure
prior it)it%issuance,also requires the applicant forsuch Permit n file a signed statement
en that he i,Bcen.edparsmmttomepmvNlonsof(tic Contramor.LieeaseLawtchapter') Sq. FL Floor Area ;t�'tion
(,rommencing wi,h 6ttnlon 70(X3 ratDo!..... 3.,Il the Business and Polmsion,Code,
or that he is exempt mercurous and the basis for the alleged excn,pa"d Any violation
of Section]331.5 by any applicant fm a permit subjects the applicant to a civil penalty
of not mase than me hmndred dollar,SSW), APN Number Occupancy Type
O I,as ow net or the property.or my employee,with wage,, sole canlpemali.nn.
will do the work,and the ehmcmre is not intended nr ollemni for talc(Sec.70,14.
Business and Pmfession,Cod,Tho Contmctar,Licensa Law does nm apply man required Inspections
r of property Who tui Ids or proves thereon,and who es such work himself
urvthimNo
rmgb bi,own employee..provided mm amt i,npr,vemeal,are tut intended ,, SEWER R' WATER
ouered for sale.If,however.the huddling.or impmvenanl is sold willtia ono year of 1.1716 —
,mpletion.the owner.Mhdder will have the burden of,coming that he did not build or o 2 — IINDERFL01]R PLUMBINGi mpm.e for purpose of sale.). 20
❑1,a,owaerorlie prope y.an'nanlasianlymntmetmgwith benn,di contaclm.to 301. — ROUGH PLUMBING
Loohomi the project(See.8114,ilusiness and Prolcssi a,.Chile:)The Cmnrsctor'e 302 — TUB B Ll R SHOWER
icense Law dnnot apply an owner of propwho build.or improve,thereon.
and who contras for such projects with a conimctogs)licensed pursuant to the
c,.mmer„xLiven,eLaw. 502 — FINAL PLUMBING ENE
RGY
❑I amesmnplr de,See. .B&p C lar miarea.on 506 — GAS TEST
Owner.Date507 — FINAL PLUMBING
WORKER'S COMPENSATION DECLARATION
1 herchy affiran under penalty nt'perjury one of the fnllnwing Awlvmions:
J I have and will maintain a Ccnificme of Consent to albmsure for Worker's
Compemation, as provided for by Section 3700 of the Labor Code, for the
pcnbnna,c of he wink f",which Itis Pott,la i.sucd.
❑1 have and will maintain Worker',Compen,minn la,man ce,as bectured by Section
3100 of the Labor C,xi”,for the performance of the work for which this permit is
issued.My Workers Compensation Insurance carv•er and Policy conniver um'
easier: Cf�-t4�I"LO) Policy NoCJ((J LA10 Ul
CERTIPICAHON Olt EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
IT his welon need not he anmpleted it ha,prmfid is f r enc mundred dollars .
(SIM)car rem.)
I crucify that in the perronnance of the work for which this permit is imued.I
shall nal employ any Person i, any nr,n,r w hh
as m become salcoa to c Worker,
Co..i'a'ntion Laws of Cnlifomia.[)am
Applicant
NOTICE 10 APPLICAN'r:If,alter making this Certificate of Exemption,you should
became subject ,the Worker's Compensation provisiotn of the Labor Code,you must
Q 5 ntormwim comNy with seen prwisiam on, parurit shall be dee,ncd revoked.
Z iZ, CONSTRUCT ION LENDING AGENCY
a > I hereby amen that there is a construction lending agency for the performance
01 he wink for,aid,This Penna.Is mind(Sec.3097.Civ.C.)
y O leader.Name
= Z LcudW,Address ,
U0
'certify that l bavemad this applicationand date that he ahove information is
{s P cn.cct.1 avec m mol Ply with all uhy and w"sty un innn,cs and,tate laws mhaing
C) V m,building eon.uac,ion.and herelyawhoroe represemmivesof,hixcitylococrupon
} W the alromanentirmed pmpeny for inspection pagnnm,.
F pr (Wc)agree cut indernarYned kceplmrm'ess the Pity of Criteria"against
V1 liu1,11ai.,prdgmer".costs and,.,cases which may in any way accrue against said
U z
Cit,in .at,rl..cncc of the Frantngot'I hi,permit.
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Slgnamrcal Applinumr NCoahmDate Re-roofs
fIAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future nnilmng oceurant more or htu le hr..,moa.ma„i:d Type of Roof '
as defined by the Cupeninn Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Switch 235321a1^ ❑No
13 ye, All roofs shall be inspected prior to any roofing material being installed.
Will the applicant tar Bnurc twilling,ra,tant use ayuipmem or Jevicn which If a roof is installed without first obtaining an inspection, I agree to remove
mit Imitations air contaminants as defined by the Bay Area Air Quality Management
hismRl all new materials for inspection. Applicant understands and will comply with
ElY", C-1 No all non-point source regulations.
1 hoc mad the hmmdous mmcnal,requimmcmx under Chapter 0.95 0l the
California Health k Safety Cale,Sections 25505.25533 and 25531.'understand that
it the buildar,doeanot currently have meant, hot it i,It,on,,cnsihility to unity the
ap:un or Ili• , whtd,a t be a a prior in iswunsb at i, "I
("`cep. ,rasp G L j�'nl Signature of Applicant Date
owner or ahrmodr agcrnt _V -4 I W All roof coverings to be Class `B•' or better
OFFICE