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DIVISION PERMIT
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PALISADE BUILDERS INC
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PERMrr"`64090152
A
909 ALMA STREET
PERMIT ESUE DATE
OUPERTING HGUSING PARTNERS
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SANITARY N0. CONTROL NO.
ARCHITEC IENOINEER:
BUILDING PERMIT INFO
RLDO ELECTm
PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
]old Description
I hereby .farm that I am licamed under prnvinms of Chapter 9 (Commencing
,
wish Section 70M) of Division 3 oldie Bualawand Prefesalons Code.and my licen¢ Is
mfull mne.naerrem.
License Clw 6 Lic. AAW6
NEW CONDO -1087 SQ. FT.
Date TECunrwmr SflN
tITI
ARCECfS DECLARATION
I unMnlg9ppJ my punvh tl u abet
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby .(from n I em exempt Item the Cosions License:Ac law for the
Co county
ug moon. (Sedan ]03L; Business and Professions Code: Any city
moo o
how
or rtpnr any moment
which alwa improve, de s
which Caqulms . pcnnb to cox,
irmill
prior m its omen., the pati. w Nt
mquim lW arras
Sq. Ft. Floor Area
Valuation
.Signed.(nmmcm
om of the Uxnse
athe Con
that Wu0cenwit pSection7
)pmvipou
ximsCepmr4
(commencing with herefore71100) of n3of Business Code) or
Wexe
125831
basis a e exemption. vi of
the io ts campy thertfrom and Ow bur. for Ibe meted tsemanm. Any
APN Number
Occupancy Type
it penalty
any applicant Sobjecu the kppileanno.clvilpemlSy of
not mom Ilan tiro hundred dollars (f500).
hot
❑ 1, AS; owner of Ile pmpeny. or my employes with wages u Nth wee examemalim,
31620084.00 Required Inspections
will do the wmk,ana theswmum Ism, Intended wonemd foruk(SecJtke, Business
and Prefeuron. CContractor'sertde: The Contractor's License law does Coy apply m an owner of
9 P
propy who bu Ilds a improve. thesean, and who doeuuch work himsel f or through his
awn empioyaa, provided that Such Improvement, ret not intended oroRernd f"AAI& If,
hose.., She building or Improvemenl I. Sold within oive year of campledon, the Croce,.
builder will have the burden of proving that he did vet build or improve for purpose of
ASIA,).
❑ 1. as owner of the property, am exclusively conlncmng with licensed Contractors to
constr ct the project (Sec. 70414, Business and Pooresdam Code:) Too Cmuwror. U.
wore law does not pply in an owner of property who Wilda or Improv thereon, and.
who contracts for such projects with • contractor(s) licensed pursuant in the Connomrs
License Law.
❑ I am exempt under Sec. BIS P C for this Mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ON of the following decimations:
have and will summon a Certificate of Consent toself-Insuro fm Workers Compere-
h
.o1. provided for by Section 37of ft Labor Codperformance Chile, for the perfoance of IN
uti o 00
A, for which this permit is issued.
❑ 1 have and well maintain Workers Compensation Insurance, AS, required by Section
3700 Close laborCode, for the performance or the work forwhlch this primly IS Issued.
My Workers Compensolon Insurance canner and Policy number aro:
Canner. lefAy7es7:C .TV.G Policy N..:C?
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(This seelim read not W completed Ethe permit IS I... hundred dollen (SIM)
or Ives.)
1 certify that In the performance of the work for which this permit I. Issued, I shill not
employ any person In any manners M in become mbjecuo the Workeri Compematlnn
Laws of California. Dela
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
Weare subject m She Workeh COmpemdon provisions of the Labor COM. you most
forthwith comply with such provlalnns or this permit shall W deemed mvnkea.
CONSTRUCTION LENDINO AGENCY
I herby alilthi that SWn Is construction for She performance of
s 7, Cinpgeney
' the work Ire which IWIS permit b issued (Sec. J1197, Clv, C.)
Lender's Name
Adda
4naer'a Addrcas
I 1 certify that I haw read this application and show the the show Infammmm IS
' cared. I agree m comply with all city and county ordinances and sum Lw Catalog m
building construction. and hereby amhorlex representatives of this city to `mer upon the
move -mentioned property for Inspection purposes.
(We) agree to row, Indemnify and kap hi mleu the City of Cuperlino against
j liabilities. judgments, cuts and expenses which may In any way seem against said City
In consequence of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
�I`M t% dY
Signature of npppM nVConuwla - Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant slow or handle ha ardous material
As deamd by the Cupenine Municipal Code. Chapter 9. 12, and the Health and Safely
Cade, Section 25532()7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant m fumw wbuilding=up.., ooqulpmcnt in dcvices which
bassoons car cmtuninsmu u defined by the Bay Area Air Quality Management
all new materials for inspection.
utricli /
❑Yes
I have mad the haaardnumawlats mquimmenu under Chopwr6.95orlhe califor-
niHHealth&SatelyCOM.Somau23.N15,]5533.d2553<,IunMraand Jwlfthe Wilding
Jos not curtenlly have a tenant, most Il ho my romodbility In mdfy the mensal of the
requiremcma which mum be mat prior to Issuance or a CeNOcate of Occupancy.
Signature Of Applicant Date
��.
roof coverings to be Class "B" or better
ownes ar.mnnm . Am DateAll