00120013OFFICE
CITY OF CUI'ERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
HU ILOING ADIIRESS:
19785 STEVENS CREEK BLVD
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RMIT NO.
00120013
(IWNER'S NAME'.
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APPLICA'f10N SUIT LATE
"YAMAON.A GEORGE AND MISAKC
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12/04/2000
IONS:
SANITARY NO. CONTROL NO.
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ARf,I II'I'IiCI'/IiNGINlililt
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BUILDING FERMI IINFO
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❑LUG E' PLUMB MEC11
LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby a1Erm that 1 ant licensed under imtvi,iom of Chapter 9lcommcncing
DiviTion'yLLle lluxire" Prntc"dons Cod dory he"'ve
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witl+5vctinn]IXNp of and
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INSTALL ILLUMINATED P/C LETTERS ON FP,ON'
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ARCHHH ECT'S DECLARNI'lON
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1 undewand my plans sM1ull h.wd a, public record,
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LiccmN Prol'e,ional
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DIeCe
thin Contractor law for the
I hereby a1Enn ohm I ant csempS firm the Cnnion% Any
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II ]03L5. Huxine,x and Prnfcainns Co : c
following Any city nr'a
any
Bre signayslrunwc
lillemmoa moil u. ,,
whichitsisu npcnuo recorestet.pplicrt]or
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sudemolish.
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nsficallisadprsamquirce the applicmfthe r'inicenseaw slumn¢m
Sq. Ft. Floor Area
Valu t'
Contratoch
that hor
that nri,dattwit pursuant to+lhc pr a Contractor's lJanw law
R,kiaaf3 of or, C,cr4
1, with ]II(Od dI Division 3 of the Rosiness and Professions Gfio )l
It,or
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or that he ix a l huref and Ne basis for the alleged raentplion. Any
that he
Iany
-
1penton
31.5 b applicant subjemsthe applicum macivil penalty
ofSection]U3L5byaudred
AM Number
Occupancy Type
ollfor$permit
of not more nnln hva ntmdmn dollar, I$51a).
31620083. 00
01,a. ovine, nfinepmpray.nrany cludoyeexwith wa,s,a.stheir .ol, vane-inial.
Required Inspections
will do the work, and the structure is not intended or nlrered (or %ale (See. ]OW.
Ha,inew and Vnd ..was Cndc: The Convrnar'x Licenw law docs not apply In nn
owncrof Will, builds or cv and Maldive, such wunkNo
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1.01 — FOUNDATION
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or through his own employees. pma.idedthat sucM1hiris am amt intended or
olmred for sale. If, however, the building of improventrta i, ,old within Inc rear of
103 — UFE R
a+mplmlon, She ownerbuilder will have Sha burden of proving that he did not build or
improve for purw,, ofrme.). -
104 — REBAR
01 II he t ty 1 .tyannia,fia,will+fau,d anournalar,m
1.05 — ANCHOR BOLTS
ir%1 ul p j t IS nW4 13-ins, d l I n. C I ) Ih L tailor %
- nfproperty no build, inausloa,there..
1
304 — ROUGH ELECTRICAL
e dice, and ap,l,l n owner I,,
e
cad wins coIn t, Iash pry sI. 'l t S (sl li I p a t h the
505 — FINAL ELECTRICAL
contractors lieraw Law.
01 am mrip, undrr, See . If x P C fuer tai. rca,nn
514 — FINAL PUBLIC WORKS 2�/O
owner Dale
WORKER'S COMPENSATION DECLARATION
/
I herchy IdEn l nndur paaaliy of perjury one of ire following decWmtions'.
13 1 nave and will maintain a Cenifcme of Convent to self-irwrc far wader',
Coo penxution, us Pru. Wall for by Srelion 3700 of the labor CIA , for She
,,I.....wna ..f the wok for which Ibis pe uii is owed.
01 have and will maintain Workers Comperomion Insurance, as required by Section
97011 A the Lohor C«Ic, bir the prrfun.... III the work for which this permit is
Isonal, M.y{ W`orker's Contpan.vahosa (Insurance carrar a�ul Von1sXiLcYSn alserr are:
Cxrric _-,i 41f 7^
Ili LXLh11yylc Msj tlh1N'OkKllil'
CO.\tl'[NSA'1'ION INSURANCE
'
(This sactinn nccA nut he cva+pletcd ilthe permit', for ono hundred dallars
($IIX) or less.)
I crify (het In he llorli onancu of the work for which this permit 'u issued. I
shall not airplay any perwn is any .nanner so as to become subject m he Workers
'
Campcnwtion Lars of California. Date
Apphcanl
NOTICE'IO APPLICANT: If, alias making This Cr,ddwvm of Excniption, you should
Mcont<subject to the Worker's Compensation provisions of the Labor 0.1c, you mus
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forthwith comply with such provisions or this permit %list[ W damrd revoked.
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CONST RUCTION 1.1?NDING AGENCY
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1 hereby alTmt that there is a construction lending agency for the performance
Q(suer'.,
of the work L,r which Ibis penaii is issued (Sze. 31197, Civ. C.)
Nati,
tender's Address
1 rOuJy lh 1 1 have r,ald ,'011 J IIUI0iatth hove aflarnalion is
1 1 agree t ply iih 11 city and caunly aditunce, .,,,I ndc 1cI Pm tg
V
mWilding con%loactiun. andh by annhorice representativesof this city to enter upon
y R7
the in,,ait 'I t npT
S+.c J my [kpl I:: theCly lCmi gu ld
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hob I ties, cos, and spun..% which stay n any way eawe against sv J
w
saliletrnts,
City in the A of this 1x'CO.
AI'I'LICAN'r UNDERSTAND$ ANU WILL COMPLY WITH ALL NONPOINI'
R NDS
ANI UNDERSTANDS
'
Issued b Ste
y'
UREGULATIONS.
RCE
Re-roofs
Signature of nppreanl/Conrado, Date
HAZARDOUS h1A'IERIALS DISCLOSURIi
Wlldtc it'licmn on future Wilding WcuNnt.wxeo handle hvaNtw% maerial
Type of Roof
as dchned by the Cupcnino Municipal Code, Chapter 9.12, and She Health and Safety
Cndc, Scatinn 25532pp!
O Yes ON.
All roofs shall be inspected prior to any roofing material being installed.
wiulhcapprcantortmmeillIliag —ClenlnsecgldpmentOrda.i—which
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hammous air cnnumin ins as dcfumd by the Ray Arca Air Quality Mi nagnnrnt
Lnorice
all new materials for inspection. Applicant understands and will comply with
GYe, 0N
all non-point source regulations.
1 have read She hmanlou. muterials m,.ircmcau under Chapter b.95 of She
Calif urea Ilerlth k Safety Code. Sections 25505, M533 and 25534 1 undersand that
if it, baldil"I'a"gut ran mnly have aI,naii. aha , ismy raspn....Mlhy h. Badly the
ernpart of the re,dremmhmuof n, whicn%t he mrt prier , i........ a crniftamr of
`mueniey' -
Signature of Applicant Date
All roof coverings to be Class "B" or better
ower, ar andtnd:ed agent Dam
OFFICE