00060171 CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:44 T-USeANY Fit
-
BUILDING ADDRESS 1'ERMI'I'No.
OWNI?R'S NA 1;:(3l'! JOHN AND ANGELA APPLICAn ON- 57ZG7eF41414
JaiPHONE: SANI'I'ARYNO. CON'I'Bid.NO
0
00 RCHITECTIENGINEER: - BUILDING I'LRMITINFO
BI.DG ELECT PLUMB. MECH
a c
5 NLICISNSIR)com'RncroR's Drc1.ARArroN )b Description
1 nereny mrno mat 1 am rcenaom ander prolillon,of C hips,9 ammnen ing NEW WINDOW
O=F� .ith Section 7000)of Divisi J of the Rioine,and Prom."ms Cal Jmyh k
¢ in roll force a ma3 �g $f(
K alacS Liteo'Cla.,s V V
j 9 c O Date Camracto�QG���
H i O
ARCHITECT'S DECLA N "
m rnan Ira shall be mad IIs puhlic r"on],
w D O cnxdNo�tt.a�,l/ul man` -7/
e'Ir o ftiy OWNER-BUIIDIiII DECLARNNON /
a=v 1 hembv affirm,that I am exempt from the Contractor's License Law for the o
F-]N fullov ing maam.(Section 7031.5.Business and Promsiom Ctdc Any city or county
R o vhlch r,luires a permit to nmstmch al,c,il,lpruve.di nmlfi h.Or rcpuh any trevOme
�id,rs$ Pdortoit%luaanee.nl.mreyulres lhcappllcaull msuch lermiuofile a signed statement
that he is licensed punuanno the posomomol the CnntmcltNs License lrw(Chapter 9 Sy. Ft. Floor Area V• JA91P0
(cuntnienelmg with Sc,loo 7000)orni,oinn 3 or the Bnsioe,sad Prefesaiais Calc)
nr Ilial hills exvmpl IlaYcimmh and the Kok on,the.11c,cal eaan,In inn.Any nolatinl,
trisection 7031.5 by any applicant four o permit subjects the upplicmd to a civil penalty
onto,mom,han five nlmdred dollars S500), AP a Occupancy Type
01,as owner Of property,or my employees with wages us their sole complication,
will do the work,and the travore is nn,intended nr offered for sale(See.7044. 101 — FO
Roos cis and Pml'cssions Cndc:"1'bC'
Ill. nnlm ? "m—
un I.Icchxc I.uw dmmw ol apply all rrT3 Wections
,,.net of proll Who builds or improves thereon,and who does such work hlmsall 102 — PIERS
,mnagh his own employee,pmnJcd tbal such improvrntenls arc not intended or
nneral or site.11;hmwevel:the hudding m intprn.�e cut'I.Wald will,im oma year of 103 — UFE R
nuplenim,the own,bailder will lace te hbuNco of ponying that he dud not bund or
hilptt,. efarpuposcor,ale.). 104 — REBAR
OLa,.,netonne,on,cri,am .ew.leelycanmetimswin licensed enmme,ayln 105 — ANCHOR BOLTS
Linnsumetire e project(Sec.7M4.Hmine,and professions CW,:) Me Contractor's
cense Lnw does my apply to an owner of proWny who buildv or hnpoves diction. 1.05 — SEWER & WATER
and who contracts lot such projects with a contuctims) heemcd punamn, to the
Conlmators Licnne Law. 2202 — UNDERFLOOR PLUMBING
❑I am exempt under See .B&P C for this reason
203 — UNDERFLOOR MECHRNICAL
°x°`r.
WORKER'SCOMPLNsnr[ON DECLARATION 204 — UNDERFLOOR FRAME
I heathy dfiml ander penall,of pe,ju,she'it he fnunwing deelamton.: 205 — UNDERFLOOR INSULATION
• 0 1 Itis.nil will maimam m ccrnrcele of come,,, to self-htme for Worker. 301 — ROUGH PLUMBING
Compemmion, as provided for by Scc,lon 3700 nl the Labor Code, lit the
perfnroancennheworkfar xInch this pemthisissued. 302 — TUB & OR SHOWER
0l have and will,mdmaln workers Cmnpcnatimh msamn,as reydred by Section 303 — ROUGH MECHANICAL
3700 of the Labor Code.for the perfonnaace of the work for which thus permit is 304 — ROUGH ELECTRICAL
ssned.My Workers eompcnsli lon Imurance carrier and Policy mnnber am:
Crrier: policysm: 305 — FRAME
CERT'IFICAT'ION OI'HXEMITION FROM WORKERS' 306 — HOEDOWNS
CUM VENSA PION INS U RANCE -
phis section need not be complied iI the permit is for one hundred dollars 307 — INSULATION
atix,j or d„a� 308 — SHEETROCK
I ccnify that in the padisma ace of the work for which This permit is issued,1 309 — EXTERIOR LATH
shall nm etl,loy any PJnmn in any manner co to to been tne subject 0)the Workers
Co."ti'aton l.a.,.f eaoromm.Date 310 — INTF_RIOR LATH
Applicant
NOTICI?TOAPPI.ICANITIt,ensf making,his CeniBcac nl Hmninicn,you should 311 — SCRATCH COAT
became object me Woke
rr's Cnmpauauon po)v.....ns e W bur o1'thCode,you muss
p C tI
fonhwim comply with such provisions or permit shall he deemed mvoked. 313 — ROOF NAIL
F in CONSTRUCTION IJINDINcncuNCY 501 — FINAL ELECTRICAL ENERGY
1 hereby affirm that there is a construction lending agency for IIIc performance
� > Idhewmkforwhichthisp.itisasaed(See3l>77.Ci..C,) 502 — FINAL PLUMBING ENERGY
y p I,crillNAddress amc 503 — FINAL MECHANICAL ENERGY
= 7 lender's Name
v O Icertify n,alIhanareadmi.,pphc,Itolhand man than thcamw.inknnoaa,ia 504 — FINAL BUILDING ENERGY
Ids F. colied.I agree to comply aim all city and county oNnwnces and state laws reining
o V tohuildingnmsunction,and hereby authonmmprewnmtivoonhiscity u,counupom 505 — FINAL ELECTRICAL
I e uhn(WO a,ee toned Itnpera lou Inepand ke p Intrucs.
w.)a toohve.mde,nnir and keep I me Cl rca 506 — GAS TEST
f” L ( agree ram p,arm est y o pct loo against / D
h liabilities,judgments.coins and cspcnses which may in any way'seethe against said l/ 507 — FINAL NAL PLUMBING r
�J
City in umwyuancn of the Btnming of min Penni,.
APPLIC UNDERSTANDSANU WILL COMPLY WITH AL ONP NT Issued Sea — FT IOI Date
sou�TUNDERSTA y KI MECHPUICAI_
Xsig�,m`'Fn�,IJs�unnT ems h Re-roofs 509 — FINAL G RADE
HAZARDOUS MATERIALS DISCLOSURE 510 — FINAL PLANNING
Will the apprcarlmfatn,ebuddingonapaal.storeorhandle naradm%matetid Type
a,defined by heCapenim,Mmtici,nlCode.Ch:Ipmr912.andmeuealth:,r,JSalety 514 — FINAL PUBLIC WORKS
Cock.Stilton 25532(x
0Yo )i
0N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use cyuipmmnlor devices which If a roof is installed without first obtaining an inspection, I agree to remove
ctnil haaaninus sir c anaminanls as defined by the Bay Arca Air Quality Management
/10,4erl all new materials for inspection. Applicant understands and will comply with
❑Yes ID No all non-point source regulations.
I have one the Jmmrdnaa InateriaH reyniretneme under Chapter 6.95 of the
California H.Im&Safety Calc,Sammi 25505.255)3 and 25534.1 end crs,and,un
if the building does not currently have a leant.than it is my res,auno i'ty ton ify the
occupant of,h "unnce a C" Ecam of
Oevapa y
.Signature of Applicant Date
ecr, au no me ailD4' l All roof coverings to be Class "B" or better