00120021C�
CITY OF CUPFRTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDINGADPR.y,g'33 VAI_LCO PY
GORDON—PMIJ INC
PERMIT No. bo i'CO3--I.
OWNER'S N
AC4.71YIF'Rf
c
iR.45 PEAR AVE
APPLICATION SqN U@TI;-
!;V_Yt !2000
I PEONE:
(FS0)335-1991T
SAN] 'T'ARY NO. CON 'IBOI. NO.
ANCHITECI'/ENGINEER;
-
BUILDING I'IiRMI r INFO
BLDG ELECT I'LUMR- MECH
f_I C1 IJ CI
LICENSED CON'I'RACI'OR'S DECLARATION
Job Description
I herehy 3111.... 1hm id m limaced ander pr,v..ions of CM1apinr 9 (aommmaing
km1.11tiorelgm onlial%n,n3 nrdhe �l:xine..,a:w Pmra..im,x code. rada, license
is in lull force and cth / /
'((�J
LOBBY
FINISH MODTFICATIGINS/CONFERENCE R
'� sc Cl Lic.p_ �1
Uatc _ //li_ A�a��-�ll��_
A("lans%hll ie use DECLAR, fr,NT�ON��I-�_�
S DEC AR, .
I understand y plans shall M used as public mrordc
Licensed Professional
OWNER BUILDER DECLARATION
I hereby affirm Thal I am exempt front the Contractor's Liceoc I.aw for da
following a a (Sanl9n 7331.5. Pu%inav and Prores a Codc: Any city or only
o mfikh
which n4 11 t- n h ,' J p. . ,y struu, c
\
1000,
prior old, Quante, d ng1'r�,m%"pplcanl f atnm 1 6 dHaanaal
Sy. FL Floor Area
dual �0
mal he in rtanxed punam,Oome pro—incl nn he Commmnr, Lilae law lchapmrn
(Omancncing with Section 7010) 1 Division 3 ill the htl,im,Q and Profession, Code)
1+ d,
or that he it exempt therefrom and the basis for the alleged exemption. Any vid, anon
of Schierl 90315 by any applicant for a permit subjects the applicant a civil Penalty
than five hunJmd dollars ($503).
AP�1 NmQer
OCCD C 9c
of not mom
1
31 bet .077.
00
❑ 1, as owner of the pn,pery. or my employee%with wages it%their sole compensation.
UI CCI spections
will do the work, and the sh"ttu2 is not intended or optical for sale (sec. 9040,
Baine„ and Pml'e,o 11 Cwle:'I'he Co.vumor'e Li.cnce I.aw Anon Hol up ly ". t
woo noun%. a:pa, e. m,tr,nh d,m1 who a:,rs satM1 woo IrIr
- 1.01. -
FOUhIf-1 L C�Ff
ori propadr
rvOmnnglt his own o::,ployee,.w,naiaan that such i:nprwame:n' art not man m
�'/, _
1
r•
FI I L Ra
.t
offered for sols. IL however, tae building or impn,vcn:cnd ic,nlJ win,' r or
Y.rL
nomplOnon, he mvner.hudder will have the burden or pmvi..g tool he Aid unI bu
'
103 —
UFE R
nprnve for purpose eradcJ.
104 —
REBAR
❑I. as owner of the pvpvhrl', ant exclusively contracting with licensed contractors,,,
Lnmlmct the project (see. Hua, Business and Profession%node:) Tae Contractor.
105 -
ANCHOR. BOLTS
icense Irw does not apply o an timer or pm,rhy who huilds or improves Neronn,
and who contracts for such prnjeci% with a cormttmr(sl licensed pursuant to me
10 F, —
SEWER 3• NATER
Commcml, License Law.
Gl dddd, exempt under Sec. ,B&PC for 'Ili, reason
;_011 —
UNDERFI_C10R PLUMBING
owner Dim
2:0 , -
UNDERFLOOR IvIECHANICAI_
WORKER S COMPENSATION ULCI.ARA1 [ON
204' -
UNDERFLOOR FRAME
IherebyafifirmmatrpemlyoflKdayoneofhefollowing declaration%:
�0`
I lhIDEP,f= I OOP. T PISIJI_ AT I Ord
❑ I have and sill maimam a Ctrfiamm of Consent to ,elein%ure for worker,
Compensation. as provided for by Section 390() of the Labor Code, for the
_
301.
ROUGH PLUMBING
perfoolanceoftheworkforwhichIli,p.itisi%sued.
0 —
TUB R• OR SI-101•IER
I h:ma all t will manlain Worker x ComPtnx nn Ito Coe, as race area by Station
a %
a d m' me Lahor Coda. res d,n peaormateaa„r the walk rot which nits pe dui
303. -
ROUGH MECHANICAL
'rxnu I MY Worlarx Cnmpcn,a.i and laminate tarter ::n,1 Polity n nohcr are'
���[Z
?6?4 —
ROUGH F_I_EC'I'P,7CAl
canis _ rorty No:
C[RTIPIGI'1(IN OPIJiF,MITION FROM WORKERS '
�,ItIJ —
FRAME
COMPENS,VION INSURANCE
.300, —
HOI DOI,INS
(Tris anion need nm be cum,eval if the Pemdit is fill are hundred dollars
307 —
INSULATION
oIIRp m Icscl
306 -
SHEETROU
I taw➢ ma in the am ora oo, onnc work lttr which this varrail t, ixxutd. l
xhddl nalamPlry ally Jah-ais%tidy mama, xo a,,, become,,bjua to lie worker,
3,09 —
EXTERIOR LATH
Compvnadon Lawv of Ca1'donrm. Dar
-
Apl,liennl
31.0 —
INTERIOR LATH
NOTICE TO APPLICAN F. it. alter making this Certif ia:ne of Exemption, you should
become wbjecrto me Worker,C�nn,emaion prnvisininof he laMa nrJe, you must
311 —
SCRATCH COAT
forthwith comply with such provision, or this p[,mil shall Ix Jecmed revoked.
_
.;i.3 —
ROOF hIAII
CONSTRUCr10NLENDINO AGENCY
I hcmby allied, that there is a con,tmction lending agency forts, perforoance
501 —
FINAL ELECTRICAL. ENERGY
if the work for which this scram is ivsucd (See. 30l Civ. C.)
Leader, Name
902' —
FTNAI PI IJNBIlIG ENERGI/
Lads`, Addm,,
503 —
FINAL MECHANICAL ENERGY
I c,fy mal I hove rand thin d,firaaoa and ,fade dna the (move information i,
cores% I agree to comply with v11 city and county on iamwa, and slate law, relating
T
504 '�
_� I�� p t]
FINAL.
t I NAL . BUIL DING EHER13%
to building con.amaion, and hereby aathon7c representatives of this city m, enter upon
505 —
FINAL ELECTRICAL
,he imove-madmtedpoviedyforne,tdoncmpwwlx
(we) agree to save. indmnnify and keep hammers the Cry of Corinna against
liabilities. judgmenn, cost, and expenses which may in any way acerae against said
S0(:1 —
GAS 'f EST
City in consequence Cor the granting of this permit.
APPLICANT'vDF.RSTNDS AND WILL COMPLY WITH Al . NON INT
u EGt d aqo I NON
Issued by: 507 -
Y
FINAL PLUMBING^ Date
”.
...__.
Re -roofs 509 —
..:. ... ...'toss
FINAL GRADE
igdat r In pn,S:aitnaimnor none
IIA%AllllllU9 MA'IFRIALS DISCL(m111213
'ill id,appremn m nae hOldna, v, aad oom or handle ha(umnus maerhd
Type of Roof ,-, j 0 -
F T MAL_ PLANH I NG
m &dined by the Cuperinn Municipal Code, Chapter 9.12, and the Health and Safety
Code. stttion2553260?
❑res ❑N1,
c - FINAI. PIIRt Tr. wnt?f;S
All roofs shall'be Inspected prior to any'roofmg material being installed.
Will the applicalnrfatim budding,ccupam a-evl ipmed or Jc°ices which
If a roof is installed without
first obtaining an inspection, I agree to remove
emit hmamoa%air n,maminmllx as defined by the Day Area Air Quality Management
Districn
all new materials for inspection.
Applicant understands and will comply with
1, ❑Yeo 0 N
all non -point source regulations.
I i have dead the lodoldav mamdal, dO"aiameal, aodar Chapter 6.95 or the
Cal dondo Health N S:dny Code, Sections 255115, 25533d 1 25534. 1 undcrox Wait
if ds building d:x. not currently hme n teanm, shad II i.v tiny m,f mkiblli , to notify the
s,cupanl of the requiremcmv vhich must he met prior to iQu:mtt or a Cenificae ill
r,
"racy.
/ �',//
Signature of Applicant
Date
"B"
— /
All roof
coverings to be Class or better
< n oraama eedagent
OFFICE