02040048 CI OF nrEONO
BUILDING SSINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
19736 VICKSBURG DR 02040048
OWNER'S NAME: APPLICATION SUB DATE
ARA MARKOSIAN 04/11/2002
t ONE: SANITARY NO. CONTROL NO.
a O GZ ARCHITEC(ENGINEER: BUILDING PERMIT INFO
y BLDG ELECT PLUMB MECH
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Ni t J C=I L,.-J IJ
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LICENSED CONTRACTOR'S DECLARATION? Job Description
rye;S v 1 hereby affirm that 1 am of the B under provisions of Chapter 9 nd."incing I3
with sclion]loo)efeaivieinn3onheBusln<ssanAPmfa.ionsCode,anJmyliari0 $PCIAL INSPECTION. wy
I,in full lko,and cRect. 'v A e E
:OIta Date .la..v Conn ORIGINAL # 11894 (19 kYe
O q.U Date Contractor
I 3 t+v ARC HIT he T'S DECLARATION ADDITION 450 SQ. FT. (+/
°g de rm
and my n..nnll he aam as pabho r<aom. Ak 12 2002
I i p O Licensed Prafessionnl
c y ONNthat I ce exempt fr m the Contractor's
=' thereby,scatthus1ameBusinfromtb<CosionsCs .AnyaLaw for the BUILDING
I-z a following reason,(section]omm.,.ino.and ve.Professions Code:Any city or mane
E F o which req pc t t comm., It .'mpro demolish.sh,or reran any.w<ture
nam prior to ilkalso rcqtheapplicant hpc 'uo Bless Bled aatement
......... ....
that hell' ices!punwaintombp' 'os avec t t sLiame Law(Chillpi aN' , Sq. Ft. Floor Area. II Wation
Isom '.F withS t ]11(101 of Div 3 of the Bp;ncssand Profcsvons Code) �,`„ 1 {, s L .:,t. -N('sk,q f,!,j : $1557 /
or that fie a csempt thertfmm end the buhis forme alleged ucn Prion Any v alauon
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
I of rum mare than five hundred dollars(s5Bo1. 36 ATODjTV0 ., �' Occupancy Type
01,as on net of the In openY,or my employees with wales as their sole compensation,
-will ne theand
Prk:and sne'sw:Thi,C not intendedCsLi or c Lre for sale(See.row.' 101 - FOUNDAT ft?Mired Inspections
Business.and Pmfand the
SIMCThe is n t License Ww does not apply mon '
owner of progeny Who builds or improves thereon,unit who don such work himself"
or momgh his own employees.provided that such imp...ememh Bic not intended or __ 1 O 2_
offered Bd sec lf,howver,
eme Wilding or improvemmon
�i is sold within e yen, -- .
completion,the no nor-builder will have the burden of proving that he did not build or 103 - UFER
improv,erorpnrpoxof.Sale.). 104 - REBAR
01;as owner n(the pmpeny. I sin ly contracting with I iccnwd contractors to
10 5 - ANCHOR BOLTS
consumer the project(Sec7000 Business d professions Code)The Contractor's .t ,
License Law does not apply toanowner ofpropenywho Wilds orimproves thereon, 106 - SEWER & WATER ...
unJ.who contmcts for-such prvja,ts.with u.commctor(s7 licensedpursuant to do, ..,... .. _._ .._..... ..._ ..
131CommunesLienx Low. 202
,
= UNDERFLOOR PliUMBING " '
❑Ioma,aencmptunderSec. ',B&1 .PCfonhisreason 203 - UNDERFLOOR MECHANICAL
Owner Date' 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby affirm order duty of perjury,one,of,he find—ms declaration.: 205 _ UNDERFLOOR INSULATION
301 ROUGH PLUMBING
0 1 have and will maintain a Certificate or Consent to self insure for Workers 3 02 - TUB & OR SHOWER
Compensation, as provided mr by Section 3700 of the Labor Code, for the
performance of the work for whiah,hi,permit is I...uea. 303 - ROUGH MECHANICAL
" 0 have and will maintain Worker's Compensation lnsomncc,asrtquiredbyStation 304 - ROUGH ELECTRICAL
3700 of the Labor Code,I'Ar the performance of the-work for which this permit is 3 0 5 - FRAME
issued.My Worker
Workers Compensation Insurance airier and Policy number arc: `'
Carrier. vohayno 306. .- jHOLDOWNS ,
,1 .I CEUTFICATIONOFEXEM"IONF1tOMW7ORUM'L- - � 130 — `INSUHATION
COMPENSATIONINSURANCE'
-308,;= SHEETROCK _ _.. ._-._____.;__.,. _....
nph s xcuon reed not be completed if the permits for one hundred dolls I ' ' t.L 1.
Is1001 err less), 309 - EXTERIOR LATH.
310 -` INTERIOR 'LATH
I n fy m i n th' Par f th k( h' h th re t u a 1 ( ,
mall t ply a�ny,y rso y ) t b mea bj tom w rld rs 311 - SCRATCH COAT
C .at gLn)4�f elf r�;D
NO m PP f 1 T: /� -'- --- 313 - -ROOF--NAIL
N CETO APPLIC TIf ft ngn cnf roofE Exemption. emshouldmulct
Z bemtnehcomplywit suchprvomnsort tpmvhohallbethe
omandCode.youmust 501 - FINAL ELECTRICAL ENERGY
Z0 0 Forthwith ply with on pro ormt.permit.nmlxd ntmm k<a_ __., _ 502 - FINAL--PLUMBING. ENERG)
^-fin '•' f "•'CONSTRUCTION LENDING AGENCY '' SO3 — FINAL MECHANICAL, ENERGY"
1 he reby ff nri that there vier on lending agency f theperformance
ofthework for whichhispermitisissued Se.3B9zCit.C.I --_,504. - .FINAL -BUILDING ENERGY_. ._
0 lied N e. tv .,.: - ..-. ...
z Leade Aadr. 505 - FINAL ELECTRICAL, _
UO I far I stn City nit .tmtdhe howSandsttelawsreum. 506 - FINGASAL
o
I'se.E, correct,, uilI s ,ply m u<ty toe ty, d' Sala.tate lax,erupon 507 - FINAL PLUMBING
C) 11,C.> thea low-menstmet pr -ny for imloo,"
nmho aI prehenmt nes of this city to enter upon
yIy
the abovementieemarapniandikepuh lei SOH - FINAL MECHANICAL
i L Italic)agree Ice. .,Iw.indemnify lideenseskeephaM. inthe way of accrue
eg Slid
in
Vj liabilities,juopa ervl.,costs end expenses w erg may i- o. way same asaI .ata 509 - FINAL
[�_Z City in conscquentt of the AND
IA D This permit "' -
PCICANTUNDERSTANDS,ANDWILLCOMPLYWffHALLNONPQI Issued Or N ING Date
V EGL \TIO.-'. '',pp�M/y/--s��AA ^^� l{_l(.7CJ _
signaw% of h' pva •Chmmctor � Re-roofs
HA]ARDOUB h1ATERIALS DISCLOSURE
vrn y, rrl con, r n
ss oY r ming act partett,tmc}pr handle h ardw.mate
. Type of Roof
def d by the Cupertino
peri oMumeipl Chapter 9.12.and he Health and Safety
/` 1 �'
CM 52aJ dAlroofs_shal] beinspected1.prioe r to anyroofng-ma[enalbe-:in.
g installed.
ro aviumapplicanto fill
._.
building mcupa utuse
a qap t tie i erawntoh If
• n hararda roof is installed,without first obtaining an inspection,-l-agreerto remove
e o . onmm t o f by the B y Are. O al iy M gement
D'.t ct - all new materials for inspection. Applicant understands and,will,comply with
t1 ` ❑Y No - all non-point source regulations.
Ste' I have read the he do., Iaar,itfl.regwrementi under Chapter 695'of.to
California Heall M1&Sdfety Cade,Sections 23505;25533 and 25534.l understand that
irthe building dins not currently have arenam,tha it knt hilit to nodf the -
'&cu
at of the Y rcspons Y Y,
p iequiremenss which must,be'met,piior m ismence of a Cenif arc of
can ° <y' Signature of Applicant Date
—I l-off
o.Mr aptomd ad ager ate All roof coverings to be Class "B" or better
_.. -- OFFICE -._. . .... _ .. .. ... . . . .. .