00120002L I
0
OR
r
CITY OF CUPEO
1
BUILDING DIVISION
st°N PERMIT
CONTRACTOR INFORMATION:
I W B.DING ADDRESS.
PFRMIT No
21877 WILSON CT
ROYAL FOOLS INC OF SiiITA
CLARA00120002
OWNER'S NAME:
AITLICATION SUIT DA'I17
LARRY WOODWARD
2258 CAMDEN AVE
1.2/01./2000
`I•IIONIA
SANITARY NO. CON'IROLNO.
4083718000
ARCH[ "I'EC /fdoGINHER:
BUILDING PERMIT INFO
.
BLDG ELF,CIPLUMB MECH
LICBNSED CON 'rRACiOR'S DCCLARAI [ON
Job Description
I hereby atlirnt that am Iiecu,ul under pwvi,t:m, of CLupwr9leotnn1ar.w,
.
with Scdinn 701X)) of ilivi,ion s nl'tnc Busincs wW Prnlcx,ions CnJc, and my Ilan,%
m full and eBzet
Class Lic. n I `•++Z
+Tule
'
SWIMMING POOL/SPA
se _ _y_p3 _tet
Conlmctnr_ 041,}
ARCIII I'ECI"S DKCLARA'I'h
I undardn lid illy plans %hull M used us public record,
/
onal
Licensedouch,.111
` OWNER-BUILDERDHCLARA'1'ION
s Lium.a w for the
me Coni....
1 touch, up lens taut 11.. Bcarxurin s
of Cars: city or county
y
followingrms a(Basion 7on,on Bunitc %nuawc.
dconn,rAny
or repair any snurmm
whichno, "o.nc'nniuocoor"Ite alter, tit
to,t,demolish.
locrmiunliltasigned,tmmnem
Prior u,slctuntaee,o,n
Sy. Ft. Floor Area
Valuation
th,t hceacin,e,i tirn o,, Ilustheapplicant the J
n,• pnn„nm n3 he lrutnr, License L,w lar,
of linIO
Section 71XXp of Division 30l the Busine.a unJ Cod
Ian i, tion 7
.�
ionl Anions
esenh
t he i. cwmpt menimm ant, bash, %the enempnon. Any siolmian
of id he
Gwa PJOUp
t n csthe
of Section 1113 by any arpheaut fora pcnnit ,ubjens the applicant m a cis it penalty
Se
Number
Occupancy Type
n
nu,m .+,ore hon list, I+,ttldrcd daB,tx (%So).
APN
01. as owner ofthe titularly. or toy employers with wages as their sole cooperation.
326490 J. 7. Q)0
Required Inspections
Mil Jo the work, and the arumurc is hat intended or otle,ed rill sale (Sw. 1(W.
If. ,incx, and Prole sunt, C+nbrl'be Comraeto„ License Low does not apply to tin
orwmr of pmpcnY Who builds or unptuves thereon, and who docs such work himself
103 — UFE R
rvugh his „sun eroplayee%, provided that such impmvemems are not intended or
offered for ale. If. howcwc, be building or imtimwement i, ,old within one year of
104 — REBA R
ow
,nonfiction. the ner-boulder will husc the burden or proving that he did not build or
riprowe ria„+trpa,c of wale.).
1.07 — POOL/PONDING -
❑1.a, owner at the propeny. nor exdu,iwelycontracting isimhcenxedcontractors to
301 — ROUGH PLUMBING
muruet the project (See. 70W, Business and Profusions Code D'1 he Contractor',
Liceniehwdor. not.pplyintnnwnerIll uropcnywhit ha,Imorhuprnwc,mrrron.
304 — ROUGH ELECTRICAL_
loin who ..... rc tar such projeeu with a ,o.bacmrfn) licensed pa...I I ,, ,hc
Contractor's license law.
502 — FINAL PLUMBING ENERGY
01 am exempt under See. . B & It C for this reawn
50TL3 — FINAL MECHANICAL ENERGY
franc, We
WORKER'S COMPENSATION DECLARATION
506 — GAS TEST
1 nearby ohm, ander penalty ifperjory one ohne fop oxia, dacwranon,:
510 — FINAL PLANNING
D I have staid will o,amtain a Cenificote if Con%sun to ,ell-inxme for worker',
51.1 — FINAL POOL
Com,in,diot. a, pnoided for by Section 37(X1 of the Inbar Cale, it,, the
perfanee or he work for which this roue is issued.
m,a
-
516 - -, FINAL NAL BUILDING
)baseI and will mainmin Work"', Cnn..en,atinn Imuran%, u, rdeitcd by Section
.
of the 1rb,r Code. for the performance of the work for which this pcnnit is
icaed, My Worker's Cnmpena,ian Insurance carrier lidPolicy number are:
10^ Poliry No
C: rn,,:_0M .N/A306537lO
CI' IIBLArONOF E)EMI'I'IONpROMWORKHRS
COMPENSATION INSURANCE
(Thi, section need nm be completed it the pcnnit is for one It died dollars
181001 lir les.)
I certify that in the perfomanec of the work for which this pa ran is i,mcd. 1
.%hall not employ any person in tiny manner so as to beenme subject to the W..kers,
C.... tlion Laws of Cutiror a. lime
-
Applicant
NOTICE TD APPLICANT. If. after making this Cenipcum of Emmption. yen should
become subject to the Worker'. Con[wnsmlon provisions of the I lNor Code, you must
t hwid: un+q,lyg with such pro Nion, u, nth pcnnit ,bill be dcaoad resided.
-
CONSTRUCIION LENDING AGENCY
I hereby affirm that mem is a construction lending agency for the performance
at the work for which this Penial Is issued (Sec. 3097, Civ. C.)
'
Lender, Nun,c
Lender's Address
I eclat l y that l hove read this application and .,tate that the arose information is
-
c, . I line u, colvm
npy with up city and connly ord,oemal ,tote laws retailingu,
Inns
herebyambmLetuaire uutives ill'suiscity munwr atian
-
r1awngcan,weum,,and
thc prow e) al,roee,, Property tar inspection ke p hantr,.
to Cupeninu against
(We)agrcea,cine. oule,perw,
which only an way II
Cityitis, jua,ei,n , costs :tad in, Ili hi which may In any way uccruc aguinct aid
City in e+�t„eynana oI me gushing lir this pcnnit.
APPLICANT UNDERSTANDS AND LLCOMP YWI t LL NON fANT
ISSUE etC
'
SOURCE REGULATIONS.
Re -roofs -
sigomn¢of npphcmu/Cnmucl — - Date
HALAR1lt115 MATLRIALS DI 'LOSURH
NSll,be applicant or future building acct tart a handle hacvJ.... nler,li
Type of Roof
ux deposit by the Cupemno Municipal Code. Chapter 9.12. and the Health and Safety
Cale. Section 25512no?
0 Ycx 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the uppheant or fwure bsilding twerpen, use equipment or device, which
If It roof is installed without first obtaining an inspection, 1 agree to remove
snit hvardou, air connunimnt, a, loomed by the Buy Arco Air Quality Management
D11111”!all
new materials for inspection. Applicant understands and will comply with
` 0yr, El Nr
all non -point source regulations.
I base lead oho hoeardoin materials nyuiocments under Chapter h95 or the
CuIfid'lot Icalth & Safety Gale. Suctions 25505.25533 and 25534. 1 unde„tand ohm
%-
itthebuildingdoa nu currently lay. a tenana. thus' n,y rcsIsn"Pili,y u, audy in,
of the leyuim which must be me lir Cenif le lir
Ocupa
Occupancy.
cy. ��
e0
Signature of Applicant Date
All roof coverings to be Class "13” or better
Owntc,or aidar, t agent — - Da
OFFICE