00070112 CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADIR.:.. WUUL)Lf4HK WY PERNHYNO00070112
OWNER'S NAO.HHULEY CYNTHIA M nrrl.IcmlDr urynll$/c^000
PHONE: SANITARY NO. CON I'ROL NO.
ibis 0 0 A RCHITBCPENG I N I a3R; BUI LDINO PERM I INTO
W— BLDG ELECT' PLUMB MRCII
6N
0z LICPNSED CONRunderrDECLARATION Job DCSCrIpIl00
O z= I hereby mlirm deat I am ithelicensed under provisions of Chapter,Cola)Icommenemg
„ wimserdnnnegnnruivi,.inn3nneenusme...navrnraaa,.cralr.andrnyhrrn>< WIRE SUMP PUMP, ELECTRICRL
"Z-1 sinmlllmreamtcffer,
m a� Li"use Class Lie.a
Ko Dam C...nmcow
a O G ARCI 11'1 EC'I"S DECLARATION
g 1 understand my plan shall M used as public records o
` isl
a: s O
. z p License Yrofcssional
y e y OWNER-BUILDER DECLARATION
1 hcreby.term dent I-,r+mna from me Comraaors lJoenu law for the
z r following mason(Scaion 90315,Ilmincs and Professions Cude:Any coy nr cuunly 'l
owhich charm—permit I,comtruc6 Nle,iinpmvI,dnnnli li,or mp.ir any smictom _
ti3� rein..its issuance.at,(,r,,nirettner,,licantdepemulilc
In,such ,in axignedsmtnncnt
tbathe it licensed poauum toampmmorrof inecnnm:mons License l..w(Chamer9 Sy. Ft. Floor Area Valuatiolb1
(commencing with Section 9000)of Div'nion 3 of the Buidn is and Professiom Calci
or that he is exempt therefrom and the basis ionic Hegcd exemption.Any violin nn
of section 7031.5 by nny applicant far.rennin,ablL the rpplicmn m.civil penally
of rsm mme than five hundred dollars H500). AP�igltu@4934. 00 Occupancy Type
01,ns ow,mr of Ilia Pmprey,carry eamloyccs wan wugex as their solecnmpersolor.
will do the work.amt the o&I he i,not ui nn Li e nnLaw for gain nn y to f.
an 304 — ROU§Hl tmk L'4 FTFi CAL
toner of and property
Who
ilds or int Gnnraaorthereon.and w Lnw encs nm a w rot u
r of h his ow Who loyee lir ovided tatsuchmpr who dna such t work adedor
lf
or Qvolgn his own however.t holding
that such improvements mems winit ine yew or 501 — FINAL ELECTRICRL ENERGY
coflerodomple i for sale.II:howae,the nave t or improvement of pro%n.old heroin nue yam of
improve
for lM1e owner-builder will have the M1UNcn of proving,hm he did not Mill or 505 — FINAL ELECTRICgL
..prow for paory,w nr.aa).
[:11,us owner III the propery,nm exrinsively conmcfing will,li,anwd a ir.n Iurs In
,n.tmet life pnjrci Ilea 9(94,nusinees and Pmressin I,Cndao'I he Contra.....'.
Lica a Law dun an apply ,,u.uwmrnl'pn,pcny won builds lir iitp,r,vcs then..,
and who c„mrucu for such projects with n contractor(s)licensed pursuant to the
Comracmr's License law.
❑1 exempt unJer Sec. B&p for this orators
b OJ ,
WORKIiH'S COht 1'IiNSAI'ION UF.CLAI All(
• I hereby.diode nndar penulty at perinry one of the rnlluwing drelnmtiuns:
❑ 1 have and will maintain a Certificate of Consent In sclbinsum for Worker's
Compemation, us provided for by Section 370() of the Latour R,de, for the
performance of me work for which this permit is mod.
01 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labs Cude,for the Paforn,enm of the work for which this permit is
.suds My Wmkcr's Compummiun Insnnnab<arria,and Policy number aha:
Cunico folies IL
CERTIFICATION 01'I!KEMPI[ON FROM WORKERS'
COMPENSsYI'[ON INSURANCE
(This section need not he completed if the permit is for one hundred dollars
(5l W)or lax.)
I"Oily that in the perfnnnune.nl the work for wuiah ilii......it is issued,I
shall not nnpl ly nny petxon In any manner s„ns t9 heeullle enhject to the Worker'
Conhpcmation Lox's of California,D:mc
Applicata
NONCE TO APPLICANT.If.after nuking his Cenificme of Rxnnpti...you should
become subject to he Workers Comisenvtion provisions of he IaMr Calc,you mus,
Q 0 forthwith comply with wch provisions or this permit shall M dccmd proved.
E fi
E
rs CONSTRUCTION LEADING AGENCY
7I bcvhy India that there In a conanmtim,lending agency for thp
e mforaaacv
nl'tn.work to which ins permit Ia issued(San's 3097.Civ.C)
QLv,dc,,Name
.= 7 [,Met,Address
V Q I minify that 1 have mid his application Laid state that he above information is
:Y ;: cored.I a6mc m comply with all city sad cuunly nrvinanra.ad stare laws minting
Q C..3 m building corotrvctinn,and hereby uummrie mprewntativeso(this city to enter upon
m .
e a ol. netmPropertynncdProperty fin,Inspced1-T
owl
puows.
t�. y 6Yingreto r;, fyundII,,,h .the Oily of C wrI ,ug nxt
firs front t : l Ik c c t 1 1 set I' r, ,any y against Inst said //////
U G Cay' 4 g t g I ',- ♦ _
co
APPLICANT UNDERSTANDS ANU WILL COMPLY WITH ALL NON POINT Issued by: Date
URC LIT IONS.
sign.mw ,,–p ✓can�aar D.te Re-roofs _
II/sLARDOUs MArr:RlnLs DlscLosuxr
W'i..the"Ph"o nr fum,e hnilJing acupwn atm lir hunJl.hureNous mntcdal Type of Roof
,s dcfind by the Cnpcnlnu MunicilxJ Cat,Ch.pte<9.12, and the liahh anA 9.Icry
C'oA,"conn 25532(.)!
13 yes 0No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant mfuture building ucrury,mIII,c,domma,desire, ldrh If a roof is installed without first obtaining an inspection, I agree to remove
emit hma kn.%air connaminams us th,ined by he Ray Area Air Oua1'ny Mgmr
ann ,c n
Dime"? all new materials for inspection. Applicant understands and will comply with
C Yes 014, all non-point source regulations.
have mad the hazardous nonoral,mcimmumats nndcr Chapter 6.95 lit'the
Califorain Heahh&Suto,Code.Sccu(nis 255f1.5,25533 and 25534 I understand that
foo building does not c rmaly have u mount.that It i my oc"ommil'uy,n nosil y the
occupant of the a9ulmnmnts which must M ami prior u,is,mama of a Cenm ificnof
oCCOpaV /e „� Signature of Applicant Date
7 if s
owner rsr i,eu Igen, Dn,. All roof coverings to be Class"B" or lienee
OFFICE