00090145 CITY OF CUPERTIN0
BUILDING Ot`'tst()N PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: PERMI INO.
f IWNEIt'S NAME"s WOODI:ARv APPLICATION SUIT UNIT
ONE: B11HULLYSANITARY NO. 'NGROL No
0 p O ARCHfrECf/ENGINEHR; BUILDING PERMIT INFO
m BLDG I'Llm, PLUMB MECH
r --
1)>�' LICENSED CONTRACTOR'S DECI.ARAI[ON ,lob Description
�' I herchy Rina mm 1 an,licensed under f Cho tar 9(commm�cm
y es provk,iole n p e
O=E� w'nh Section70(OpofDivision Jill the Business and l'n,kswons Code.and my little
ace m is in full force and effect.
s�< LlcwvcCIss Li`" REPAIR MUDSILL
�•O i O Dam Contractor
vS 3 u.t; ARCHITECTS DECLARATION
t a to 3 1 understand my plans.%tall he used as public rccoW,
W p O L lren.ad prof..ional .
�xfOWNER-BUILDRR DECLARATION
u=so I hereby aflian that I um exempt from the Contractor's License Law for the
r o- following reason.(Section 7031.5.Business and Professions Code:Any city er mums
O xhich re4uires a Permit to construct ulm,imcw
prove,demolish,or repair cry uctum '
ad ei prior to its issuance.ulw,requires the applicant for uch Permit to file a signed statement
that he is licensed pursuant n me provisions or the Commi License Law(Chtpler9 Sq. Ft. Floor Area Valuation
(commencing with Section 7100)of Division 3 of the Business and Noression,Cada
or that he is exempt themfrnn and the basis for the alleged exemption.Any violation
ol'Section 70315 by uny:q,plteam for a permit subjects the appfieant in a civil penalty
OI more an live andorn dmllne(s5ou), APN Number
rnt, m -- - — Occupant L
❑1.as,).want he no,.y,in,employee,with waves as thci, ,,In on,en,ation.
will Jo the work,and the somenne is nor intended or offcre for sale(Sec.7(94,' _
Business and Profession,Cock The Contractor's License law does amt apply ,,un J Cr (red Inspections
owner of pmpsny Who builds or improves thereon,and who Jces such work himself
u thmugh his own ennpleyee..provide the such improvements arc nut intended or
nacre for tale.If.hnwemr,dm building or improvement is.old within One year Of 101 — FOUNDATION
c p,le m b IJ 111 m lied Ip ,donh J'J to ldor
'n" r p'v l ) 1.02 — PIERS
01, wfie, 1 ty Ir mywith l l thonrcor,In 1.03 — UFER �0����
Lto td pits 70438 Prof,,,khm, 0DCoalition s 1.04 — REBAR
tocn L ti tpply t at I p pe ty 1 builds improves tit ruin.
and nes contract,for with such project,w, contractor(,) licensed pursuant n the 105 — ANCHOR BOLTS;
m
Cmnncmev Lieee Law.
❑lon,morptandefsec. BSPCfor this mason 1.06 — SEWER 8 WATER
Daner ''^'� �' "+� Dun 5/2� 2202 — UNDERFLOOR_PLUMBING
WORKER'\COMPENSATION DECLARATION
l bereny
IT mt ntaOf 203 —neriOry Onc Of meti,uOwing deelmarmn,.. UNDERFLOOR MECHANICAL_
a"tanihy '
I nage:ma
,,If stn anion it Ccoin`me Ot C.....ma to.elm-in,Ore for worker, 204 — UNDERFLOOR FRAME
Cnmpen,ution, a, provided lin by Section 370X1 of the Labor Code. for he '209 — UNDERFLOOR INSULATIONper nmentee of the work lar which this permit is Issued.
❑1 have and will maintain worker',Compensation Insurance,as required by Section 301 — ROUGH PLUMBING
3700 Of the Lamm Code.for the performance Of the work for which his penin i. 302 — TUB 8 OR SHObIE R
issued.My Worker',Cron',oration Insurance carrier and Policy mumhcr we: -
343 — ROUGH MECHANICRL
c°`°`° POmy No..
CE304 — ROUGH ELECTRICAL_
R'I'IIBCA'fION OP EXIEMI'I'lI1N FROM WORKERS'
COMPEN5AnoN INSURANCE: 305 — FRAME
(Thinseeinn need not hc<ompleed if the pemit is for one hundred Jolla' 306 — HOEDOWNS
(X01)m lesx.I
I cenify that in the performance of the work fm which this permit i,issued,1 307 — INSULATION
.nun not employ any person in any manner s,as to become subject to the Wader: 308 — SHEETROCK
contpcnseion laws nr Calitorniu.Dune
Applicata -
NONCeTaAPPucANT: Lahermnkln,dd,CamncmeefExentpit(n......%,,,a1J 309 — EXTERIOR LATH
enn,e,anjcetnonewOrkar,com a,nOOpmmi,ion,orthe Lab orCodc. imancla
310 — INTERIOR LATH
O O rnnhwimcomply w,,It srich pmvisia,nr this penult shall redeemed rcvnksd.
Z (A
CONS TRUCTIONLENDING AGENCY 311 — SCRATCH COAT
x > 1 hereby aRmn that them is a comwmmion lending agency for the Pefformmnce 313 — ROOF NAIL
fit.sod for which this p.I,I,i...o f(see.307.Civ,C.)
Q i.•irersname 501 — FINAL ELECTRICAL ENERGY
U O 1 Onrtiry n,at l ba,m read mix appne:,,lOn amt,teeraat the dawn imrOrmO,iOn i,
502 — FINAL_ PLUMBING ENERGY
k1. F cOr co.Id,wrm..mPly wireall say had...ratry nmhnaoee,and,lataI,—rsath'g 503 — FINAL_ MECHANICAL_ ENERGY
O U :o mimingcnmweoOn.nm:umrenv aehmi,e rtmewomdvev.1 his City in enteropen
W heannv meanonedoopen,I,,, nspectionompos•. 504 — FINAL BUILDING ENERGY
E. 0. (We)agm.to.ave,indemnify and keep harmless the City of Cupcmho against
(/) liabilities.judgments,cost,and expenses which nmy in any way romuc.,ain't said 505 — FINAL ELECTRICAL
U Z City in consequence of the granting of this permit.
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT IssUedb 506 f7f TF_ST Date p-�Q--CJCI
SOURCE REGULATIONS. v:
si,n:nurc of Apphc l lA%A UDDOUS MAHTIRIALS DISCLOSURE Unte Re-roofs 508 — FINAL_ MECHANICAL
Will the appncum„t comm haudO,Oa,g,a...mm Or handl,ha,.a,dont'onan ml Type of Roof -
.,dibythe Curti Municipal Code.Ch:mmr9.12.aadthe ficalthand Safety 509 — FINAL GRADE
Code,section 255320)'
D Yex 0N All roofs shall bJililAcled FrKMR- of loRiqUACerial being installed.
wiRthe arprcant Or future buidin,Occapant use egai,.c.t Or device,which If a roof is instal 10411naut FfiMatahh)kjB'n irEpebigiRKSgree to remove
mit haearclou,air com:nnircros a..Jenne by the Bay Area Air Quality Management
istrict all new materials for inspection. Applicant understands and will comply with
C Yes No all non-point source regulations.
I have read the haa.anlons nmtariuls icquir on cam under Chupmr des of the
it the ail Hg does S:dcur Cala Sve a u 25505. is yo25534.1undcrnotil that
if the building dem not currently have a moue.the it is my romance of ay m amity me
,ccupam of the myniremems which maim he mer prior m issuance nr a Ceniticac of
°rS'p• Signature of Applicant Date
O%l r tmmaae agent - Date All roof coverings to be Class Bor better'
OFFICE