03080094 (2) CITY OF CUPERTINO s "+'.r "•+'. •"x�.
IT
DIVISION PI✓RMIT CONTRAC',TQR INFORMATIxON
Bu1LgINGADDREss: HOMEGUARD INC PERMIT"'03080094
A7zWQQD DR
:S NAME: 510 MADERA AVE PERMIT LSSUEDATE
INET (408) 993-1900 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jor LICENSED CONTRACTOR'S DECLARATION
2 u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
auj with Section 7W)of ivision Jo The Bust nev anQ Profession C e, my license is
ZT i in full
cemeL;e.g✓X PA
BATHRM TERMITES REPAIR
f1,0 Date Co Tac
A TECTS D ATI
1 I understand my plans shall W recd as public records r
cs.
Licensed Professional
H 3 OWNER-BUILDER DECLARATION
�<I 1 hereby orfirm that I am exempt fru.the Contractor's License Law ror the
.,]0 following rtaon.(Section 71D L5,Business and Rofeadoas Code:Any city n e 'y
e � which republics a permit to construct,alter,notation,demolish,or repair any stroaurc
uZi
prior Ili its issuance.also requires IW applicant for such permiuo rile asigned statement '
s< thathcislicensedpursuanttothepmviaNnsortheComwnur'aLicenseLew(Chapmr9 q. t. Floor Area Valuation
r1-O (commencing with Section 7000)of Division 3 of the Business and Proressimm Cook)or
$ Nat he 0 exempt Oterefmm and The basis for the alleged exemption.Any violation of 31630014 . 00
Semon 7031.5 by am applicant for a permit subjecialhe applicant to a civil penalty of APN Number Occupancy Type
not more Than five hundred dollars($500).
wilLashe woroRnd progeny, re is employees withwagesuNairrole7044,B utlon,
and do fewoh,and The he Cone snuti Licenstended e Law
does met apply t 0an Business — d Inspections
and property
who
Code:The Contractor's nd who Law does cat apply lf rt owner of 102 - PIERS
tworpmpeay who builds or Improveshat cherco r end who does such work himself edthrough his
however.too ea,providedtprvememprow.enta arenet ear Of completion,
for Owner.le.If. lO3 — UFER
however.Otebuildingori.prow.ennismidwuNinone Wild
of completion,Neowner
builder will have The burden of proving Net he did not Wild or improve for puryom of 104 — REBAR
sale')' 105 — ANCHOR BOLTS
1,a owner of the property,am exclusively contracting with licensed contractors to
construct the pmjm(Sec.704,1,Business and Professions Code:)The Contractors Li. 106 — SEWER & WATER
come Law does not apply to an owner of property who Wilds or improves thereon.and, 202 — UNDERFLOOR PLUMBING
who concocts for such projec9 with a com uctor(q licensed puma.to do CGROK101'a
License Law. 203 - UNDERFLOOR MECHANICAL
p l am exempt under See. .B&PC for this reason 204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I herchy affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING
l hawand will maintain a Cenifese of Consent to scvdnsum for worker's Compere 302 — TUB & OR SHOWER
atian,as provided for by Section 7700 of On Labor Code,for The performance of the 3 03 - ROUGH MECHANICAL
work for which This per.itisiasued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Well Contaminate.Insurance,as required by Section
3700of NC labor Co ,ror Theperformance f the work for which this permit is Issued. 305 — FRAME
My workab Co ei no carr' and Po' tc To
306 HOLDOWNS
Cartier. R IF •O...Elvin NFR 11 RK. S' 307 INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Thus moron need not W completed if the Permit is(in one hundred dollars(SINI) 309 — EXTERIOR LATH
car ksa)
1 cenify Nat in the performance of the work for which Nis permit Is issued,I shall not 310 - INTERIOR LATH
employ any person in any manner so as.become subject O thewomcfe Compensation 311 — SCRATCH COAT
Applican e'iromis Date 313 - ROOF NAIL
NOTICE TO APPLICANT.if,after making this CcNOcsm or Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J ,'ZfonhwithComply With such provisions orthis permit h.11TO,decmndrewkcd. 502 — FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[..T� I hereby affirm Nat There is a consimedral lending agency for the performanecur 504 - FINAL BUILDING ENERGY
(z.moi The work fur which this permit is ivied(Sec.3097.Civ.C.)
W p Len
der'3Name 505 - FINAL ELECTRICAL
Censer's Addrcsa
U Z 506 - GAS TEST
UO I«miryNnIhawmadNistyapplication ndcounand mon NathesWwimnationis 507 - FINAL PLUMBING
F' carted.I agree to comply with all city and county ordinances and sate laws reining to
U Wildin{conwvnion,and hereby auNorire rtpresenutiwa of This city reenter upon the N MEC CAL
00. Wilding ainanedproperd for inapecOonpuriwsea
(We)sg.to taw,indemnify and keep harmku the City of Cuperino against %FI FIliobllitia'I g ouendexpenms whicA mayinanyway accrue egainsaaidCityNGC) Cy c f D TANDSofing of tAND his rWILL COMPLY WITH ALL NON-POINT Issued by: CF
WORKS Date `
SOUR
sign h n c ror are
Re-roofs
H RDOUSMATERIALS DISCLOSUREya Type of Roof
Will No applica or future building Occupant or hand havardousmatedd
defined by the Cupenlno Municipal Code.Chapter 9,12,and the Health and Safely
Seefon 25532O)7 All roofs shall be inspected prior to any roofing material being installed.
7 ❑res �7 Nu
Will Nc applicator or Powrc Wilding acupanl tate equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ill haramous air contaminant,as defined by the Bay Area Air Quality Mangcmcnt all new materials for inspection.
❑Yes QINoIh ad a tar cusmemriahmquimmenvunderChapwr6.95ortheCxliforHealth ct Owv25N15.25533u 25534.1eedmsmnddwlflM Wilding
s o lot a runt Not it is my responsibility. dry tircw. Signature of Applicant Date
ncroramhanzcd Da All roof coverings to be Class"B"or better