01010017 (2) CITY
DIIVISIONNO
BUILDINGPERMIT CONTRACTOR INFORM TION:
BUILDING ADDRESS: PERMIT NO.
v 01010017
OWNER'S NAME: I APPLICATION SUB DATE
1` 01./04/2001
ONE: 11 SANITARY NO. - CONTROL NO.
7Q ARCIII'I'GCI'/ENGINEER: 1`1l• BUILDING PERMIT INFO
t�q5+ BLDG FLCCf PLUMB MECH
N z¢�
O m LICENSED CONTRACTOR'S DECLARATION lob Description
z_❑ 1 hereby upon
Ihm I ran licensed under provisions of Chnpscr 9(anmmenaing �• P
nCw whl,Section 7(Np)of Uivisi°n3of NC Business send Pn,lbssinns Cwe,and mylicense
ie y is in full fnrce and eB'cen.
ffi�S LicroseClnss « DINING ROOM EXTENSION
LL O y Dam unalmi 0 itkiii It -
ARCHI"fECT'S DE.CLAIdATION
g I understand my plans shall he used as public records
d O o Licensed Pn,fessional �/ /� b�va'I/ �/ar/ Ca J •~G�Y�
o� OWNER BUILDER DECLARA 3
1 inch,ufrrm phut I am eselnm from the Contractor's License Law for the
G
Following re.n.(Section 7031.5.Business and Pntfessi ry t rcoumy '
❑ whieh regmres u permit IL e m rme"alter,impnwo,Jen, ,[�$Y�q�(/(�
air n it,insuunce,also requiresthe a,PlicAm tnr such pcAII 1 1(TIL'tfAaR l
Nal he is licensed prrsuanl to the provisions of the CLnuacnn's License Use(Chapter 9 Sy. Ft. Floor Area - Valuation.
(ennmencing with Section 7(ggB of Division 3 of the Business and Professions Cale)
urban he is cumpl themfrom macho basis mania alleged esemptinn.Any violation
of Seed°n 7031.5 by any applicant for it permit subjects the applicunl m n civil pamlty
of not more than five hundred dollars 11500). APN Number Occupancy Type .
01.anrof the propcny,L my employees with wages lheirsole eampenn
sslio ,
will do he send the❑'mnsature is ani intended ser offered nor ante(Sea.7004, ReyDlred Inspections
Business and Profession..C°de:'rndoe
e Cnntractnr's License Law s not apply it,an
owner of Property Who builds n impreves'hereon,and who does such work himself
m through his own employees.provided Iba1 such imr o an@nas are no froWdnl or 101 — FOUNDATION
oRered for sale.IL howeveo the huilding ser improvement is sold within one year of
completion.the owner-homer will have me harden of proving ilia,he did not build o` 102 — PIERS
improve for purpose of sale.). -
❑I,os owner of the poled,am escluswdy contracting whb llmnsed comma...to 103 — LIFER
Lmsumer the project(Sec.7(W ,Business and Professions Cwe:)'Tic Com.tor's 104 — REBAR ,
ivensc Law does Wapplyman owner of property who holds in impm.exmereen, 105 — ANCHOR BOLTS'
and who contmets for such mn
pmjems with a e°mmis)licensed putsuam'n the
Contractor's License Law.
Cl lam acmpt nailer see. ,B&PC fedi,mason - 106 - SEWER 8 WATER
owner Dam 202 – UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 UNDERFLOOR MECHANICAL
lnereny aninmanaer penally nflwrjary one of me fnnnwing deemmtinnx: 204 — UNDERFLOOR FRAME
I have and will maintain u Certificate of Consent to self-insure for Worker's
Coorpcnamlod. as provided fnr by Section 37'10 of the I.Wr ewe, for the 205 – UNDERFLOOR INSULATION
performance of Im,work for which this .It is timed. 301 – ROUGH 'PLUMBING,
0 l have and will nlainlain Worker'..Compensating I.....e.aeregnircd by Secfnn 302 – TUB 8 OR SHOWER
37W of the labor Code,for the perfornwnce of cannot the work far which this ot is ,
issued.MyW°eversCompensaEenInsmmn«eanierand P.1i, anrherare: 303 – ROUGH MECHANICAL
Carrier: Pot icy 304 – ROUGH ELECTRICAL "
CF:RI'IFIL'AI']ON OF FPoticy o.: FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
(This section need an be completed if the Tannin is for nnc hundred dollars _ al •I
D3W,nr leaa.l 306 HOLDOWNS
leenirythat inthe perfoemanceofthe work for which inispermit isissued,1 307 – INSULATION
shall nm employ any pexin in any manner so m or Mcome subject 10 the Wnrones 308 — SHEETROCK•• ^
Compensation Laws nr Ctifforni..Doc s
Applicant 309 – EXTERIOR LATH
NOTICL TO APPLICANT:If,idler nasking this Cendi,me of Esen,ptin i,you should
Ohac°me hi to the Wiaker'sCompensation provi,im,ofrhe l.obnrCwa.you must 310 – INTERIOR LATH
wforthwith comply with such provisions m this permit shall W decmed rooked.
53 CONSTRUCTION LENDING AGENCY 311. – SCRATCH COAT
a7 I hereby Oinn that there is a constructionlending agency for the performance 313 — ROOF NAIL
Lender's N
Lend❑r'swork Name for which this lutmirk issued(Sec.3092 Civ.C.1 501 – FINAL ELECTRICAL ENERGY
w e
0
z Is Jv's Address
Iamlfythmfhaveaeud'hi eatelen,mnicannaelnfmmaliania 502 – FINAL PLUMBING ENERGY-
Grs O rrceLl"ogrtemmnsplYwilhallciryundcnumyoNinancesonJsmmlawsrelaling 503 – FINAL MECHANICAL ENERGY
V to Wilding com0uction.and hereby amherize represemmlves of this city to enter upon
it, w he above-mm,rnaadproparty forin.peelimi mPows, 504 – FINAL BUILDING ENERGY
We)agree to save,indemnity and keep harmless the City of Cuperti no against
Va li505 – FINAL ELECTRICAL
Fs uhi l hies, adamant c°1
.,send expeaccrue nses which may in any way acce against sail
led � City in comequence of the gaming of this permit.
APPLICANT UNDER.SSTANDSAND WILL COMPLY WITH ALL NON-POINT Issued by: 306 �6 TEST Date
. granum of cp muni/Cmnracn
DA, O! Re-roofs
HAZARDOUS MAI TRIALS DISCLOSURE 508 — FINAL MECHANICAL
Wdld,eapldmnm or loom hailiingrecuptm aarmor handle naaardnus m'''`etal Type of Roof 509 — FINAL GRADE
as defined by the C.Peninn Municipal Case.Chapter 9.12,nod the Health and Safety
Code.Senior 25532(u)'1
0Y`" - g"° All roofs shall begqrr���� ddc[ed rn Q/y1[.�,}7N! ((W��Q❑gR, I(��P'Jjj�l installed.
WiItthe applianl or Rinne buildiii ,eWpant use cgmaninil ordeviees which If a roof is installAlVithout I3FtlDTAi I��S O"Ii1 �QI0ir,-18gree to remove
-mil hazardous ser mntamfmns as defined by the Day Arca Air Quality Management
I`trI`tore: rCrn all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read the huenslous materials requirements under Chapter 6.95 of the
California Health&Safety Care.Sections 25505,25533 and 25334.1 underxmnd that
d the building does not currently nave a teLm6 that it is my responsibility to minty the
«cupam.,f the requireincros which must W mel prior 10 issuance of a CenlBit caIc of
occupancy. - -
Y �L aaILMD Uft . / ,�/� Signature of Applicant Date
Owisror mmi d agent—T� �Date All roof coverings to be Class"B"or better
OFFICE