03010064 (4) CITY OF CUPER'I'INO --
BUILDINGDIVISION PERMIT CONTRA CTORINFORMATION
BUILDING ADDRESS: STARBURST CONST CO PER MIT NO.
21904 DOS PALOS CT 03010064
NER'S NAME: 1207 REDCLIFF DR APPLICATION SUB DATE
RENNICK LYLE V AND LESLIE J 01/10/2003
GoDONE (408) 448-1328 SANITARY NO. CONTROL NO.
ARCUITECr/ENGINCER: BUILDING PERMIT INFO
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BLDG ELECF PLUMB MECH
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kl O p LICENSED CONTRACTOR'S DECLARATION
.-7: I hereby affirm IM1m I am liren.¢�JJyJer provisions of Chapter 9(commencing Job D05Cfl IOn
endo wimn Scmion 71N0)nfDis"' 3oflhc�ncss aImZrncssionsCWc.underylicena is
FU mfullfoaea Ieffea 'al/ 5ergU0jZ _ V MS BATHRM REMODEL p I�ALI�
of„O-: Licca a
Q—o Date LY°�/ _�o f�m.��I�nE11
a �dcrstandmypl nssWI MCuse as public records APR 0 4 2003
i-rep R
Licensed m
fnasnal BUILDING
OWNER-BUILDER DECLARATION
Ki<2 I hereby alllrm that 1 am exempt from the Contractors License Law fur the BUI
a_00 following reason.section 7031.5.Business and Professions Calc:Any city or county
which requires a permit to construct,altar,improve,demolish,or repair any shoo um
Fir prior am its issuance,also requires the applicant lin such Permit o file a signed statement
fz`o that he is I mensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area $126'00alion
INF (commencing with Section AAg)of Division 3 of the Business and Preorssiuns Code)or
a $ Nat he is exempt therefrom and the basis for Nc alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not moa than five hundred dollars(5500). be Occupancy Type
0 1,u owner of the property,or my employees with wages as their sole compensation,
will do IW work,and Ne svunum is not intended or offered for sale(Sec.704a,Business
and Professions Code;The Contraaar's License law does not apply to an owner of 102 — PIERS egwred Inspections
property who builds or improves thereon,and who does such work hintalfor through his
own employees,provided that such improvements arc not intended or offered for adc.If, 10.3 — UFER
however,me building or improvement is wild within one year of completion,the owner. 104 — REBAR
Wilder will have the burden of moving that he did not Wild or improve for purpose of
Ml`')' 105 — ANCHOR BOLTS
❑1.as owner of the progeny,am exclusively contracting with ferried contractors to 10 6 — SEWER & WATER
coastrct the project(Sec.]BJJ,Business and Professions Code:)The Contractor's Li
ccnsc law does not apply to an owner of property who Wilds or improves merman.and 202 — UNDERFLOOR PLUMBING
License LaWls for such projects with acoraumr(s)fmadpwaaxnno the convenor:' 203 — UNDERFLOOR MECHANICAL
❑ I am exempt under,Sec. ,B d1 P C for Nisreason 204 — UNDERFLOOR FRAME
net Data 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby affirm under penalty of perjuty one of me following declarations: 302 — TUB Tic OR SHOWER
(have and will maimaina Certificate cale of Consento mIf-insua for Worker's Cumpen- 3O3 — ROUGH MECHANICAL
sxtior,as provided for by Section 37(x)of rhe Lahar Code,for the performmce of the
W
ork for which this Permit is issued. 304 — ROUGH ELECTRICAL
I have and will maintain Worker's Compensation Insurance,as required by Senior 3 0 5 — FRAME
3700 of the labor Cale,for the performance of the work for which this permit o issued.
M Wnrkrr''sCnmpensationl 'uranceanmm dPafeynam arc: 306 — HOLDOWNS
nie°��7A�parfry Na.:.�_— 307 — INSULATION
Cf;RTIFICATE OF ESTipfPl'ION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(Thr section need not N completed](the prima is lotion,hanNeddruars uua) 309 — EXTERIOR LATH
or less.) 310 — INTERIOR LATH
eanhrmalermenany manner in work[or wlurn this the W is issued,Compensation
311 — SCRATCH COAT
employ any California,in any manner so into become subject m the Workers Compensation
Law'of iorniaDm` 313 — ROOF NAIL
Applicant
NOTICE TO APPLICANT:II,after making this Ccnilieac of Emmption,you Mould 501 — FINAL ELECTRICAL ENERGY
Nome subject to the Worker's Cam Pe motion provisions of the UNr Cak,you must
pz forthwith comply with such provisions or this Noon hshall he deemed mvoked. 502 — FINAL PLUMBING ENERGY
? O CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
is s r KrImm necof 504 — FINAL BUILDING ENERGY
F Ihemby affirm
that ST Ua ION LENDING
c Ino the
C > me work for which this permit i.sissued(See.3097,Cv.C.)n
Lenders Name 505 — FINAL ELECTRICAL
ITa Q
7 Z nJcr'sAdtlrcss 506 — GAS TEST
U O 1 rcnify Our 1 have read this application and some that the above information is 507 — FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and stale laws relating m
C) U building construction,and hereby authorize representatives mNixCity tocntarunion the 5 FINAL MECHANICAL
F0. Worse mentioned propeny for inspe 'nn purpnes. 09 — FIN E
(We)agrer msam.iWcm andkcep harmless the City of CuNnino against
fn Imbilities,judgments,cosor and ex ns"which may in anyway accrue against said City 5 N G
U z ton onscquenceot0 norgn his permit.
A PLICANT UND TA AND WILL COMPLY WI 1 ALL NON-POINT Issued
UR WORKS Date /
UR TI \
Signature of Appfc. VCoo c `D to RC-roofs
BAZAR US MATERIALS DISCLOSURE Type Of Roof
Will the applicant or to a building noutiEs .lLme or handle haiudous mammal
s def rid by the Cu in,, icipal Code.Chapter 9.12,and the Health and Safety
e,Seclfon 2sv2lan i All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant fret building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit Nemduus air contaminants as defircd by the Bay Area Air Quality Management all new materials for inspection.
Dtarim7 /
❑Yes 7Rhu
I have mad the Jn niamrialsmquircmentsunJer Chapwrfi95ofine Cahft)-
niuHealthgmS:dayC c cc- ns259)5.25533md255.1.lunJcrst dJ ifdr Nilding
Joys of currentlylet m,that it is my ml,orc ibihay m mrNy tM cupam rl thc
in`.I mmpriormisscmeer,facunificr f0c aey. Signature of Applicant Date
Owner ormthorie wig Data All roof coverings to be Class "B"or better