00060080 (3) CITY OF CUPF.R'1'INO
BUILDING DIVISION .PERMIT CONTRACTOR INFORMATION:
BuluylNc gUli�}LJ.SS JOHN DR rERMrr nG00060080
OWNEWS NAME 1 APPLICATION SUB DATE
DEGEIIS RICHARD AND LORENE D 06/13/2000
ONE
- SANITARY NO, 'CONTROL NO.
ARCIIITIiCI'IP.NGINBI BUILDING PERMIT'INFO
cCBLDG ELECT PLUMB MECH
vs'•.S a 1-- =1 IJ C_I
a k N ZLICENSED CONI'RACFOR'S DECLARATION Job Description
O z_o I hereby affirm that I am licensed under provisions of Chapler,9 momnencing
rF0. so ith Section 7")of Div ision 3(if the Busime,and professions Code,mrafinyNcare,o REMODEL
m^: i%in full forte and carat.
g ce a Licaso Clair Lic,p
3 C v Dale Contra"", '
,- ARCHITECT"S UfiCLARAI'ION
g I understand an,plans.hall be usJ records
public carJ,
z O License)Pro4•siona1
ce
m OWNER-BUILDER mDECLARxrION
Cartmeta
c," I hereby affirm.a I am exempt IN,n the Conlmntnh Lice's Law o for the
Hi
ftillmowhichinge aPen. mitto caPIS,Bualtnrand
prove,demol Our:A, an orcountyoO
leZ N1,IC1,RGYlfea a pellllll IY Cana1NC1.altar.N,pfav[,demnl[n,or ffpalf any alNfNfe
s_p prior to its issuance.also requires the applicant for such pcmriun rile a signed awlelsrm
c. that he is licemed punoatnu the prowno ns of the Commi Limns Law,(Channel 9
(commencing wllh Section 7000)of Division 3 of the Business and Professions Code) Sy. Ft. Floor Area Valuation
or that he is exempt IM1csfmm and the basis for the alleged exemption.Any violation 11 000
of Section 7031.5 by any applicant for a peril subjMl%the applicant no a civil penalty
of a.,mart had rile handled dollar.($500). APN Number Occupancy Type
01,as caner of the progeny,or my employees with wager's their side compensation. 36927057. 00
will Jo the Nord.and the.fracture is not intended or offered far sale(Sea.70-14.
Busini and PNfesslon,Code:The ConrCLm*s Lice's Law does not apply u)an Required Inspections
owner Who Builds or impmvcv lhcaan,and who mils such work himself 101 — FOUNDATION
or Ihnmgh his own employees,provided that such impnn'c ucaus am not intended or
offered far sale IL hawcvec the building or improvement is sold whdlm ane year of 102 — PIERS
nmplelioq the oNmM-builder will have the burden of proving that he did nm build or
cop/for pmpoxalc.). 103 — UFER
erof
Fps dcr of the property.am excluaivcly contracting with licensed conwcto^m 104 — REBAR
m,NCt the project(See 9044.Business and Professions Cat ro The Contractor's
License Law docs not apply to an owner of pml,cny who bunds or immocs thereon, 105 — ANCHOR BOLTS
and who contracts for such pmjeclr with a corrections)licensed pursuant to the
Care..lors'Licen.ed.Iw. 106 — SEWER R. WATER
01 am exempt under See. .B&P C for Thi,rejoin
�'IM1vCp�, ,,. 20^c — UNDERFLOOR RLUMBING
0,n �'•
WORKER'S COMpENSArION DECLARATION 203 — UNDERFLOOR MECHANICAL
I hereby affirm under vai of perjury mm of rte following decmN6ons: 2204 — UNDERFLOOR FRAME
I have and will mdnmin a Cenirfate of Consent m,wif-inone IF..Worker, 205 — UNDERFLOOR INSULATION
mnpensatlan. as pmoldnl far by section 3701 of the Labor Code far the 301 — ROUGH PLUMBING
gafornence of the soul:for which this pe nal is armed.
❑Ihave;aid wit]maimmWorker oCompcosaaonlnsarmuv,a%required bySection 302 — TUB & OR SHOWER
39011 of be Labor Cade,far he p,nbmnm¢v of Ilia Nark Bar Nhwh this perof is 303 — ROUGH MECHANICAL .
....it My Workers Cotnpmuutlun Imm'ancc carrier and Polley nalumll arc:
CardcT: Policyrl 304 — ROUGH ELECTRICAL
CERTIfICA'I ION(Ip BXI:MpTION FROM WORR1!RS' 305 FRAME -
CUMPENSAl'ION INSURANCE
(Ilo, acaanoaedoatoo.00,plMedifineneroi1i,to—ona eoodardlma 306 — HOLDOWNS
($100)arl"") 307 — INSULATION
I reedy mal in [in parformnom of me walk fat sottish td.".atm i...,o.1.I 308 — SHEET ROCK .
alndl nmearday any person in any n,nnne,so"m ovo ne sable,,m de W..kern'
Cota (iiLa"ofCalipeosamm.Date 309 — EXTERIOR LATH
m
A""Tics,„ tg 31,0 — INTERIOR LATH
NO....c object
Wor':r',arks makl, 1,pe,o nllinv I of Loh...io d'1111on nlot
becomeh corepm ma such ar C'anmu or
r do%perrol Iia ul the Labor Cude,You,nail
O � roe,nwab ramnly suint sense pN.niona.sari.penal,a,ml be dastard rc.okon. 311 — SCRATCH COAT
CONSTRUCTION I.IINUING AGENCY 31.3 — ROOF NAIL'
a > I hereby affirm that them is a taneNclin i lending'gansy for the performance —
oflhework forwhich mi.permit i„iaxuld(So,.1097.Ci,C.) 501 FINAL ELECTRICAL ENERGY
a p [f"Je`,N`m'e 502 — FINAL PLUMBING ENERGY
Lender's Address
U O Icertify that Ihave mail this a I t fall but he:d,oseinto...union'1, 503 — FINAL MECHANICAL ENERGY
w F coral.l.ngmeI.,ould,.1thall ciiyand.... y„rdiname,sad ,are In,,aelfam, 504 — FINAL BUILDING ENERGY
m building Mesm,etlon,art herchy mah ire rtprexmative,of ihi,city a,enter.,at
he abo(We)ariamedpve.indfarly adikepIwatux. 505 — FINAL ELECTRICAL
[moi 4 .creegreety save indctnnily:mdkecphun,dnsthe City of Cupeninn.ngxins
IA Iiabdair,.judgnteno,co.is and notion—which ,my in any way accuse ugamo,said 506 — GAS TEST
U Z City in comequcrce of the griming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITN ALL NON-POINT Issued by: S07 — FINAI PI I]MR TNF
SOURCE REGULATIONS. / _ y' —
(/ re L ME HANICAL
Signature of Applic'MZARDOU rr Isla Re-roots
HAZARDOUS MATERIALSDISCLOSURE509 —FINAL GRADE
Willy the Cupertino
lmarc building occupant Chapter 9.12,
handle H,ardauo,medal Type Ot Roof
code.Seedy me 32(anino hfunicipal Gde.Chapmr 9.12,and the fImI1M1 and Surely 510 — FINAL PLANNING
Gdc.Section 255321')^ J
Dr°s All roofs ilial5lk/+nspecEeaAJillctfWtlRlrgD(ptg,$6jlRj4Q5 being installed.
Will the applicant or,alum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection. I agree to remove
emit hmundous air contaminant,as der of by Ill,Bay Arca Air Quality Management
)n...ic'? s I< all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read the bmardous materials requirements unser Chapter b 95 of IM1e
California Health&Safety Cars.Sections 25505,25533 and 25534.1 Inde stmal thus
ifine building does not currently have a enmt,that it is ey responsibility u,notify the
occupant of the"mremems which mint he mel prior to issuance of a Cenificam of
°Leap'” Signature of Applicant Date
All roof coverings to be Class "B" or better
owner or authorized ae at Dam