01040151 (2) CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADD Y10205 JUDY AVE. 010,401.51
OWNER'S NAM THOMAS WOODS APPLICATION: AT��
) s_1 /2001,
PHONE: SANITARY NO. CONI ROL NO.
GOO ARCI if rECIENGINEER: BUILDING PERM]l'INFO
&L' BLOCilli PLI t Nil?1*0
N�ILL,, _I i - J
y Z LICENSED CONTRACTOR'S DECLARATION Job Description
OZ=O I hereby arctn that l am IicenuJ under provisions of Chapter 9(commencing .
fv_,Cw wishSection 9gln)ofDivision 3ofthe Business and ProfeoionsCore.and city licenu BATHROOM REMODEL.
adi -1 n fall roma and elTwet.
ae a a i�ianse cIa„ Ue.ra
Dole Cmhtmeor FINALED
ARC111'I'ECI"S DECLARATION
y 5 I rndemmnd nay pem..hml be...ed u.pobfie reco,d,
wiQ;
G p LiccmN 1'rn(ecsional JUN 0 4 2001
OWNIi -BUILDER DECLARATION
e. I hereby of in r that I um exempt from the Contractor's License Law for the
t-Z e Following reason.(Section]131.5.Business and Professions Cade:Any city or county
`Z0 whichrequirsaPermitmcon.wct.alter.imprme.demolish.orrepauanywmcture BUILDING
wap prim to as issuance.also require.the applicant for such Permitao file a signed.statement
a. that he is licensed pursuant it)the provision%othe Contractors Limira,Law(Chapter 9 S Ft. Floor Area Valu
(commencing with Section Yg(ry of Division 3 of the Business and Prules.ion,Coude) y' MOO
J 00
initial her,exempt thercl'mm and the bud,for the alleged exennion.Any violation
of salon 7031.5 by Any appbcnm fora pennn sabjeev the ap'li'a toaemu patahy witNumb
or nm aoofe lhm five hoodred dollar,(s50l). APN `V1 058. 00 Occupancy Type .
[D L:w owwe,onhc pro,erly.oa'my employee.. h wage,as fl ci,sore eompcoal �_vl
will do the work,will the.structure is not intended or offered En vale(lice.7V41.
Business and Podes.dons Cale:'rhe Contractor's License law does not apply to an R ectlons
sof ppsty Whobuildsor improve,thereon.and whom,c,such work himself 101 — FOU �1'�I�
r ro
through his own employees.provided that such improvements am not intended our —
orcemd dot sale.1r.however.the building or impmvemcnt i..sold within one year or 10e2 PIERS
ompiniorlheowner-Fuilderwill havcthcbmdenofprovaNtlewhedidno,buildor 103 — UFER
imp we[or Ourpmu of solo.). '
of property,am exensively contracting with licensed contractors to
104 — P.EPR R
m:�;� t owner pr. t(see,Taos Ew,ines Ind Pmres.mns ctale:rrne comma"r' 105 — ANCHOR BOLTS
Liear'so law does am apply a,nn owner or nupety who build,m improve,ther^on. _
nod who commet, lor,wch proiees whh a commaortm usYaad nantmm to ale 1OF, — SEWER R' WA rF_R
Cor"I'lor's I lana I.YW.
❑I xmo' aptuader sec. _ B Al Pc kali tsisre1a"^ 202 — UNDERFLOOR PLUMBING
w,,or- _ lZf 203 — UNDERFLOOR MECHANICAL
WOR ' 'S CUMI'ILNSATIO )E RA ION '
Inemnv arum under malty or pe,jary Tree ofine fonrm;ng declarwt;on,: 204 — UNDERFLOOR FRAME
. 205 — IJPIDEP,FI_OOR INSULATION
o I have and will maintain a cenificate of Consent or elf-m.wre for workers
compensation. as pinsider! For by section 37W of he lath, Cale, for he 301 — ROUGH PLUMBING
pe,form.mce onhe work for which this permi(s i..mal. 302 — TUB R. OR SF1014ER
Cl I halt and will mountain Workers Compematlon Insurance.as raquimd by sevai n -
3700 or the Labor Code to,the l,utorname at the work rte which dr,per i, - 303 — ROUGH MECHANICAL
isu,d,Myworlees Compen„atioohooricearrierand Poreyanual,soot, 304 — ROUGH ELECTRICAL
Carrier: Policy Nn: fA
CERTIIICADON OF HXEMPIION FROM WORKERS' 305 — FRAME
COMPHNSA'I'ION INSURANCE 306 — 1-101_DOWNS
Tbis section need nor beCompleted ithe Permit islot one hundred dollars 307 — INSULATION
(SBro)our les,.)
I comb,that in the perfom,ana of he work for which this pmmh is issued.1 308 — SHEETROCK
shall not employ any penon in any manner so as to hereon subject to the Workers309 — EXTERIOR LATH
Compensalaw Laws of California Dare
Applicant 31.0 — INTERIOR LATH
NOTICE 10 APPLICANT':11;after making this Cetif,ab our Esenplion,you should
tee„mo,nhicclmthoWorkersCompaaslmowprovisionsormoLaborCodc'yourni'l 311. — SCRATCH COAT
O Orothwhh caaapiy with such providaa,o,oris pcmhlt shun be decimal revoked.
F y CONS"I RucrioN LENDING AGENCY 31.J = ROOF NAIL
Iherebyamorthatthemisacon,tcaonlendingagemyhntheperfmmarm 501 FINAL ELECTRICAL ENERGY
tzi A the work for which this permit i,issued(See.3R49.Co.C.)
a c l<nderIName 502 FINAL PLUMBING ENERGY
Lcndcr'.Address
U O 1 cenay that I have read this application and state that the above Inflationism is 503 — FINAL MECHANICAL ENERGY
Fa mml.I agree to comply with all city and county ordinances and state laws relating 504 — FINAL BUIL I NG ENERGY
(, rebuilding aonrtmction,and herehy aulanim reprosenmlivei nl this city n,enter upon
y e rdawo-menaoned property m,inspection purpose. 505 — FINAL El
R I CAL
Fs M. (sum Agree m ase,imleandy amt kap hmmdeaa the City hn Copenhho agatno — _
m fiahBlde,,iadgmcm,,loos and as"cn.es whlah may in nay way aeawe ngnbaa,mall 5 . GAS TES r
U City is coa....ne,a or mo g,a...o'efthi'arool. '
A(PPLICANT'GULARS-EAND N/DWNS, ,11,LCOMPLYWIf1iALLNIN-POINT Issued by: 50 INAI MBING Date
1 sigma " a 'GUS-`hx_7P1*- Re-roofs
'HADA )US MAIHRIAISDISCLOSURE 9 — 'FINAL GRADE
will the applictm our Imam building occupant non a handle bvuNswsmmenal Type Ot Roo
510 — FINAL PLANNING
Code.Saban 25532(a)"
oyes IID No All roofs shall be Itillpecte('drlgRo nNP 89eing installed.
W.11 heapppcmato,Illmmbuilding oeeatamuse efusecal adevies,whi,h If a roof is installed without first obtaining an inspection, 1 agree to remove
c t hwurduo,ter commnimam,ao defined by the pay A,ea An,Quality Managanam
. Instill' all new materials for inspection. Applicant understands and will comply with
0 yes 0 N all non-point source regulations.
1 have read the hamrdonr nanerials regmm^mns under Chapter 6.95 oI''he
callfnrnia Health&Safety Code.Sections 25505.25533 and 259)4.I undemmnd th o
If
rhe building doe,nm cutemly have a tenant,that it is my responsibility ronotify the
recuym of the nuame nems'.*Ch m t an r prior ro issuance of a Cerbacwm of
0"
"' 1e' 4� Signature of Applicant Dale
Ownr1 amhmaed ageni- — �-�jjf� Dat --— All roof coverings to be Class "B"or better
OFFICE