02080112 (3) CITY t DING DIVIISiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20095 LAS ONDAS WY K DESIGNERS Plg�J�Alf APPLICATION
RICKSON 11261 SUNRISE PARK DR 08/20/2002
PHONE: SANITARY NO. CONTROL NO.
(916) 631-9300
WOO ARCHITECTIENGINEER: if BUILDING PERMIT INFO
H FF BLDG ELECT PLUMB MECH
z`uf Ul 11-:J L=1 LJ
Z 8 y i LICENSED CONTRACTOR'S DECLARATION Job Description
o z_ I nereby that I am licensed unJ inions of Chepmr 9(commencing VINYL SIDING
n t witn se=lion y > I.ian 3Orme Buai�a ares �nd my,cense
in full for a FI ALEr)
o.0� license C Lic,p —
SSS Dm G Cuar¢ _
u3.WO ARCHITECTS 9BCLARATION
,g:il 1 undcmwd my plans shall be used es public mcoNs AUG 2 7 20 02
5 N
a i p
Licensed Professional -
,q, OWNER-BUILDER mDECLARATION
1 hereby affirm Nat 1 1. exempt from the C Professions
:Any c law for the $3900
Fad which followingsession.a (Section'const, t.alessand Professions Co de:Any city Stax ry BUILDING
F C which Icquiux a penlrl!m mnnlun,Niter.improve,demolish,or repair my swclurt
s3_ ,alsary Iheoad.m. the Cohperm uofleae Lata listre! - - - - -- --- - - — - --- ---
W '^pn rl IIS ISSY811[e -- --
thi rte q licensed wh le em tp th-piovision.n 3 of m Bu int License law(Coapt 9 , ,3 639L3 0 2oI P�FFa t f Valuation
q'll•"
(c mm cmgg with Sermon 7IX10)of Divson]o(the EusineSand PrafAnyvi Code) ( ,�(,�7; s ,y y,, l-„1:1 f, P.
or that he is eiempt therefrom and the basis for the ulleiul cemption.Any violation
-of Section 7031.5 by any applicant for u permit subjects the applicant to a civil penalty
jet not mare than five hundred dollars(t50n, 10 TARN P'6q*FJATI ON i i Occupancy Type
C L as owner of the property,or my employees with wages as their sole compensation. 102 PIERS
will do the work,-and'the structure is net intended or offered'far mle'ISec.7B14, 1 O3 — UFER Required Inspections'
Bminiis and PNfessiom Cade:The Contractor's License law docs net apply tow -^
owner of impiety Who builds or improves thereon,and who does such work himself 10 4 — REBAR
or liedthroughfo his own employers.provided Not mar impm t is sol vre not intended or __ --------
applied
_ _ _
-complefor we.B:Fowevec mellhiave t tibimpmvemanin torp he did not y.,.or "'105 — ANCHOR BOLTS
'completion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of sale.). 106 - SEWER & WATER '
___.._.... 202 -' UNDERFLOOR- PLUMBING
_ ._
"Cl e.owner.of the prnpetY•OmcxJus velyconrcating wOthl«nseA rnmmcnsrsm 1.i, , . 1.•
consumer the project(Sec.7044,Business and Professions Cade:)The Contractor's 203 - UNDERFLOOR MECHANI CAL'"
License Lew does not apply io on owner of property who builds or impmvea Thereon, '
..aod..whaes Licensemawrn prajec¢.wuh.a camrwmrtm.fimnud purswnr to the_ _ .. .-....._204----.UNDERFLOOR--FRAME- -------
C nwctors License law.
Clvmexemplunder Sec. I ',B@PC for this¢awn 205 - UNDERFLOOR'`INSUL;ATION
owner bite 301 - ROUGH PLUMBING
--WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IheubyaRmlunderpenallyofperj.'mre.rdiefid.in9dedvalions: 303 — ROUGH MECHANICAL
❑ 1 ha:BEnd will maintain'. Cerif¢ute'of Consent in Wbinsure far Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance orlhdwark for watch this permit i.issued... 305 — FRAME
C 1 have and wilt ma ruin Worker's Cnarbartaimarnsurance,as required by Section 306 - HOLDOWNS
37W of the Labor Cade for the performance of the work for which this permit is 307 — INSULATION
bored My Workers C..pdpauimi msutenca ca 'er and Pobcy numrer e2 3Q6—: SHEETROCK' - - '""
:', .p� —�-rwJpr,Por iiJD30i _.. ....
er Gor'PiE , 'v.,, 1
1 i :tCERTIFICATIONOFE%E ION FROM WORKERS `.I!ti r 809, t—' !,EXTERIOR' IIXTH%'
- COMPENSATION INSURANCE ,.
_.310' '-: INTERI'OR---LATH
(This section need nm he completed if the permit is for one hundred dollars 311' - SCRATCH COAT
_313"- ROOF- NAIL.,.._.
Ic iy�lh tin lh p 1 uu oflhew kr' hchtl p in":is dl
".an a not employ any p. o f n any r um r s.is to hcaume subject to the Workers S01 - F I NAL ELECTRICAL'-ENERGY ,
APaip1tanLwaarcafirnmm:Date, " 502 , -- FINAL PLUMBING ENERGY-_.. ....
NOTICE TO APPLICANT If,after making this Certificate tExemption:you should 503 - FINAL MECHANICALENERGY
O Cbecome a bject to the Workers Compensation p o s of theLab. Code,you mass
mtbwithcomplywithwmp previsions this permit shot the _ 504 - FINAL _BUILDING ENERGY
_._. ._
CONSTRucnoNLENDwcAGENCY 505 - FINAL ELECTRICAL '
ai ; 1 rercby effrm that there is u conmuctron lending agency for the perfomance 506 - GAS TEST '
W-r hof the work far which this permit is issued Sec.3p)],Civ.C.) ._.............. ....... ... . . ......._...... ....- .
o L1 ..sersNme 50.7.. . ..__FINAL PLUMBING
a z Lender Add rci -
U`O '' ' ' information50 FINAL MECHANICAL''"'
I certify that I have rand ih s applic.uon and state that Iberians. is
O:f� ,correct.I agree m comply with all city unit county ordinances and state lows relating 5 9 INA G E
) to building conswction,and hereby authorize representatives of this city to enter upon. 5 0 - INAL NG
�-W ,Ihe uGrve-mentioned pmpaty for inspection purposes- - .
d lWelagree nnsave,indemnify and keep harmles±iheCity ofCupeninoagainst 51 - INAL RKS
rn liabilities,judgments,costs and expenses which may in any way same against said
't U..Z iI mcansequ7ceofthe g, linga(this arm. - 1
A '.T UNDERST IV s'ANDWILLCOMPLYW'ITHALLs )N JM, (/v
r sol r REc laJI NS. � �8/�� Issued bye Date
arafAriplicartaCiminiCler .at Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
O WII th appl"int f ante hu lJinga pan score nr handles z Nous met nal Type.of Roof
pec J fined by flic,Cuperturn Municipal Code.Chapter 9,12 out]the Health and Safety
Cod ❑Y .2553 (a)?.! a s. `:. ,l Y' I, n ,:v'Rle�i,�t ;a„ib - If . ._ .
All roofs shall be inspected prior to any.roofing.matenal.being installed . _._.
Will the applicanto future Wildg occupianstuseexip can or de ices w hien If a roof is in4ittled without first obtaining an inspection;I agree to remove
�em t hiccoccus itur contaminants as refined by the Bay Area Air Quality Managcntcm
•,�
District?0 yes.• eta all new materials for inspection.- Applicant understands and will,comply,with., .
, all non-point source regulations.. .
1 have read Ihe hazardous materials uquimments made,Chapter 6.95 of the
California Health @ Safety CW e,Sections 25505,25533 and 25534.1 underssand that
if the building does not currently have-u tenant that it is my respnnsihility ninmify the
nceuponi ofithe reyuir lcnu which mnv be mel prior m'su;mc of,a CetiOcmc of
Y
_ Signature of Applicant _ Date
o pramnn aeaagemt . Efate All roof coverings to be Class "B”or better,
OFFICE'