01030168 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BIIILOING AODIt ESS: PIiItM19No.
7926 MC CLELLRN RD # 4 PSG FENCING INC 01030166
OWNER'S NAME: APPLICATION SUB LATE
CAMPBELL ASSOCIATES 11.33 N 10TH ST 03/29/2001
IONI;: SANITARY NO. CON'1'ROI,No.
4089953397 -
W,
08 953 -
O O ARCHI'I'EC'I'/ENGINHER: - BUILDING PERMIT INFO
1 Ii1.ECl' I'LUMB MCCH
ad
N v" LIC,IIna I.CON'rRACrOR'S DECLARATION of Chau
z.�° `— ,1 hereby aprt„mal 1 al I lit 11 H ower m,ti ll I s afcmllncr q tkvmnrnense Job Descripti t
F with I III ll]tl ad of Divi 3 t the liusincex and Py1I'uyyyannyyy',,,6,yyyIll��� d In}license
in lullhmc and clrccl �— /
O z a i icen.e y�7) U. a V) 2ND FLOOR BALCONY REPAIRS
O a'� Dae��-.sL� Cnnlr'acl;n C
3�+ I ✓ nucruTrcrs Derl.nxnno �}� .
F''=° I table..l;aid my plana.shall he used to.pubrc,ecord.s
w O�O I.i"awd Pn,iheeional
OWNER-BUILDER DECLARATION
W= 1 hereby oRnn that 1 an,e,ma rt from the Cmrmwmr'c License law for the
following mason.(Section 7831.5.Business and Pre ecsiens Cale:Any city or county
{rat m .1111 " p 1l .t65 'I lip J I_B p- y......am pro t I. 4 II ppl'
' II - 'l l It II 'isn't"Rica o,t
mma me
al he is personal, n„' sefthe Lunn icier s License U (Captery Sy. FL Floor Area Valuation
le. i be with Section 910X)n1'Div' n3 of the Hue and Pmfes ns Code)
or that he is exempt thercfmm and the Nasi for the alleged exemption Any violation
of Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty
of nal tion mhnm
all live heti do]ms($500a APN Number .Occupancy Type
C 1.as owner of the png,eny,or by employee,with wages as their sale compenad on,
will do the work,and the suucutm is not intended or offered lin sale(Sec.70o.
Bmilw,A ad Profession,Care Thec t t Lioan.Laos case,man apply to as Required Inspections
„w f 0 pcny sen M1 lei r .m J h d It k massif C
ti yI I': PIy : I ttnt. ] P ,. I n• ALS 101. — FOUNDATION
"ticWlarwlv.ILhweve-.the b,'Id ,),,,'n pro e ,anluWwdlin o
ron,plaion,the owncrM,ilde,will have Inc burden orpmer,thus he did ail hull;or 1.02 — PIERS
improve Ila putry,se of Itled. /IssffII ,r
°I.ase ra,f the ny,ant esclookel comrmtin with hecnsed conlractom 1 O ��O 103 — UFER
Trope. ,r iw 1.04 — REBAR
m vI 'w does
a:l(Sm.7844.owner ss land erly who
'met lds or The improves
them r,
andwhLawdoes n lapply mtat ownerof a c(antty whohn license pursusthit,1 1LDING 105-- ANCHOR BOLTS
mJ who commms ILr wen nnjeer.wim a a,nlmnn]s) licensed pursuant m
01mexe ptundese. BA;rCfor this mission 106 — SEWER & WATER
Owner Date 202.. — UNDERFLOOR PLUMBING
WORKER'S COMPHNSAI ION OHCLARAI(ON 203 — UNDERFLOOR MECHANICAL
herebyarnnunder'Penaltyof erjn,yone ofthe fanowingdeelal,lhnn,: 204 — UNDERFLOOR FRAME
ad wit tnalmafn a Certificate of Connenl m wil:irome for W..kc,'e 205 — UNDERFLOOR INSULATION
Cuut,enealion, us pnvidid Int' by Sectian 371111 of In nLabor C,,&. for the
petionname onhe work Nr which this permits blood. 301 — ROUGH PLUMBING
KI have and will maintain Worker's Compensation Insurance.as required by Section 302 — TUB R OR SHOWER
ql of the IaMa Cook.for the perfnnmore of the cod for which this permit is
Iuacd,Nfy Worker',Coa,rfn�a'hon Insurance carrier and Policy annumr are t 303 — ROUGH MECHANICAL
cr"°' �, r""k>'"o.:/� �cJc� 304 — ROUGH ELECTRICAL
NIIP ]ATION OVI?%IiMNI'IUN I ROM WORKERS
COMPENSN'ION INSURANCE 305 — 'FRAME
nIn%section need not he cotnplel.d ante permit is sur line hundred dollar. 306 — FIOLDOWNS
Ibh0)o' kI sd
B teddy that in he perform mae of he work bur which his permit is issued.B - 307 — INSULATION
shall not employ any pesos in any mmnc,so as ,,become subject to the Workers 308 — SHEET ROCK
Compemutiaa law.W Culifomia.Dae
Appl'a':tnl 309 — EXTERIOR LATH
NOIICE'r0 APPI.ICAN'I4 tl:afrar lnnkinb],is Certdwalc of l?actnefo.,you should
O
I Isane subject W
to the orker..Comp.„.anon Prism I,of he l.abo,Code lot'111.11 310 — INTERIOR LATH
Q forthwith comply will,such pnwision,n,this permit shall w deemed mocked.
311 — SCRATCH COAT
F es. CUt Ocra 1,a l,or LENDING AGENCY —
wemny anion mat mer i. eonamcdo„1197,C.C'i ,r],e d'on,laeae 3.1.3 ROOF NAIL
w [aarale;:Na�°�wniehlhi.rarn'ilisisn`dts"'311"TCL'c.) 501 — FINAL ELECTRICAL ENERGY
0
Leader,Address, 502 — FINAL PLUMBING ENERGY
U O i lenity Dant l have man tat,i"and]on and Oate,n:e ma tato.:wa""Indi is
w F c, ,len.nilcoma-li.aplywiltel"nanamt aaltmyadinanaanantl.talelawsrelan,g 503 — FINAL •MECHANICAL ENERGY
OU m .1soe-oaawme]on,,mylta,wi,rianarpownta]no„nlroshymen'.„q,°n 504 — FINAL BUILDING ENERGY
0. tM ulx(We)
,,pa ..,,my sur ify ad ke Puga^cn.
(•' a (Wel atmclo save.indemnify ad whihamayto the City
,aCupe againto st olid
—
h City i s.politicians,costs ami e,h a e.wenn tear in my way ace a against.aid 505 FINAL ELECTRICAL
Cip'in cun.wynencc. Inc sms'i W)WILL COMPLY
O
5(B LE NI UL lu)NSN S )WILLCOMPi,YWITBIyaLNl`OIN9�— Issued by: 506 — GR 'fT Date ��
nuu w tKamr, sur GGIILL Da�_te(ll�`»� Re-roofs 508 — FINAL MECHANICAL
IA yARDOUS MATERIALS DISCLOSURE
Will the alts team„t boom ranking aacupaat state or handle m a,nka.material Type of Roof 509 — FINAL GARDE
Its Ju]ncA by the lupenino III eipal Cndc,Chn,nn'412,and the Hculth and Salety
Code Suction 2553201! — pp ppppIIII�kII Tee°3'e, Kit All roofs shall be�l7��slQfected or Q an WoTnibTlBterial being installed.
wsu me applicant or mime building tnmapa,n use egaiPmmt or devices which If a roof is installCfl'v�Sthout t'tlir i 4r itfI e I'figgree to remove
emit h.tmNous Hina arm Dials ns d I- cal by the Hav Area Ai,Quality Management
Do,nel7 all new materials inspection. Applicant understands and will comply with
”" all non-point source
regulations.
1 have read the hazallous nuterials requirements under Chapter 695 of the
Culiannia Health Re Safety Coote.Sections 25585,25533 and 255.34.I understand that
Ir h,baild'mg done nm currently ante a tenant that II is my teapansibili,y m bitty the
a and of Ina—ia"I'llen ich nmq be mel prior u,ivo,an,a of u Cenitic le of
Oc
I_Q ._O • Signature of Applicant Date
r w, a ed agent Date— All roof coverings to be Class sB” or better
OFFICE