01030180 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
7934 MC CLELLAN RD # 4 PSG FENCING INC 010301,80
OWNER'S NAME APPLICAnON SUB DA'I'H
CAMPBELL ASSOCIATES 11.33 N 10TH ST 03/29/2001
10 ONE: SANITARY NO. CONTROL NO.
i 4089953397
n 5 Z ARCH]rECIIHNOINEEW - BUILDING PERMIT INFO
O H %' ELECT PLUMB MECH
tidy
r Lrri hadI?DCONTRACT'OR'SDECLARATION Job Descri TIO
z= hereby nffnn Ih;n I um Ilccn,eA under pmvismns of Chapter 9 feonnneneing p
w with Section 7000dit D;v;ei.m3 of Ills Ifa.;nc.,; nfcx.u'T Clldtauud alp lice
<' J isin JOB I aandAt— / n 2ND FLR BALCONY REPAIRS/RESIDENTIAL Al
z C�m S Hub, l^ hie.H_ '_
O a tJ Ilam
'a�F LLO G / — `V.f HCHI'1'IiLT'S DECfARAI'IUN
g I understand my plans shall be used us public records
H�;:
,tea i p,O Licensed l'rnfeec;mn l
c.1f OWNER-HUH DIiIk UIiCLARA'I'ION _
W I hmvby ullinr that I Tun esengn from the Contractor'.Lwenw,haw li,r the
t < following rea,n,t.tscaian 7031-5.Buri .
and 1'mm fess Code:Any city n .a,y
x�O which re drn a permit n,conrn
rc,.1mr,imtuama.do nnlisn.or repair any arvcme,
.ca
3$ prion t L 4 theT such l mitt fl .'g dst statement
Wt heis licensed purst to the provistom,(ifth Contractors,L "a IChup",9 Sy. Ft. Floor Area Valuation
mom f. tiS t 700(( f1) 3 of the Bali axis dlaf .Cade) $35@@
lir In.,hes .rept Iherdo. ,ul the hao,for tne
e;dle,d eaatphoa.Any violation
of Seeaon 71r
5 by any applicant fill:1 permit sunjce,s thnnppl;aun,Io„Oil Venuhy
III no,Inane min Tire w'lred doi—(SNX)), A PN Number Occupancy Type
01.m owner of the propery m my employee with wages a duir,ole c.mnpenwnn r, 3621.20 @ 1.. 00
will Jo the work.and the stmclam is not intended or offered for sale sus 7044.
Business and profession.Code:'Ihe Commcmr's License law does no,apply Required Inspections
ox lir property who load,lir improves t thereon.and vert elnts such work n p a� 101. — FOUNDATION
r eredr bin own employees.pmvtJnl,nil,milli i enimut is old are in;mem �� J
amn,laloramc.B:hmv",me n.dble,he harpr.,it emir,old wens)o,nn year.d' Ep 102 — PIERS
ompletian.m"owner-nuudntwih I,uvn tree nmden.��nn,rhng Inn he did mil n,;qd or
improve s,.propose of-ha) #1 Ay 1 O2�0� 103 — UFER
❑1.asOwneronhepropety.ameaew>ivelycontmetingwitnrcensedemnrwlonto 1.04 — REBAR
consular the project(Sec 70u,Business and Pro&saaas Code:)The Contractor's
Idcruse Lew d.ee"I apply ro air owner of property who builds or improves there' Vt ^ 105 — ANCHOR BOLTS
,.ad wbo coma,,ls for.wen rrnieaL.flim a couractonf,)licensed par nam n,o �® p�
C m.L.O."Lieen,eLaw 1N((1 1.06 — SEWER & WATER
01 am cac,npl ander See. ,B&P C for this,,aon
202 — UNDERFLOOR PLUMBING
owner Have
WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL
therebymrrrn under penalty of perjury one of the lbllowing declarations: 204 — UNDERFLOOR FRAME
❑ 1 hire ani will m,im:in a cemfcal, of Consent Io .elf-,n.m,tot workers 205 — UNDERFLOOR TNSI-11_RTI ON
Compcn,alim, as provided for by Seat 3700 of nuc i.unor Crele. for the
pens,mnnoceofthe work for which this p,.allsi...ed. 301 ROUGH PLUMBING
0 l have and will maintain Worker's Compensation Insurance.as required by Section 302 — TUB & OR SHOWER
3700 ofrhe 1aM,r CIA,for the vrfnnnancc of tic work for which this permit is
issued.My Widej's Comi/rroa�ti,m,,_IInsurance carrier and policy number are: 303 — ROUGH MECHANICAL
r.:,rde,: I�_�"t+'pmBeyNo.: � s3�9a'� 304 — ROUGH ELECTRICAL
U N1IIrRVTIONOtrixRn119IONFROMWORKERS' @5 — FRAME
COMPENSAI'[ONINSURANCE d
Qhin section read not be completed iftnc permit;,for one hundred dollars 306 — HOLDOWNS
307.- - INSULATION
I eerily that in the ,rforoance of tine work for which this emit is issued.1 308 — S"HEFT ROCU
shall urn cnpluy airy pernun in any,,It at tin,as In bccoum suh)em n.the Wnrkc,i
C....l"n'don Us, Ifralilarnma.Date 309 — EXTERIOR LATH
d Applicant
NO]WE10APPLICANT.If.afler making this Cenilicme of 12senption.)tau should 310 — TNTERIOR LATH
become subject to the Workers Compensation final hinn.wf the Iabi Code,you must
O 0 forhwithcomplyxsm,nchprori.loon.or mi.pernnaanauxdeemedtoroked. 311 - SCRATCH COAT
P V1 CONS'IRUCTION LENDING AGENCY 31,3 — ROOF NATL.
It 5 I henby affnrthat flute I,a co,Isernenon lemhng noun,for the Isc,fomm
roe
onhe work r'wlden lnispannit is jawed(see3lrn.C,,.C.) 501 _ FINAL ELECTRICAL ENERGY
a z uOncr Address 502 — FINAL PI_LIMBIAIG ENERGY
� z
v O
1 certily that I have read this application unit state that the above information is 503 — FINAL MECHANICAL ENERGY
kss F. nem.I a,mu I comply skin all city and eomny oNhmmes and awte laws minding
O V "�n..d.mlge.nalr¢tion,:mdharebyauthmn,ampreemati.e.onhis1ityloenterIlion 504 — FINAL BUTLDTNG ENERGY
fahnove.,,l a,mala save,Oy nudyun ke p'pose.
F y twergtectasave.lodeelpiri eswhihamay aan Wayacomanangamst 505 — FINAL ELECTRICAL
City Inco sequence costs and expenses which may in mry xay'eme.gums,said
U Z eitymeoa.egoenee ohne gmnang(If pemnd. 506 — GR�.�T�C� ,,/'r
APP CAN UNDERSI'ANty�fJD WILL COMPLY WI ALL NON.POIN Issued by: sm� _ et.n(nlrJn. Iflwfn r NG Date �' "T--el
namre of rein ealnv onaaa„ Dale Re-roofs SlZiB — FINAL I+IECHAN1 CHL
IIA%ARI)OUS MATT2R I AI.S ASCLOSU Rli
Will nil.appfenm or m"<bnudhtg oatrn,n,Tote o,handle namtdo'mmcnal Type of Roof 509 — FINAL GRADE
l as defused by the Cupenimi Mua;dp:d CIA,Chan,9.13,mod the❑carob aad Safety 51 @ — FINAL PLANNING
Coir,Section 25532m)'!
11 yes (Vit All roofs shall beaJlp'Wctcd PrMALanptqalln;LlrlaW g¢e'j'ng installed.
Will the applicamormrumbuilding occap:mtuse equipment ordevices which If a roof is installed without first obtaining an Inspection,..}} agree to remove
dI naaatdata,air sa ilio ra us as defl'd by he Bay Area Ah Quality Mulugsmem
i>l.,cier; all new materials for inspection. Applicant understands and will comply with
0f'es "" all non-point source regulations.
I ImsI,read the Meador,m¢
ariaH requirement..under Chapter 6.95 of the
California Health&Safety Cole.Sections 25505.'-5533 and 25534.1 mut isrand that
if the buithng does not currently have a tenant.that it is my respomiblliry h)notify the '
Occupant of the accur I OcTilm,wh;ch roil be met poor en ow.ance ora Certilicam of
o"apa, 77 / Signature of Applicant- Date
ow Or Eas ,orae agent `4 Date l All roof coverings to be Class`B"or better
OFFICE