01020058 (2) CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO, 01020056
90E,P. PARK VILLA CL
OWNER'S NAME: APPLICATION SUB DATE
_ 432/1.3/2001.
111IONIi: _ ER SANITARY NO. CONTROL NO.
7 m z ARCED DUCT/ENGINEER: / BUILDING PERMT INFO
a w O BLDG Ii1.I;cI PLUMB MGCH
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LICIiNMiDCf1NTRAClOR'S DECLARATION Job Description '
_ L hcrchy tdlirm fitI I Ins,licensed nml..par.it...sofChTur,v feommancmg
F:tw wnM1 Section 11NN11 )LVLT+u of the Business tnA l'mfc.ions Csde.unJ my licenu
islnlidllirtttunJlie'a �� o3 � L REPAIR BREEZE AY AND HOUSE EXTERIOR
s[0 i .men�l1fr���lass
ate Cnlllraaor_
3 u AHCIII fiCi"S UEChAH N
C v��� I undcruanJ InY Pmns nbull INt used us punLc recorJn �
to 6 p 0 LinmeJ 11..esaonal
I,LL f)WNCH-BUILDER DECLARATION
Ia. =' I ncrehy al'lino that I am caenlpt from the Cnhinamr'a License Law lin the /
F:< biluwing ration.section 71131.5,Bromma,and PnReseion,Calc:Any city ur come,
2 D which eeyuires a parmit to consorter,altar,impulse,demolish.or repair any structure
I�i61 3 m Pr: fill, IM1 nl l' t f h pc 'r t fie g J.ennnnn
tfar he is licensed pt to rhe provisions of thec t , r'%Ucaus,Law counter 4) Sq. FL Floor Area Valua�i41L00
Iclt g 11S 't '.I 9an1 rlyl f1h Business IProfessions Cato lb
o.That hesamp.Iherefirumi the bast. for the alleged« p A y inlanum 0 Of
of section 913 m a
5 by any applicant for ancou il.vnhjerls Inc Ilppllamr macivil penalty
of as mom than Ede hundred drift..lssgn. APN Number Occupancy Type
o 1,as owner mthe pofeny or my eniplo)ces with wages as their sons ahmpcnution. 396 1 00,7_1
will Jo Inc work,am]the noxnre is nut intended a olmied for sato(Sce.91144, -
Business and Professions Calc:'me Contractor s License Law does not apply to an Required Inspections
owner nl'property Who hnild,or improves Ihemon,and who does such work hinhsell
horough his own employees.provided that such improvements are not intended or 101. — FOUNDATION
offered bar.me.If.hottest, he buEding ,,hnprovcited 1,.sold w'Illon one year o' — PIERS
icompletion,the nwoer-builder will have the burden of proving that he did not Mild or 1 QIP
mprove ler pugnew.1 mm.). 103 — UFER
01.as owner of the pmpert.ate exclusively contracting with licensed contractors ill 1fD4� — RF_BRR
Linstruct the project(see.ttH4.Buomms and Professions Codii)The CnmencLer's
cense law dues not apply to an owner of property who builds or options.thereon' 105 — ANCHOR BOLTS
mad who eonnor,for mh mbjcaa with II cunbactor,) licensed panoant eh the
Commelors License Law. 1.0E — SEWER & WATER
❑I ant sirloin under Seo .B L P C for this read
Owner Data 202 — UNDERFLOOR PLUMBING
WORK12RSCOMPENS,VION,DECLARATION 203 — UNDERFLOOR MECHANICAL
Irerchyabout ruderpenahyofper.,one ufinefollowing dccmratmos: 204 — UNDERFLOOR FRAME
❑ I mon and win maintain a Certificate of Consent to.eB-insure for Workers 21215 — UNDERFLOOR INSULATION
C..orientation, as pownI our by Section 3901 N the Labor Chale, rnr file
permnttnceof me work cur which his permit I..issued. , 301 — ROUGH PLUMBING
0 invited oill nadmain Worker's Compensation Insurance,as requiredby Section 312 . — TUB & OR SHOWER -
370p of the Labor Core.for the perf ormmnce of(lie work for al ich this Nalood is
one.My Worker'sCotnpensatimInsurance carrier and Policy number are: 303 — ROUGH MECHANICAL
Carrier: Policy No.: 304 — ROUGH ELECTRICAL
CERT IPICA'I'ION Of;EXPMPI'ION FROM WORKERS' x05 — FRAME
COMPI3NSATION INSURANCE
rI his seaaia,need inn he amuplocal It he permit i,ler ono flout dollars 302 — HOLDOWNS
is Ian fir less.)
307 — INSULRTION
1 certify that in the performance of the wod,for which this permit is issued,I Sf IEEI ROCK
shall not entpdoy any perom In city n ter so as m humor snmjal m fins Workers 308 —
con Ism I Cdilomia.Date 309 — EXTERIOR LATH
Applicant/) ®/ _
NDTisE 0 L1eWorkersCmrmakitioniowsroctenfbith ode....hnold 31Cry — INTERIOR LATH
MentIi subject bh the wurkur'.Compenmthis permit shall
ha or the Lamm Gdc.You nwst v
O z0 larthw'inhcol,hplyw'Itnsmeltprovisions ormiapennh.nanneaeemalreahked. 311 — SCRATCH COAT
y CONSTRUCTION LEND]NO AGENCY
t"I 1111mlfimtthat here isaconstruction lending....c,kod,"wa ...ounce 31.3 — ROOF NAIL
of he wore F®r 060, his parmit is issued tree.3097,Civ ca 50 f — FINAL ELECTRICAL ENERGY
Isnder's Name
U z0 L.arderAddress 502 — FINAL PLUMBING ENERGY
I ccln l y lltal l hate roan mid atoll lei'non andlite 1111.1 dteabo„e inihmmlion is 503 — FINAL MECHANICAL ENERGY
W E.. corral a
I agree ,comply with all city and county ordinances and state laws raising
C) r, toholdia,con.nation.and hereby and,III-repee.am:mves(it lhis city toenter upon 504 — FINAL BUILDING ENERGY
W the alswomention al property for in,paltm pt rfuses,
pa a (We)agreemnace.InnamniIyand keel,Inanities,de,City Ifctmemmtnear .� 505 — FINAL ELECTRICAL
UZ) I ahil ties,judgments,conn and eslheaw,which may in try wvy accrue tr,onrt said
Z City in comegnenccof the gmntint,ol misparelf. 50F, — GAS TEST
APPLICANT EGUDELAIRSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: INQate
atrcof ApplicanJCaoracmr Date Re-roofs 508 FINAL MECHANICAL
I LAYARDOUS MA'T'ERIALS DISCLOSURE
Will the applicant or future building occupenl mote fir hanllehauNuus material Type of Roof 509 — FINAL GRADE
us th fntod by Inc Ctmcnin,municipal Code.Chapter 9.12 anti the Ilcalth:md Safety
Cottle,Setion 25532(a)^ 510 — FINAL PLANNING
0 yes El No All rool's shall be Tru �aCprjrIllNA y f�gg.WeW0Wlj installed.
Will the tpplicammmmre baild oecloht (lite equipmant or necice.which If a roof is installed without first obtaining an inspection, I agree to remove.
emit hnmrdeus air communion.,as defined by the Bay Arca Air Quality Management
District all new materials for inspection. Applicant understands and will comply with
G Yes 0 N all non-point source regulations.
1 bane read the hazardous materials m niremenu under Chapter 6.95 of the
California Health h Safety Code.Nations 255115,25533 and 25534,1 understand that
if the Willing Lincs not currently have a mn:mt.that it is my re.rym.ihility to notify the
occupant of the requirements which hills[be met prier to issuance of a Cenllicam of
Octal
Signature of Applicant Date
rat aumnri.ed agent ])am roof coverings to be Class "B"or better
OFFICE