04010110 (2) CITY OF CUPER'fINO
BUILDING DIVISION PERMIT C®NTRAGTQR`INk'ORMATIQN •,_
BUILDING A DURESS: PERMIAN BUILDERS INC. PERMIT NG04010110
R'SNAME: PERMIT LSUB DATE
NE
NE: - SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
G o LICENSED CONTRACTOR'S DECLARATION lb Description
w I hereby affirm Net I am Iittrue0 under provisions of Chapter 9(Commencing lp
ing �
i with S=hall t(IfMI)OfDiviAion3oftleBai and Profe siunC dmylieense is
^?h in full force difBam ,q
Lieam-ClxxE(`g Un REVISION--WALKWAY WORK
nose A °"'r"`"r� TION NO NEW PERMIT ISSUED/ORIG. #03120023
i < 1 ruder end my ; h u scads
Deas
jo Licensed tilSectiom �)
-
y TION
<IS 1 hereby nsept from she Cnnuacmr's License Law fur the
00 following reason. I. Business and Professions Code:Any Oily or county
$ which requires a mel,el¢r,improve,demolish,nr rtport any structure
prior In its issuancthe applicant for such Permit to 0 lc a signed statement
s0
that he ishcenscd Inc provisions of the Connector's license Law(Chapter 9 Sq. Ft. Floor Area . Valuation$83
tt$ (commencing with )of Division)or be Business and Prorations Cook)or
3.. Net he is exempt tWrefrom and d¢basis fa the alleged exemption,Any violation of
Section 7071.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more Nan Eve hundred dollars(5500).
❑I.as owner of the propeny,or my employees with wages u their sole companuuon. 35907005 . 00
will do the wart,end Ne awnme is not attended or offered for sale(Sec.7044,Business
and Pmfassions Code:The Canna am,License Lew does not apply ban owner or Required Inspections
property who builds or improves thereon.and who does such work himself or through his
own employees,provided that such improvements she not intended or offered for agile.IL - /7
builder ,illhline awd ase or improvement iswldwdiinot year ore prove on,for the Oseof �\
builder will hevx du burden improvement
ement i test ihe did not build or improve for purpthe own rr \ \\\
sale.).
❑1.es owner of the progeny,em e.elusively contracting with licensed contractors to
came La the project(Sec.7044,weer oss and Profusions Code:)The Convector's and \`C
cense law dnaf not applyto m owner of property was Wilda or Improves thereon,and
who se La contracts for such projects with econnacNK[I licensed purauamm We Convector's \ v
License law: \\\
❑lam exempt under sea .B&PCfor thio won
Data
WORKER'S COMPENSATION DECLARATION
Or I hereby aRrm under penally or perjury ore of the following declemllons:
❑1 here and will maintain a Certificate ofConsen to¢If-insure for Workers Compcm
ration,as provided for by Section 3700 of the IaWr Code,far Ne performaxe of the
work far which Nis permit is issued.
❑I have and will maintain Workers Compensation Insurance,a required by Section _
3700 of the Labor Code,for the performance of the wart for which Nis permit is Issued,
My Worker[Pgraparrication Insurance canter end Policy'"amy7rt/:j
CERTIFICATE OF E%EON FROM WORKERS'
COMPBNSATIIIII1666666N INSURANCE '
Oink section need not W completed ifthe permit is for one hundred dollars($100)
of less)
I comfy that in the perfmmenee of the work for which this Permit u Wood.1 shall nes
employ any Nixon in any counter an as in become abject to the Workers Compensation _ -
Laws of Cal Burma.DOW
Applicant -,
NOTICE TO APPLICANT:IL after making this Caturaale of Exemption,you should
become subject to Ne Wohci s Compuuatian pmvidons or Ne LOW,Code,you mum
.Jz foMwiN comply with such prnvisimss or Nis permit hall W demand nonted.
,z,� O CONSTRUCTION LENDING AGENCY -
[—rI Wraby from that the to is a construction lending agency for Performance or
C4 > the work(tar which that permit Is issued(Sec.3097.Civ.C.)
dQLander'.Name -
= z Lenders Address
U C) I canify inn 1 have rtad this application and sum that Ne allow information is
D. F cotmm.1 silica m comply with all city and county aNiwwca and rare laws relating to
0U building conswxtian,and hereby authodre repoomativescar this city to cnmr upon the
G shove-mentioned prolixity for insi ecuon purposes.
(Wc)egrte t ,indemnif d keep harmless the City of CalMnlno against
`ate'fq Iiebiliva,judgme des s which may in any way so.again'eaid City
U z in cormt cc N ran' g this hall.
APPLI ILL COMPLY WITH ALL N N-PO issued by: Dale
SOU TI
71 D Re-roofs
Sig tar RDOUSMATERIAISOISCtOSU0.E D ir Type of Roof
Willlnxarn loan,or ruturt building Occupant or handle hnardous maredal
ss derined by In acentric,Municipal.Code,Chapter 9.12.and the Health and Safety
aJasxctt n 532(a)7 Na - All roofs shall be inspected prior to any roofing material being installed. '
wi the acphant car rawm Wilding an:ap.nt aro egmpmmt car dx.iroi which
-If a roof is installed without first obtaining an inspection,I agree to remove
Omit havardous air contaminants as Jcrincd by she Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes
T haw read!In m sols irtmcnu coda Chapter 6.95 of the C4liron
ruts Health&S t )25534.1 understand thmifNe Wilding
dao not c nen y his iohly to noy the Or of dv
reyui0 ria m mip� in.. ecemrarear pan Signature of Applicant Date
own m a ! to All roof coverings to be Class "B" or better