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02110147 (2)
CITY ON CUPER'I'INO j ^� z • ' rrgL -. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .3, BuH 1 6%2grsSUNRISE DR KEITH GARVINE PERMIT NT 2 110 14 7 OwWAEithERDE MANUEL TRUSTEE & ET A3077 ZION LANE APPLICATIIIN�INI2,gy2002 orONE: (408) 259-7874 SANITARY NO. // CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMU INFO BLDG ELECT PLUMB MECH 0 0 0 0 µ^r00 LICENSED CONTRACTOR'S DECLARATION ,m0 thereby affirm that lamlicensedorder provisionsofChapler9(commencing COPPER REPIPEJob Description �I with Section 7(XX))of Division 3o1fNe Boar sand Professions Codc.and my license is H 'n full font and effect. ZaIChS ����® ZOf,{'� Liccnx,Clus IR.3f�Lic.p a' F`D`O Dafc�l 25.L^tpC Cmnvamor /'04 k�ls�») F� �_ 1 Jets nil DIY pissha�b ,gDs�I.AR—rN r� ~ is x csml al FEB 2 5 2003 OWNER ex ER DECLARATION Contractor's ON u�00 I max.ereby infirmlar 11. caemnl from he COntfae Co IAnyc Law(orthe BUILDING $5000 6pO followingreaun.(Semon IIonstru Business mpr Pmfessions Obs:Any city or county 1-$vii which requires apermit requires to alter.improve,demolish,Ire asiranytarudurc FZQ prions,lits cenedpairlsor,yvirhe lhovisu sofant for achpmm's License Lawdsammem (commencing wit pSectiol toth,pl Division of the Colistno's License Law(Codo)u, 3�j&l.ff '�6AI©� Valuation (commencing exempth Ration7tlnd o,basiisfr O the[list exeandon,Any vi star of Nal he is exempt therefrom and doe hats for Ne alleged eaemptinn.Any vinlatinn of Section 703 1.5 by on,applicant for a Permit ubjecu the applicant I...vil penally of no,mmcdon fiva hundred dman(S500). 202 NUNDERFLOOR UMBING Occupancy Type ❑ h as owner of the propcny,or my employees with wages a their role compensation, will do the work,and Be structure is not intended or offered for safe(Sec.7W Business µ' and Professions Code:The Comai License Law does not apply to an owner of 302 — TUB & Fu9r 1IN8fV"aS pmpeny who buildsor improves thereon,and who deessuch work himselfur through his W GIC own employees,provided that such improvements sm not intended orortered forsale.If, 502 - FINAL PLUMBING ENERGY however,to building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build or improve for purpose of 506 - GAS TEST ak')' 507 - FINAL PLUMBING ❑ 1,as owner of the propenY,am exclusively contracting with licensed contractors to consumer the project(Sec.7044,Business and Professions Code:)The Contractors Li- cena Law does not apply to an owner of property who builds or improves themlm,and who contracts for such projects with a contractors)licensed pursoem in the Contrecmra License Lew. ❑ I am exempt under See. .B&PC for reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hcfcby shim under penalty of perjury one of the following declarations: I have and will maintain a Ceni fiesm ofConsenuo self-immic for Worker'sCompen- sininn,as provided for by Section 371X1 of the Labor Code,for,he performance of the work for which Nis Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as requited by Secdon 3701)of the IeNr Code,far the performance of the work for which Nis permit is issued. My Worker's)Compensotlon copper rtier and Policy number am: ® Gamcr: T; r( lt:70NO Policy NOM,9OIL'IVIT`lUO ; CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forma,hundred dollars($100) ,it lem.) I cenily that in the Performance of the work for which this permit is issued.I shall not employ any vown in any manner m u to become subject to the Workeri Compenation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Candie t,of Exemption,you should become subject to the Worker's Compensation provisions of the IaMn Code,you must O ,Z 7forthwith comply with such provisions or this Permit shall N deemed revoked. q O CONSTRUCTION LENDING AGENCY 1-+ I hereby affirm Nal there is a construction lending agency lot the performance of 0Y > Ne work for which this Permit is issued(Sec.3897,Civ.C.) 4 0 4ntler's Name z Lenders Address V C I cenily Nat 1 have read this application and suite that the shove infuriation is (, correct 1 onset to comply with all city and county ordinances aivesOf and state laws relining e building construction,and bercns enthonpurposes. res of Nis City menkr upon the IUT] ahnvc(We)ascd to save for inspection Purposes. G (We)snore to rove,indemnify es keep yinharmless N,City o against id City �- h st Iinbilitics.judgmenas,costs and expenses which may in any way accmc against suit City V z men sey Actof 'u grind gulf ispermil. AP C NT U ERST ND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S REG TIO ,/ 40V !�V (" S ' Z Re-roofs m A JComry r Doc ifnzlsR US'A1# ERIALSDISCLOSURG Type of Roof Will the applicem or uwuNlding Occupant store or handle hauNous material as defined by the Cupaninm Municipal Code,Chapter 9.13,and the Health and Safety clxle.sadiron lsss(a)'' All roofs shall be inspected prior to an roofing material being Installed. ❑ora "Xi Nn P P Y g g Will the applicant or future buildingoveapent use equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove coil hasardous air contaminants ea defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes I very Oct., a tial quimmenu under Chapler b.95ofNeCalifnr- a, ca &S cry Cork, Nos NIS SS33aJ 15511.1 undersand Nail Ne Nildinn does n I its 11,hax avant, as i1 resPnmaihifity m notify IN weapon)of Ne treat 'n1 Which mu Nm amanermraCenlO,hmorfxe`pancy. SignatureofApplicant Date 0 net uthon ma em DLA- All roof coverings to be Class "B"or better