01030064 (2) 1erry OF CUPER'rINO - -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRISS: PERMI INO,
20084 WHEATON DR BEN WILLIAMS INC 01030064
OW NIiR'S NAMIi: APPLICATION SUB DATE
KAREN HUSHER 91822 COKER RD 03/13/2001
{ONF: SANITARY NO, CON'IROLNO.
(888) 469-7003
0-7.
rc7. ARCHITECT MNGINECR: I'I'hDIN'O PERMIT INFO
.D ULECPLUMB Mi:
I=1 Cl U
5 N j LICIiNS1iU C'ONTRACTOR'S DECLARATION
1 nercny mrimm ml 1 amt Lcm,ori under Imwisi,mr ofcharlcr 9 a„nm tncins Job Description
01t__Z Wl —
Sttdan v ab!1 )is....n hAmc Hu,i,mss and •I yryt le,alxl mY limmc
testhtureraant'I rp WOOD FRAME.
ls. Lica ////////CP
CnmmcmrI,�RCI1rII:C'rs )ECLARAriory � REROOF/ 40 YEAR COME. //�1 l InI understand my ran„hll m m,ed a,pubhe record, , ,.•N',..® leal
� V
s ea ae Littn.¢J I'mfcaeiunal �}'
j(o a. OWNER-BUILDER DECLARATION MA O 2 20 02
w= 1 herchy altin'm tlm1I ren vxecoa fn,m the Cummnur'.,License Law Ib,M
Z¢ following seem.(Senion 7031.5,business and Rtfnsions Code Any city m county
`S O whit 4 I Inil, 'I I are,iniprive.drancifish, bitterry structure
i�C ex prion t .: do ex .du uplic ril for ..it,a millfl 'g d s on,
mrn In real tt top ne nn c 1 cmr,l e - La (chaps Sq. Ft. Floor Area Valuation
(commencing with Schon Will Dickler Sof the Businessand Pbdcnsion,Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any viulmion
01'Section 710 1.5 by any applicant tar u perfri sid cels time applicant ton civil penalty
,if.,it ream than lie hundred dollars Will A PN Number Occupancg ff)30 0
❑1,us owner of the rrorenY•or my employees with wages a,their sole comrenc:nion.
will do the work,and the,wemm is nom intended or offered for sale(Sec.NWa.
Bmim'h,and I rtare„im,a Curb c Contract m'.y License Law does I,,(aptly m an 316:308.gPPOed Inspections
owner of property Who build,o,narrow,mercon,and xho duce such work himself
or mrough tis owl cotploycax.provided that such intrrovememn are not imcnded er
offered for sale If.laavcven,he building a urpr...cmcnl is,old withm one year of
imimpletion,lhcuwner-hudder will have lhebradenol proving that hedinnit builder 305 — FRAME
prove far pamo,c of od”),
307 — INSULRTION
❑Lcr ownerot prole ject
(See 71W,
Hisinivrl yd Pruetlng withade:) F Contdom u,
n,wa the ors .(Sec.8111,nvieues,and Prue whfob code;)The cenlmcmr'. 601 — ROOF TEAR OFF
License Luo does rot apply man n,ts w of a bob who M1ulice se irrrr,manIN,remb
the
and who enmrac„for each projects watt a,„ntne,etco licensed pmranant 1a me 602 — ROOF PLYWOOD NR T L.
cenham l n.
Lh<mc Law.
E3 I'm,taeal,rutrt amlerS .Bxrchn mi,rea,mnm 603 — ROOF BATTENS
Owner. Date 604 — ROOF IN—PROGRESS
WORKER'S COM I'ldNSA1 KIN IILCLA RAI]ON
1 hereby aifmn relent penalty of rarjury nuc of,hc following du:haminnc,
❑ 1 have halt will maimain a COM,ate of Convent an¢I6inure Inc Worker',
Co n,cremion, as provided for by Section 371111 oR the Lahor Code, for the
penivmancc of the work for which this permit is issued.
O 1 have and will maintain Wader',Conmren.sminn lnwm„ce.a,required by Section '
371X1 of the Latah Curie,tut me erfhnvina of the work for which,Lis petrel,is
.ueJ.M l ,r1u� CnsaInsumnce varr'rAl'nlicYmO��/h
xx Policy No.:2 TP(lam H<
CIiR1'1F1CAI'I11N OF EXISIVIION FRObt WORKERS'
C(lMPENSSI'[ON INSURANCE
('titin tJenni need no,be c undcled If the Penni,i,fur one hundred dollar,
(",a))2lcal '
1 certify ramal it the pedbrneene of the wore for whlcpm this permit i,ix„tcd,I
shall Dol employ any pc wn in any manner zn as m hocbe 6object h,,Le Workers
Con"a'atum Laws op Culifuria,Dam
Applicant
NOOCH TO APPLICANT:II:attar maAing,hi,Crnilicac of F:¢mption,yo—lamild
because subject to the Waders Cnnu lle"d n I provlsbrv.tline LahnrCode.You nnnl
Q O forthwith co,nply with such protrims nr this pit sell M1e deemed revoked.
FCONS'I'RUCiION LLNDING AGENCY
a Iherehy of rer,hanhem I,. m„rctio.lending eme,Ronne perfonname
It Inc wirk hn'which Thi,lwr rte tx,rew.I(Sec.31197,Civ,C I
,S Q lender',Name
Com' 7 Lcudcr'v Add.I,
C.I O 1 certify that I have real this appliclion and state that the thaw information i,
lf. P correct.I agree it,cannily with all city and eerie,orfinue,ex and xO(c law,n1 ing
U haiding anstrainn.and hereby malmiae representatives of this city to enter upon
rye tea ahuvu-mculi iced propcny for innpraplan purr,ixcx.
E.n O. (We)agree to save.ialcnmif unI if l,annl fit,-City of Current against
Z) IlaM1ilitics roue,costa an I a n,es which may in any way acme against,aid
V Z City in Icncc•ul enc gmn nR thin Iutmit. /� ,yI/
APPLIC nn•1 ER. ND )WILL COMPLY WITH ALLNt,316� Issued by: Date / V
SDUR !G 3
tgnatt - nl '.,—ripe r- Dae Re-roofs
I IAZARII,US. A'IT,RIAI S DISCLOSURE
Win rime apdi,ard or fuer itding eccipent,mm at handle marauders mam,ial Type of Roof
rix d,ined by the Cupumae,Municipal Cada Chinet 9.12,and the 1{edlh amt Safety
Carle.Salim,25532m'
ID Y® 12No All roofs shall be inspected prior to any roofing material being installed.
N'ill the arplican,m future building occupant use equipment or devices%hich If a roof is installed without first obtaining an inspection, I agree to remove
-emit hwuNnm air rammninunl,u,Jclincd by Ihv'Bay Arcs Air Quclity Manuganrn,
IZInoC all new materials for inspection. Applicant understands and will comply with
13 Yes [2 No all non-point source regulations.
I hnvc . the harardnus mmerialx requirements under Chapter 6.95 of the
California) Lith HI. ddy C,lc.S&,r505.255_3_1ard25O4.1 nndcmWnJ N:v
i(thilJi, Acesn tcurrcnd ha ,my rcsp,mxibilll meotiymet her• Liehr m Iswanee nl Cenili ate nr
txcrpan /
Signature of Applicant Date
- menta ,naJ m ane All roof coverings to be Class`•B” or better
OFFICE