05110146 E
ERTINOVISION PERMITS GOMEZ PERMIT ND.05110146
RNHART AVE
RS NAME: PERMIT ISSUE DATE
SANDRA GOMEZ 19121 BARNHART - 02/28/2006
PHONE SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT IN1,13
BLDG EIF.Cr PLUMB MECH
ZZ 0 0
UO° LICENSED CONTRACTORS DECLARATION Job Description
FC 1 m,,by a m Nu 1 w li¢Nvd undo RoaWons of Clupce 9(canmeming P
�zW NNSmtion'/ )ofl)M l of lite BuuoNa and Profc '..,,.Code,m,1my lkmamu
fuurmmaMeffm ADD 708 ' -FAMILY RM/MASTER BED/BATHROOM
j5� a a"' onI;amm REMODEL KITCHEN & LAUNDRY
ARCHITECTS DECLARATION SANITARY DONE BY SUNNYVALE
I undcraund my plans ahall he urN u public rea0
3 a LiceneJ Pnucsuoul
OWNER-BUILDER pECLARATION
Z<O 1 hmbY a( Nal 1 1 uasi from ao IM fcL l Co l:MY LAW for Nc
_°O followingh ,ok.. (=it T05I3,Buuneu uW Pmfuuwu Code:Any em m =
$ doo its iss a p.m re cmauucl,alio.hnpma,d�ukfamord,t aeaur m/uou.n
bOO biucOoami aLw rtqubu deapplk of for such Coro rmltb Neaupncdnammmt
< lhuboi. njimdl.eviona)ofDivision 3 of CaNruw's li¢�Law/Chapacr9 Sq.Ft. Floor Area Valuation
� (cOramoe a muwiNSavmr0n0)ofl=isfr JhO ai Buurc mmjobrafasimu Code)or $178976
Nat he u eaempn tbuermm and do Wu.for We alkYed eaempdoN Mr violation of Ra
Section W31.5 by aey applkam fora pm ft aoirY=Ne applir Im a dAl pcnalry of APN NumberOccupancy Type
oal mwc than rLw hwxhd dnlhn MSWl
❑
will do Ne woh,aN Ne urumurt 1.mlloumdrd aroaued faraix(Se.]Ills,Buunev T_
and PNfeulau Cadc:To,CoavamoY.Llmcx law don Wt apply b m owner a( RegUlrij�l $pCCtlOn
pvopeny who bulldaor imProre.+Ncmun.arW whodou ruck work himmJrm Orou{h his /� J✓C1Y// ..
awe empbye.,pnwldW that RLN mopra u an nm invaded araBemd foray If.
bawmc.Ne huWlnt ar hoRovemmtVmld WlWn are yeu of moplmbn.the o«iu- ��
bails«wet w.e tk hndmr ar pmHn¢dw le db na hdla m impasse rrt PUToe ar Y
i
t];I,u awnm of Ik pbpen/.w uclmnely cmuatinP nth Ikraud coavacbu b ///rtl /��
Cabm La Nc Rolm(Se. .Bvuecn sad Pm(ao Code:)The Coatramar. ,1 uY//IttVv{J/
clue law docs ed apply ow . a prvpusa)B. becl p ro improsu dceon,u' .
wba cantran.far xh cLL nNa a)Ilccrled pulmlNblhc GmuacbY.
lirsve Law.
❑lam .Bit PC for Nla revue
-- -WORKER SATION DECLARATION -- -
- I busby aNrn under penalty perjury ane of the folbwiv�delamior¢ '
I h..c a�wW mW bye•CcNflae of Gauan bCod-Iurt fa Workd.Campcn-
admi,r Chi(rc,O Ss isau 7100 M the lAba Code,far do pufarmana a(Ne
wok for w4kh thi.Permit u issvel
❑I haze usd will rnwmaIn WatrY.Compmosmion Iamran¢,as l*.d by S...;""
7Rn of lite LAbor Code.fm the pmfmmul¢of the w fa w 00 pumll h Lnued.
My Wortefa Crmp tim Wormce arrler and Paley oumbm aR
Carrier. PolkY No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Clbh scctim reed nal hccmiPkuai Bde IamLL 4 Tana huvNed dollar(1100)
m kaA)
1 cmufv Nat N the Aamaeco of the work for which IN.pmmil u iswed.I IDaB nd
.Ploy 'permmYmmr�rgrYbtrcvme wbjml b Lb Worlxr'Compawtiom ,
Im of ' .Dix / 1 lNi 'I
Applion l��a
NOTICE TO APPLICANT:If,arks.=J.4 Cenireae of Eamprvn.you should
beomc auhjm b the WortcYa CompcNayp pro Luau a lbs Labor code.you lowt
.J O forth M.'ly with such Ramalns a lbia pmmll shall bo&oath rewkN.
z CONSTRUCTION LENDING AGENCY
Ihertby aRum bra N m a a mnmumlm kMin all for tho perfoxrna of
pr.> de work for which tom pe.i,LL w.d lSas J09T,co'.C.)
W Q unw.Naas
=Z ISMer'a Add=
V O 1 cvufY dol 1 lute rod NV appliudm and ahY thu de abmc Infumaum h
W P carter 1 a(rte b cvop4y wdlh all shy and county orih.1 aW wv law.rt Wink b
OU bWldinp;eanwucdon,and bemby mlhml reprucm rbcs of Nis Cily,b m=upon the
Fa mowo.mc000 Pmpony fm inslanim Pupae+
twa)ale b ase.
IiodcmPo aM whep harmlu.lbs CLLY o(Cupmtim a�aiut
r/) UM1iJ woe crmfin xpo it. mar In my way
attmc aralul»Id Cry 6i
V z ,PPLIICCANT NDERSTANDf WILL COMPLY WITH ALL NON-POINT Issued by: Dale
S RCE UI.A11 S. _ _
_
—,Re-roofs
acne fA1q HAZARD U +ATElk—I DISCLOSURE Doc - Type of Roof
W 50 Ile.Pplkam m fauao hmldin,occupant rare a haMk hrrardom material
u deNvd by Ne Cupenlm Municipal Code,Chaplet 9.11,and the Hulth and Safety
S.-O.�51ua)7 /o No All roofs shall be inspected prior to any roofing material being installed.
Will Abe applicant nr fulum WildlnZ=olaN use equipment or Ikvi=whah
If a roof is installed without first obtaining an inspection,I agree to remove
emit haiardma air coOObo .,a dcfirc by Na Bay Ana Air Qwlhy Maoapemeel all new materials for inspection.
Disvlm7 /1
E3 Y. (<]N°
I have rtad lite haSaNnw nuu.MnB�mS�yylIlrtmcru w,tr Chegm6.95 a!lit Glifar.
ria oOLC Wj Cade.Sadans 255115. my w12555/.l uraermmtlth¢ifdrt WiWft
dos.nal cnta hi has a im, l y rtapamb0ity b mhfY do peaPanl of do
mgldrdlL nu wnmh man n. nmatt ars Cotime Signature ofApplicant Date
owm er NmP20.I,'ml oma All roof coverings to be Class "B"or better