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02010107*ICY (a1F CClUU)7,P TEN(0) o l o CUPEk HO AFFLECATIDN ]FORM APIA # � /' � _ � .� .- ©.� .� Date: / Building. -`Address.:, . •..:. , ; . Owner's Name: �- 4 �� c� _ © pP l Phone #: ZS -2- -S 2 - Contractor: Contractor: License #: Contact: � Phone #: / ! -Applicant/Contractor: Boiler <=100,000 Btu ui Permit Info: Bldg Elect Plumb (Mech escription: Residential: Commercial: Sq.Ft. Floor Area:. $/Sq.Ft.: Architect/Edgineer: Valuation: Type of Construction: Occupancy Group: nn�nnti ]Fee EI D ]Fee Description Yee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOELER3 Boiler > 500K to 1M Btu MECHANICAL BBOI1LER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX.. ..:...: Construction Tax BUILDING :.. BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL IB EN ER GY Energy BUILDING BENERGYADD EnergyAddMulti BUILDING BINVESTIGA Investigation fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 _Sr ,s7Z,5 L 0 1T���(C�TRTY Orn1IrnF1T(C�IJP EII�TIENO fT�1��T CUPEkINNO ciry OF 1C 1C�1LQl ffT A1r 1r 1L�(1. ATRO1�7 F®J.Cd1�Y11 ozoi4e-�7/ I oZ-n t­bl 07 AP r � Gi _T �i Date: B 'din &27 MECHANICAL Owner's Name: r Phone #: S r, BBOILERI Boiler <= 100,000 Btu MECHANICAL Contractor: % o License #: MECHANICAL BBOILER3 Boiler > 500K to 1M Btu Contact:�pp pp '� Phone #: p k49 O " '3r? 9 1 (, �J Tim cJ C�' 9t !fes e) Applicant/Contractor: r, r5&Av" f J, ' ���9 �.�� Fax #: CAa9 , -:,z�y Building Permit Info: BUILDING BCONSTAX Bldg 07--&)0)07 Elect Plumb Mech Job Description: BUILDING BCONSTAXH Residential: o Commercial. Sq.Ft. Floor Area: BUILDING $/Sq.Ft.: Elec 600V <= 1000A ELECTRICAL 1' & 0 Architect/Engineer: ELECTRICAL Valuation: 7 - -' / `_� ' Type of Construction: (� Occupancy Group: Energy BUILDING BENERGYADD ]Fee IIS Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 1 OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B EN ERGIY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING �U, 1 of 3 CITY OF CUPS INO tITY GIF CUJP]EIl8T P]ERMIIT APPII.IICA'II'dGN ]FORM Ute` a `o�0 2,o APN #� Date: Building Address: SC�X4,k� Owner's Name: Q^ J ' 9 aod<—�.T Phone #: +9 b 1 ©�® Contractor: License #: Contact: Phone #: Applicant/Contractor: Fax #: ilding ermit Info: Bldg Elect Plumb Mech �3 ob De ription: ems` Residential: jrnmCe�r2al: f Sq.Ft. Floor Area: /Sq.Ft. Architect/Engineer: Valuation: Type of Construction: Occupancy Gr up: 5ED Quantity Fee MID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi%Mobile BUILDING BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B ENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING r � W 1 of 3 �� o 2-- n0 �(CITE' OF CUPERTINO CUI' TY OF ® PERMIT APPLICATION FORM uanti Fee IID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREIVIRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL iz JH a;0 UC5F Fr Z ZOy: O Z — C c_��x; °'Dat t..0 aaoe a3` Z� 0 CITYTINO BUILDING DMSSIIONN CONTRACTOR Ht ® ®Ne IPE PERMIT NO. BUILDING ADDRESS: 10407 SOMERSET CT RODRIGUEZ JAMES -J AND LORI 02060158 OWNER'S NAME: APPLICATION SUB DATE RODRIGUEZ JAMES J AND LORI 06/25/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l_7 F I L_J LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that f am licensed under provisions of Chapter 9 (commencing I with Section 7000) of Division 3 of the Business and Professions Code, and my license KITCHEN REMODEL is in full force and effect. License Class Lic. q Date Contractor (#02010107) ARCHITECT'S DECLARATION j I understand my plans shall be used as public records i Licensed Professional OWNER -BUILDER DECLARATION i I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county i which requires a permit to construct, alter, improve, demolish, or repair any structum prior to its issuance, also requires the applicant for such permit to file a signed statement - - -- -- - -- - Ft.. Floo[.Area :, , $ 2 5 0 ��uation . that hq is, licensed pursuant to the provisions of the Contractors License Law (Chapter 9Sq. (commencing with Section 7006) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the aIl¢ged exemption. Any violation _ - -o€ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). p L v 3 6 9 1M' ,R t6b Occupancy Type C1 1, as owner of the property, or my employees with wages as their sole compensation, -7 SV wilt'do the work, and the structure isnot intended or offered for sale (Sec. 7044,— Business and Professions Code: The Contractors License Law does not apply to an 101 - FOUNDATJI;�rNl3ired Inspections -•. - - owner of property Who builds or improves thereon, and who does such work himself his improvements intended 10 2 or through own employees, provided that such are not or offered for sate: If,w howevere the building or sold within one year of 103 -...PIERS.. — UFER burdeno pro n complerion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 104 — REBAR C! 1,* as owner of the property, am exclusively contracting with licensed contractors to 1 0 5 — ANCHOR BOLTS" construct the project (Sec. 7044, Business and Professions Code:) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, 106 — SEWER & WATER and who contracts for, such projects.. with a contractor(s) licensed pursuant to. the -' 202- -- UNDERFLOOR PLUMBING Contractor's License Law. 10ZI am exempt under Sec. , B & P C for this reason 203 - UNDERFLOOR" MECHANI CAL ne Wir 6'1--s1,- — DatJ 204 - UNDERFLOOR FRAME WORKER'S COMVATTONDECLARATION '''"'perjury 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of one of the following declarations:- 301 — ROUGH PLUMBING ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's 3 02 - TUB & OR SHOWER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 303 - ROUGH MECHANICAL ❑ 1have and will maintain Worker's Compensation Insurance, as required by Section 304 - ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work for which this permit is 305 - FRAME issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: - ° Policy No.: • CERTIFICATION OF EXEMPTION FROM WORKERS',307 —,INSULATION' '. _ COMPENSATION INSURANCE .3.08. _.. SHEETROCK-._... ..... ................... ....: _. . j (This section need not be completed if the permit is for one hundred dollars ($100) or less. 309 - EXTERIOR LATH I certify that in the perfortnan of the coo for whi$11 this permit is issued, l -.310- - INTERI-OR -'LATH -' " --- -- - -- - - -"- - - -- i shall not crop any person in a nnert� j b�ver)riikiect to the Workers l% _ZJ 311 - SCRATCH COAT •: Compensation Ca'1ifomi ate i Applicant — _ .. .. 313 501 - .ROOF NAIL _. _ . ..... - - F I NAL ELECTRICAL ENERGY NOTI O APP CANT: 'term king this Certificate of Exemption, you should In . u jest to t e Work is Compe cation provisions of the Labor Code, you mast forthwi In saeh nr [I is permit anau be deemed revoked. 502 - FINAL . PLUMBING. ENERGY .. ... . jCONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance' of the work for which this permit is issued (Sec. 3097, Civ. C.) 504 - FINAL BUILDING ENERGY Lender's Name - - - - — • • Lender's Address 505 - - FINAL ELECTRICAL I certify that I have read this application and state that the above information is 506 - GAS TEST correct I agree to comply with ail city and county ordinances and state laws relating 507 - FINAL PLUMBING to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 508 - F I NAL MECHANICAL (We) agree to sage, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said 509 - F I NAL G City in consequence of the granting of this permit. - APP ICANTUNDE '"-. f\T% 1 O r= N NG .4N17t�ILLCO�dPLY��'ITH.aLL\ SO C REGL'L: 'S. Issued Date . /.2�1� ignatu UFA icantlCo tracmr Date Re -roofs HAZ DOUS MATERIALS DISCLOSURE ' ill the app tc• or future building occupant store or handle hazardous material Type Of ROOF as a reed by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety .. -- - .......... .. -. - ., -_ .... .... .. - Code, Sectirn, 25532(x)?, ❑Yes 1�'No.` ' - "'•' All roofs.shall beinspected prior, to any roofing material..being installed. Will the applicant or suture building occupant use equipment or devices whim hazardous If a roof is installed without first obtaining an inspection, I agree to remove emit air contaminants as defined by the Bay Area Air Quality Management Diatr;et7 all new materials for inspection. Applicant understands_ and will comply with ❑Yes /�"° all non -point source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the - occupant of thTria"Iis which must be met prior to issuance of a Certificate of cupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Own r or fthorized a eat ate 'V FF10, E 9 ® CITYBUILDING ®�T° DIVISSIION BUILDING ADDRESS: PERMIT NO. 10407 SOMERSET CT 02010107 OWNER'S NAME: APPLIC TIONS DATE RODRIGUEZ JAMES J AND LORI 01%28/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLD ELECT/' PLUMB MEC L ell ' LICENSED CONTRACTOR'S DECLARATIONJob Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license ADD 18 O S Q F T . I is in full force and effect. License Class Lic. N i Date Contractor i ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records i Licensed Professional ' OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Conuactor's License Law for the ' following reason. (Section 7031.5. Business and Professions Code: Any city or county, $18000 i which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to fie a signed statement - - - • '', Valuation that he is licensed pursuant to the provisions of the Contractors License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt therefrom and the basis for the alleged ezemprioti. My violation ^ )•a1 - .' of Seeoon 7031.5 by any applicant fora permit subjects the applicant to a civil-perelry of not more than five hundred doylars (S500). 101ARN VOPhMAT ION - Occupancy Type ❑ 1, as owner of the property, or my employees with wages as their sole compensation, 1 02 — PIERS 'will -do the work, and the structurels not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an 10 3 - _ UFER Required Inspections Q p ' owner of property Who builds or improves thereon, and who does such work himself 10 4 — RE BAR or through his own employees. provided that such improvements are not intended or - offered for sale. If, however, the building or improvement is sold within one year of _ 1 05- — ANCHOR BOLTS _ Completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 — SEWER & WATER _01. as pwner of the property, am exclusively contracting with licensed contractors to 2-02 - 'UNDERFLOOR PLUMBING conswct the project (Sec. 7044, Business and Professions Code:) The Contractors 203 — UNDERFLOOR MECHANICAL' - License Law does not apply to an owner of property who builds or improves thereon, and Who contracts for such projects with a contractor(s) licensed pursuant to the. 204 — UNDERFLOOR FRAME ---- - - • - - - Contractors Licens 0 exempt erSm. B&PCfor thismason 2./� %6Z e. 205 — UNDERFLOOR INSULATION caner Date 301 — ROUGH PLUMBING 'WO CER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER I n Eby unser penalty ofper;ury one the following declarations: 303 — ROUGH MECHANICAL - ID I have and will maintain a Certificate of Consent to self -insure for Workers 304 — ROUGH ELECTRICAL r Compensation, as provided for by Section 3700 of- the Labor Code, for the performance of the work for which this permit is issued., . 305 — FRAME o _ '5_�I have and will maintain Worker's Compensation Insurance, as required by Section 306 — HOLDOWNS 3700 of the Labor C ' r the performance of the work for which this permit is Issued. 'on 307 INSULATION y Work s�ompeas Insurance carrier and Policy number are: = '•' olicyN°.: .308 SHEETROeI� t ERTER ATION OF EXEMPTION FROM WORKERS'- '30 9 '''P T1;R•I OIC-- I ATH• COMPENSATION INSURANCE ' 310 - -•IN:TE'RI.OR- LATH' r(Chis section need not be completed if the permit is for one hundred dollars 311 — - SCRATCH COAT rless.) �)or I certify that in the performance of the work for which this pertnii is issued, l " 313 '- ROOF -NAIL -•- .•--'- '-- - -- ':'- --- - ' snaR�hote employ any person in any manner so as to become subject to the. Workers' 501 — F I NAL EtECTRI CAL' ENERGY Compensation laws of California.Dare APPu�t - - _ . 5 0 2 - FINAL NAL PLUMBING _ ENERGY-_... _. . .... NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should 503 — FINAL ENERGY become subject to the Workers Compensation provisions of the Labor Code, you must .MECHANICAL forthwith comply with such provisions or this permit shall be deemed revoked. 504 — F I NAL BUILDING ENERGY, 1 CONSTRUCTION LENDING AGENCY t 505 — FINAL ELECTRICAL - I hereby affirm that there is a c6nstructiod lending agency for the performance t ofthe' work for which this permit is Issued (Sec. 3097, Civ. C.) 506 - GAS TEST ( Lender's Name - Lender's Address—.507' — ' F I NAL PLUMBING I 508 — F I NAL MECHANICAL I certify that I have read this application and state that the above information is t totted.{ t comply with all ci 'end count ordi ane and state laws relatin a� n Pr ty r a e� g 509 — FINAL GRADE to building conswetion, and hereby audwrize representatives of this city to enter upon the above-mentioned property for inspection purposes. 510 — F I NAL PLANNING q (We) agree io save, indemnify and keep harmless the City of Cupeitino against 1 Gabilites, judgments, costs and expenses which may in any way accrue against said 514 — FINAL PUB C WORKS City in consequentting of this permit OU 7 ! AND AND WILL COMPLY WYfH ALL N N -P INT le Issued b y' Date ,a r � sigttature cantfCo ractor Date Re -roofs f - H OUS MATERIALS DISCLOSURE 1 the [ fu — building occupant stole or handle hazardous material Type of Roof as defined by the Cupertino Municipal e. Chapter 9.12, and the Health and Safety Code, Se Yes tim 355;;2(-)?. ",0 N All. rpofs shall be inspected prior to any roofing inateriat being installed. Will the applicant or future balding occupant use equipment or devices which . If a roof is installed without first obtaining an inspeetion,'I agree to remove emit hazardous air contaminants as define by the Bay Area Air Quality Management Districtl all new materials for inspection.. Applicant understands and_ w_ comply with °YES _ill_ all non -point source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the CaBfomis Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that ifthe building does not currently have a tenant, that it is my responsibility to notify the occupa,q,tof the requit(!5Fi5—ts"wl7h must be met prior to issuance of a Certificate of u Signature of Applicant Date All roof coverings to be Class "B" or better Owner or au o ed Date �- -' OFFICE . i CI OF C'ISSIIONNOPERMIT BUILDING DIIV CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10407 SOMERSET CT 02010107 RODRIGUEZ JAMES J AND LORI g y AOlc/28/2002 PHONE: SANITARY NO. CONTROL NO. Z ARCHITECTENDINEER: BUILDING PERMIT INFO p BL ELECfj PLUMB MECy/' ,Os, C LPf i LICENSED CONTRACTOR'S DECLARATION Job Description O Ihertbyartim,thatIamlicensedunderprovisionsofChapter9(commencing Section 7000) Division 3 Business (� ADD 180 S 4 with of of the and Professions Code. and my license is in full force and effect. •FT. ULicense Closs Lia# Data Contract5DECLAr ARCHITECT he used 5 I understood my plans shall be useJ as public records O 20Or, SEP L Licensed Professional RATION Oat I am eUILDEour the I hereby .(Sero thin 1 exempt from the Contractor's License tow for the a following rtasoa (Section 7031.5. Business and io Code: Any city or county, $18000 which requires a permit re consumer, pplic improve, li o, demolish, e or repair any structure' it war,aY# m9 _ thathe slts cense career also inquires the of for suchpcmduofile asLndsmmmmt hper t thatheislicensed pursuant wthe pry ivisiof doe the Basi ro Uttnu Lawfnhapmr9 (comm enc is 7000) Coda _ ,tea. F,r �j e.. I1b Cr r�f?'7y-7�y1}lYy r{Y'„>,•;'��a'\., Valuation crem5ectiefr of Shatio 7 exempt Ianiefrom'and the .pees for the alleged ekdnpnoo Any violation omand thei basicor teaBusinecmNPfufesnyvi ” of Secnor fon drip it any hundred doll fora permit subjects 1M applicant m a civil penalty of not more tnanfnennndrca aouafa (ssmy 101APNftPjiQDATION tri. f.'L r Occupancy Type ❑I, as owner of the property, or my employees with wages as their sole compensation, 102 PIERS will do the 'work. 'and the structure is not intended or'offend for sale (sea 76L4. 'Business and Professions Cole: The Contractor's License Law does not apply to an —'-'-' 103 - UFER Required Inspections " q p owner of propcoy who builds or improves thereon, and who does such work himself 104 - REBAR t or through his own employees. provided that such improvements arc not intended or ':sAresd for sale. If. however, the building-" "' - t i5 said within one a -7 r5ain ob imen '- ' -'--"" "-- -BOLTS--- 105 ---'--ANCHOR' BOLTS--- completion.of pro improlve fare owner -builder will have IM1e burden of proving that he did not Budd °r for (sale.). 106 - SEWER & WATER , nwner of the pmpe6'y:emexclusively contracting with licensed contractors to. ___.._.__-_._—_..___ _ ..._.-_. .- -202 -__ UNDERFLOOR PLUMBING. .... C.ontan mct the project /Sec. TUU Business and Profession. Code:) The contractor, 203 - UNDERFLOOR MECHANI CALF ° License law does not apply to on owmf of pfopcny who builds or improves thereon, _.ane who contractsfor suchprojecm.with a mnamemr(s) licensed. pursuant. the... _suss.. _2.04' ---UNDERFLOOR -FRAME - Contractor, Lcns C', pefSK, :e&PCforthl,mann 205 — UNDERFLOOR'•'INSULATIONamim Daa' 217142 301 — ROUGH PLUMBING WO KER'S COMPENSATION DECLARATION 302 -, TUB & OR SHOWER 1 by tmanderpeoahy.nrperjmy6nFof,mefAl.wingd«lafaenns:- 303 ROUGH MECHANICAL , b I ha.e'ana•wsB maintain a Certificate of Currantm self -insure for workers _ 3 04 ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code. for the imformanceormeworkforwnirnmispermitisisaad.r.... 305 - FRAME 7WIh and willtodlnm wok C.6ponsition'I s farm req fee by s«tion 306 - HOLDOWNS 3700 f h Lothar C to ttrr mm a or the - work r which this permit . 3 0 7 - INSULATION sued y Work s pe I. u d Pul' y be ; tu', 308 =-SHEETROCK--,,,-..__... ... 3,) t ERTIFI ATION OF EXEiflMPTION FROM WORKERS" - '• ..t.'' > 130�9`'I-`t{EXTER-IOR 9•LATH�: - COMPENSATION INSURANC[ s A r _ _.. .._ _........r . �., .,..�lsi<atinnneeanmxcomplaedinnepermitia .........__._......3.1.0..',-,-'IN,TER'IOR.._.LATH'._--__.,.._.-..._..._....._,..____._...__..__.._.. for oncnpnarcaaal ars 311 SCRATCH COAT . I unify that n Ih ,performance f the rk r h ch int 'pe 'I isx d I ...-313 =— ROOF NAIL::._ . shall not ethpluy any person m any manner n as to Ween ge,puled to rap wofkem 5 01 — F I NAL ELECTRICAL' ENERGY cninij�tc inn l,pw�ofcanbtr 1 Data' - ..'Applicant. - '. - ... .._ -_. _ _. ..502 ._= FINAL PLUMBING.. ENERGY-...---. .._. ... __. NOTICE TO APPLICANT If. after making this Cenificme of Exemption. you should 503 - FINAL MECHANICAL' ENERGY visln, ohLitho, m Caou la ymust become sobject to the Worker's Compensation pmo fartbwuh script, with sdch provision, or this yermtt shall be aeeind (evoked. _____,504 -._F INAL, 13UI LD I N.G. ENERGY._. n r CONSTRUCTION LEN DING AGENCY. ' SOS - FINAL ELECTRICAL — 1 hereby affirm that there is a cbn,vuci m lending agency for me perfin-ma c ' 506 — GAS TEST of Ne work for which this permit is issued ISec. 3097. Civ, C.) : Lenders Name 's .._.__... __ suss . ... .. ...... .. . 507 — 'FINAli 'PLUMBING LenderAd Admss; ••' "fir rose 508 — FINAL MECHANICAL' hat I oak rcpa a firalmn'ana atarc Ina me.no. air maeoo is vp covecL•kagrce m comply,voth a city and county ordinances and state laws relating 509 - FINAL GRADE j tonnEgingcnmypniinn.ananerc.rpamfiefcpfeantanve.onnrcprmemerapnn 510 — FINAL PLANNING f7 the aMvrnociu mi property nion Fa for insperm,es. _ . L'Iwe,l6grtetosavCindemnifyanJkttphamlesslheCityofCupcninodgainst 514 — FINAL PUB C WORKS 0 liabilities, judgment, costs and expea,es which maty in ,my way deems against said City in Tonsequen e-# mins of this pemrii PCl(\NTI,>ER AND'AND WILLCOYIPLY W'ITH'ALL N'QN-POINT r ]ssuedb { Date DO MAI I s gnaarbvert mein(';,,' Data Re -roofs ' HA2A DOUS MATLRIALS DISCLOSURE the finfinuto hu IJ g occolintrit ,are h ndl hou-nion, m t nal Type Of Roof. _. suss . _ -.�.. , . , .. _ ...•.-._..._._. a deffirod by me Cuuneranto M p l Chapter 9 11 and the Health d Safety 1 „-r-,r \ Codesect zs53 I.. rII >7Y 1 �u a to I a I 1 I.} ', ,x: 1'.)', \ All roofs shall be inspected,prior to any roofing material being mgtalled_ •, W)II the ppi' t or future building occupant use equipment or devices which If a roof is installed' without first obtaining an'inspecnon;'I'agree'to remove lour harardous air contaminantsdented by the Bay Area A Quality M age t D'st tet n` / . Cl❑Y °' ' ' - '.." all new materials for inspection.Applicant understands and will co_ m_ ply with , 9� <". -', all lion -point source regulatiohs', I have red the homrdou, materials rcgtiircmcmi ander Chapter 6,95 of the ,I..', California Health & Safety Cole. Sections 25505; 25533 and 25534, 1 understand that --.the,u building does not currently have a¢mntme( that mycaminesibilitymnficat the 'atop .t of the req ' merits w �h mon be met prior m issuance of a Certificate of prior O_,a a Signature of Applicant Date _ All roof coverings to be Class `B" oi& better " owndr of an o d Dae.