03100169 CITY OF CUPERTINOth# n^aS m$b.t� TS7 .e `' '"` a vr•9
BUILDING DIVISION PERMIT CONTRACTQR INFORMATION "s;
BUILDING ADDRESS: RANDY A SMITH CONSTRUCTION PE1M1T N003100169
90670 HOMESTEAD RD
R'S NAME: 5662 LA RIBERA ST. #C PERMIT ISSUE DATE
GREAT CLIPS FOR HAIR 10/23/2003
PHONE: (925) 294-4340 SANITARY NO, CONTROL NO.
ARCHIT[CTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MF.CH
0 0 0
+00 LICENSED CONTRACTOR'S DECLARATION
to I hereby affirm that 1 am licensed under provisions of Chapter 9(cnmmencing Job Description
w with Section 7W))of Division 3 of NC Bu.iness Pr Icssimn Cook.inol mylicense is
+ � infullfnrceoa7erreel. / rQ(� TEMP PERMIT EXPIRES .11/23/03
�Fp Date Cunlr for
-FF7W RCIIITECrS DaE A ATION
1 K I understand my plans shall he used as puhlie mcmds
lyU
o Licensed Professional
Oar I am exempt
from
m Co Conti ON
i<O 1 hacior affirm Ihm I I.S.cxcmpn from de Codons C's License Low fur the
ore following reason.(Sectioto Co LBusiness and fee.dkiioli h.or re Any tiny or county
<m�+ which requires a Fermis m cnnssron,alcor.improve.Jemnli b,or repair any nmcture 3 2
ppm prior In its issuance,also re,uires the applicant for uch Permit o file a signed statement
that he is licensed pursuantto the provisions nr the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
sero (commencing with Section 9fiflf)ofDivision 3ofthe Business and Professions Code)ser 32610060 . 00
c
that he is exempt about and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
oat mom than fiat hundred doll..($50(1).
❑Lunwnerk,the property,res mycmDtended with wagesas late((Sec.
compensation,
will Pr fe work,and the alromart is not intended or Law
do for via(Sect oan,Business
and Professions Code:The Contractors and
Law docs not apply to an uwner of Required Inspections
propertywhobuilds or actions hunpr.endwho dttssuchwork himselfer Nmugh his
Own employees.provided that vete improvements art m year
fc m OBereA for owner-
however.the building or improvement is sold within ore Sear or completion.Nepose of
builder will hove d¢burden of proving that be did not build or impraw for purpose of
silo 1
Co 1,as owner of the property,.Business exclusively confessing with licensed conautors i ��\\\
ccrom La the project(Sec.nOla. neerand property
whtipm Codc:)The Csnfedmon. dd
came law docs not apply m m owner of pmpcny who builds or improvers Ncmon.and.
who andcontracts
exempt
for such projects with a canfeanor(s)licensed pursuant to the Conaaeason
License Law.
C I am exempt under So. .D&P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of Perjury ane of due following declarations:
1 have and will maintain a Certificate of Consent to uiOinsute for Workers Compen-
sation,as provided for by Section 3000 of the Labor Cade,for the performance of the
work for which this permit is issued.
❑I bare and will maintain Worker's Compensation Insurance,as required by Section
37IID of the Labor Code,for the performance of Ne work for which this Permit is issued.
My Worker' �nm}pfens�aninnlnumntt cartiM and QyRtfroad ram:
Policy No,
CseNer. / FU
Ver CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(This section need non he completed If the mmol is far one hundred dollars($101) _
nr less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as M Whom subject no she Workers'Compensnion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O forthwith comply with such provisions or this minor shall be deemed revoked.
Z= CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constom in t lending agency for the Performance of
the work for which this Permit is issued(Sec.3097,Co,C.)
Z1 A lenders Name
Z Lender's Address
O 1 eddy Nat 1 have read this application aM solo that the above infmmadun is
y F" correcL I agree to comply with all city and county ordinances add sate laws relating no
�O building construction,and herebyauthorim representatives of this city to enter upon de
„4 above-mentioned property for inspection purposes.gree m ss pe
(We)asave,indemnify and keep harmlethe City of Curtino against ,
r ,, liabililles.judgmcnts,lostil dcape.which may lin soy wry accrue against said City zw7
Z
J in
APPLICANT OUNDEof the RSTANDSof IAND WILL MPLY WITH ALL NON-POINT Issued by: Date 7
SOURCE G S.
b Re-roofs
',5iIilodurc of ApplicantiCommcmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle Imlarduus material
dermed by the Co,enino Municipal Code.Chapter 9.13,and the Health and Safety
c.Section 35572(.)? All roofs shall be inspected prior to any roofing material being installed.
p Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant Or2ur,building Occupant use equipment or devices which
Cook haiardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection..
Disarm? 1J
0Ycs
1 have mad the haaardous materials requirements under Chapler695 of the Cild[m
nix Hesllh&Safcty Code,Seetiwu 255115,25573 and 25534.1 undermind that Bthe Wilding
C.non currently have a moan,Nal it is my respm.ibility,m ratify Ile<uPant of Nc
quire eats hi maatbcmetpriar iasaanecaraeeNr¢.¢ar0.epanay. Signature of Applicant Date
!'B All roof coverings to be Class "B"or better.
Owner or authorized agent Date
Nov-18-03 13:55 From-Kinko's of Cupertino 408 777 1000 T-614 P.002/002 F-110
CITY
w DPs �V G` ��I[R-11 ° CLO.R%I FMR nT
loPEP-NITeutcw
rERMrrNo.
DU1LD W 0 AODRF35;
20670 HOMESTEAD RD RANDY A SMITH CONSTRUCTION 021001.69
5 NAME; PeuVlr ISSUE DATE
GREAT CLIPS FOR HAIR 15662 LA RIBERA ST. #C 10/23/2003
swNrrnRY NO. CONTROL NO.
PHON'C:
LIVERMORE, CA 94550
BUILDINO PERMIT INFO
ARCHITBCDEHOIN'EE0.: PHONC�+: BLDG ELECT PLUMB MECH
TEMP PERMIT EXPIRES 11/23/ 3 C� 0 0-
�O J a „ .4 ti^ -A r + ,3"'�? f. TO ARRANGE INSPECTION JOB DESCRIPTION
3 jNSP Gx10i$' .'•,.a'+ty Y"'}6 tD4t D LSPEC; CALL 777.330 MONDAY-FRIDAY 24 HOU A cTn N 1
�;f kb�(iN'�tI` ?xavd til y' tx JY i' '''P�r":JN�Ii '.�li "..: BEFORE RBQUIRED INSPECTION.JOB ADDRESS ❑ SPDWL ❑ KITCHEN REMODEL
AND PE ARE NEEDED WHEN PHONING. ❑ADDITION El PLUMBING RE-PIPE
p'- I FOUNDATION/PIERS/H.D.S. Q MULTI-L•Nrr 0 STRUCTURAL
UFER GROUND MODIFICATION
Gl PADIS TBACL-CERT RESIDENTIAL_COMMERCIAL—O HER_ ❑ INTERIOR O CHIMNEY REPAIR
Eng GARAGE SLABSIMEGUNITB IMPROVEMENT Li DEMOLSWTMITIONNG POOLS
,y +-9ARrN1Uc F771 RFs Q DAT11 il'.MDDELRLEPAIR� DEMOLITION
5`o-ipOLK'NQ'GONORP,TEUNTIC'.:S fJYEfiA'S:B,BE^(57GNED.*` 7 Qo7hlER
�CCS� UhDERG ROUNDr$LAB �TEi Ifres•IundGmQna oaza CoU A roof nmmoll IS MgViNa.
730, UNDERGROUND PLUM31NG G ND mluzl I[.B.o.x
UNDERGROUND ELECTRICAL
.. !_ F '" 1�K=IN RMFCOVERINO ❑ NEW BLDG/ADDITION 0 DEMOLITION
I:DO;^(VI'�FPUR}F.000 UNT.fL tiB'VE:+ S;B..F-N IL+VEU>+a CTENANT FOOD SERVICE
UNDERFLOOR PLUMBING T— Number of adx+inC co•crinCz IMPROVEMENT
UNDERFLOOR MECHANICAL CI
UNDERFLOOR ELECTRICAL To be remo+ed Taba re,uned
UNDERFLOOR FRAMING VENT'S
UNDERFLOOR INSULA7]Ov .
r a e I" LTi, TYPE OF ROOF COVERING OpOc D
¢F?L:AC�L YOSUBFli00 Jti"I�1L,�BOyG,1410I'811 ST- NED1:+:;' F?Clr Nn. emoorarV Permit �—£-
ROOF SHEATWDIAPI.RACM (] Buill-Up �= IlAt-Up Roof
LUMBING — ❑ A:pholl SryloWafed prior to plan check c �Gtii311 as
TUBS&SHOWER PAN JDU n
'
MECHANICAL Wood ShaLbntractor and/or Owner act° n kleb
C)CTRICAUPOOL BOND wood Shin Icz
.AMINO/STAIRS/E.EGRESS - -O ❑ 0'%u t5 ponsibility for correcting ,
I INSULATIONYVENTILATION omissions and revisions on P,.,Id,I.e.o.0,Repan No,
pOv�12<YO}WORF;UNTILX34VB.THYAS�BFBNIS[GNER.+i°','u IlI9 completed Blue Print. Pre.lde Mfar,In:mlluuon Specs.
EXTERIOR SHE.ARJHOLD DOWN
INTERIOR SHFAR/HOLD DOWN pSPECt10N S PCT f�IIIRE�' a'-Zj Z7➢� INsr
SEISM- OCKISHEETROCK SHEAR I
EXTERIOR LATH(W-SCREED
SHOWER LATH
PJQ.7,4PE!Cj$'IPI•"iSSTERiUI•J'1;R:,;�SBOVfI�FlA59F,E�iSIgNE�(��,q'I ogna re
SCRATCH COAT
SEWERYWATER WW /l
TCMPORARY APPROVALS Y
OCCUPANCY
tis I
F�. PLANNING IMPORTANT 777.7708
TESi
y, a GAS T
lit GRADE408)354)
D z F[RE-CALL(a06)770-x010 When a permit has expired, a charge totaling one-ha '
0 HANDICAP the fees to obtain a new permit must be paid to
O ELECTRICAL reactivate the permit.
G PLUMBING
MECHANICAL If a permit has been expired for more than one year, a
ENERGY
VISUAL FINAL ONLY
charge totality the full fees to obtain a new permit
BUILDING must be paid to reactivate the permit.
PoO CLNINC OF+3UILDIAG IS NOT PERMITT D`', i�''ITIV'r'; ❑ Initials
�L:NT14 UCSLDL' G TlNJtiLlsijIGIED BYfBC!ILDI r r",1'
J %' d 'fx ,�^Il`4 yy,,��rv�xia CERTIFICATE OF OCCUPANCY
sP9,TORy�V'., ii7+i .i¢f:il, 1 r�it�l. � ..67;ii���hA���w
r PLYWOOD: IN-PROGRESS;
PAE•IN'SPECTION:
IN5P. DATE INSP. DATE INSP. DATE
TNR OFF INSPECTION: BA772NS; FINAL:
INSP, DATE INSP. DATE _ 04SP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION