07020111 CITY OF CUPERT!No
BUILDING DIVISION PERMIT <CCS1vTRACTpRII�k'OItMATI
eU1LD3N91`TY S6�ADA AVE TBD - TO BE DETERMINED PERMIT07020111
R'S NAME:
FERMrTESUEDATE
SANITARY NO. CONTROL NO.
ARCHITECTO:NGINEEIt: BUILDING PERMIT INFO
NEW 2 STORY TOWNHOUSE- BLDG ELECT PLUMB MECH
-00 LICENSED CONTRACTOR'S DECLARATIONQF
I bereby of iron Jul l we licensed under Provisions of Chapter 9(commencing ,^- - Job Description
who Section 70f110 of Division 3 of the Real.Md Pmfauluru Como,and my lice..is
in full forte and anect.
n�2 License class Lls.g
90 Da. Connoisseur
ARCHITECTS DECLARATION
Mewlatdul
I uml my photo l W u
used public mcordl
g XXXO Liccosed Prefeadanal -
SN OWNER-BUILDER DECLARATION
7 I hereby s171mt that 1 am eaempl fmm OM Contrunors License Law far the - -'
i a O fallowing moon.(Section 7031.5,Business and Pmressiuu Cade:My city Or county
131 which requires a permit to cvnsuucL after.Impress,demmlUb.or repair my mmtm
�' prior m its acumen,dm mquims bheapplicanl forsueh permit to file asignui suummt
�ssA that he is licensed purmant to the provisions of rete Contractor's license Law(Chapter 9 Sq.Ft. Floor Area Valuation
1-9 (commencing with Section 7000)of Division 3 of the B wines and Pmfesions Code)or
- that M is accept therefrom and the bub for the alleged osmpt au Any violation of
Section 7031.5 by any applicant far a Permit subjccu the applicant to a civil penalty or APN Number Occupancy e
not mom due fin hundred dollars(5500). P y TYP
0 I.u mm of ilia pmperty,amy mployeu with mgu u theirmle cmnpemdon,
will do the work.Md the mossy m is mtintenhd or offered for sale(Sm.70th.Business
and Prefesalons Cade:The Coruscate,Lummod Law does Out appy m an owner or Required Inspections
Property who Wilda or improves demon,and wMdoesauch work himself or through his
most mplaym,pmvldW that such improvements m Out intended ornBetad forsole.B.
In..the Wilding orbnproveusma is mid within oro yes of comPbtion,the ownm-
Wilder .Me burn tM Wrdeo of Moving that he did an,Wild or impure for purpose of
esu.).
•I 1,u mwur of the Property.am euludnly cuntraming MN licensed mntranan in
nstmcl tM pmjm(Sec.70414.Bola and Prefewma,Cade:)TW Commences V-
anse Law dm not apply.an never of prepmy who Wilds or Improves;themen,and
wine contrseu far such Wokce,Man a.=let(.)Rotund purism,us the Comm,&.
Lim ue Law.
[:3 11 under See _ BR PC far this moon
i �;,', /r^q
m / au —
RKBR'S COMPTINSATIOND LARATION
1 hareby alllrm under penalty or perjury ane of the following decal Wmu:
0 1 ban am will rott•Certifcau of Comm.,in self-loom for WoheYa Coup.
&Wm,as provided for by Section 3700 of the Labor Code,for the Md..at the
wart for which this M mil is issued
0 1 ban and will maintain Workers Cmpenudan Inturutee,as required by S.W.
3700 of the Labor Code,fn the perfamtmee of the work In,which this permit is hued
My Workers ComPm ucc m bmuame artier and Policy number nae:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flbu sallm need mtbecompleted Ute permit is forom hundred dollars(SIM)
car tau)
1 certify that in the p hies....of site work for which this permit is Wad,I shall am
employ any item.I.my...I f,co u u become Btbkcl1.lM Workers.Compensadm
Laws of I..D as Z )f- R
Appllra PP NT i�s
NOnC APP IL ager making Nu Ceniliate of em ttion,you should
became subject b the Workees Cmwoneso
pedon provisions of lite Low Code,ym
.,O foMwitb comply with smh provision or this permit shall W amused ranked.
y CONSTRUCTION LENDING AGENCY
[•+ I heathy dam des dem is a consuuaim lending agony,fm the perfermarm of
C
the wart for which this Mouth bland(Sec 3097,Civ.C.)
0 Lenders Name
Q z Lenders Address
U Q 1 certify that I have coal this application and sum that the.ban informant.is
{gv r+ Comm I agree to comply with all city and county mulnmas and sum laws misting as
Q Wilding conswcllan,and MmbymlMdse mpmmnuinsof this ciymemmfupnn esu
W above-memtio.d property for Inspection purposes.
(We)agree to ssn.indemnify cad kap homeless;the City of Cupmino against
v.v raj) liabilities,judgments.coats and aperoses which may to my wayacoma against mid City
V 7 A PLICA T of the treatingUNDERSTANDS
of this peril.
t� APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCE RE LAnONS.
/(-O$ Re-roofs
S gnstum ar pplimseXonusctor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(aunt Wilding acupont mm orhanalk haallou miedal
at defined by tM Cupenim Munic,"I Code.Chapter 9.12 and tM Health and Safety
.
Sevin.25532(a)7 /' All roofs shall be inspected prior to any roofing material being installed.
4
ov. ) .
Vill the applicant or rulm Wilding Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaNnw air couuminmu o defined by f Bay Ams Air Quality Management all new materials for inspection.
Dbuict7 (k-�
0Yes fgl Nu
I hove mil the hoardow materials requirements under Chapter 6.95 of the Califon.
.is Haalth@S.1ctyCode,Seen.25505.25533 and 25534.1 understand thilftha Wilding _.
dm not currently ban a Mount,that It u my nummembillty to entity Lite occupant of tM
All roof coverings to be Class'J¢"or better