020200893333
CITY F CUPERTIIoTG
C' PERMIT APPLICATION FORM
CUPS TINO .
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BAPPLOTHER,
Other Appliances
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Bldg .M
Boiler<= 100,000 Btu
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Boiler> IOOKto5OOKBi�
BBOILER3
Boiler > 500K to 1M Btu
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Boiler
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BCONSTAX,
! Construction Tax
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Elec, 600V <= I #It Y�
ELECTRICAL
BELEC1001
Elec 600V > 1 itt"
ELECTRICAL
BELEC200
Elec Svcs 600V tt .
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OFFICE - - '- -- - - - -
CITY
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DI ESIONO
BUILDING SIN PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
22199 HAMMOND WAY
02020089
OWNER'S NAME:
APPLICATION SUB DATE
STEVE & LISA CRAWFORD
02/22/2002
PHONE
SANITARY NO. CONTROL NO.
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ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1 hereby affnd that 1 am licensed under provisions of Chapter 9 (commencing
ithSection7000) 'moksion,
Job Descrip ion
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w' ofDivision3ofrheBuaQes and I Code. and myrc<nx<
I, in full for�a�onil efff(((�h T L/�
LQi,m1Jnu [IyR U7 ^ Lie M /
RETAINING WALL & FIR PLACE
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JS IT[CI"s DECLARATION
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1 unJenuuN my plans shall he used os public records
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Licensed Pmfessional
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OWNER - BUILDER DECLARATION
1 hereby affirm thin I am exempt from the Cm niom') License Law for the
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following reason (Section 7031.5, Business and Proessions Code: Any city or county
which to improve, demolish,
$14000
i3m
requires a permit construct, alter, or repair any structure
pan t t: Is rW t 'N PPI'canlor. ch pe mienfileasgud statement
.. ... .. .. .. ... _. .. - _
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{;1 � i3 Y•L''�t$V`18r� i_st••;. f. ll *t
Valuation
chath I e td puriWmmthepo ism fth C t cmn L¢ense law (Chapur9
(commencing with Sat 7") of D' J of the Businesl and Professions Code)
or that he rs excmpi therefrom and the basis far the alleged exemption. Any violation
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-of not come than iv a hundred doll rs (S50•nnit subj acne the uppliram to a civil penalty
of not nrm<mam five nanerca dollars (ssIXB,
l0i -PN ��UN�DATION
Occupancy Type
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01, as owner ml the properly. or my employcm with wages o"heir sole rompensation,
,ill do the work, and the soucmrc is not intended "or offered for sale (Sec. 70 ,
'Business and Professions Code: The Contractor& License law does not apply to an
103 - UFER Required Inspections' -
nwner of property Who builds or improves thereon, and who does such work himself
nnhrongh his own employees. pmyided that such improvements arc not intended or
'.offered
10 4 _ REBAR
for sale IL however, the balding mp mcm is sold within one year of
completion the ownerWlderwll have the burden of proving that he did not build or
... __ .. _.
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105 - ANCHOR BOLTS
m
improve mrppnseofsale.).
106 - SEWER & WATER
... , .. ... _._ exclusively . _ _. .._... _...
am contracting witbadens<dco
❑ga&uwner of the p(Sec.
— -
202 - UNDERFLOOR PLUMBING
-
the pm;eat (sec. 71 Buins and
Business and Professions Code) The tin
Contractor's
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cams c
to an od reon,
ord.mel.awduetfororytu.joels refprnpcnywbn
o
203 - UNDERFLOOR MECHANICAL`'
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aw.wno mmmds for such.pmj¢ts wiN a contmctor(s) licensed pursuant m.the
licenseimwu..tw.th.
enmmrtnr &wren &e law.
- `204 = UNDERFLOOR-- FRAME-
nlamexemptunderser. B& PC for this reason
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205 - UNDERFLOORt' INSULATION
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301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 — TUB & OR SHOWER
I hereby affirm under penalty of pe jury one of the following declarations:
303 - ROUGH MECHANICAL
Intuition 0 1 have and will aintain o Certificate of Consent to self-morm for Worker's
Compensation; as provided for by Section 37W of the labor Code, for the
3 04 - ROUGH ELECTRICAL
performance of the work for which this permit is issued.
3 05 — FRAME
01 have and will maimain,WOrkerls Compensation Insurance, as retuned by Section
3 06 - HOLDOWNS
3700 of the Labor Code; for the performance cif Me work l for which this permit is
iuyW My Wo k rs C pen Lion Iniumnce acre end Pocy mbar arc:
%LTG'' hUYd/Or'nhrrN
_ 307 - INSULATION
308;an :.
m«S
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ISHEETROCK r f w t
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4 CLRTIFICATION OF F. %EMPTI N FRQM.WORKERS l
-•� 3� i. } i Je Y
- F'XTF.'RIOR -LATH
o n' missocmnnnewnii icc ompledeah the for one hundred dollars
310,' -, INTERIOR LATH
permitis
,&
311 - SCRATCH COAT
lcc.nfy,thiin&prf aceofthe work 'f wnicht his proud iisruuen -I
3'1'3 - "='ROOF NAIL
shall of employ any Person in any manncraoast become subjecttotheWorLed
Compensation Laws of California . Data
501 - FINAL ELECTRICAL ENERGY
. Applicant - -. _ 1 ... ... _ :. ._ ...
_... .. .5 ... .. _...
02 "- 'FINAL - PLUMBING ENERGY---- -
NOTICE TO APPLICAN'll 11. after making this Cenificme of Exemption, you should
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hcioresubjecuo the Wmker'sCompens duon provisions o flhcLidsoCode, you most
forthwith comply - with provisions or Nis be d«
503 - FINAL MECHANICAL ENERGY
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such permit shall mw revoked.
504 - - -- FINAL BUILDING ENERGY,....
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CONSTRUCTION LENDING AGENCY
Ihereby alnuffirt di- is a construction lending agency for me perfommnce
ofN okfar whchN termisis &sew s« 309]
SOS — FINAL ELECTRICAL
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'Lenders Name ._ ... .._ .. ..: .. .... .. ..
,- . - .506...', -.. GAS_. TEST, . .:.. -.... .•.. ._. ... .
I'z
Lenders Address
507 - FINAL PLUMBING
i certify ihzt 11... read this application and state that the above Information is
508 — FINAL MECHANICAL
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ei recu -L ugree;m comply with all city and county ordinances and state laws relating
to building construction, and hereby euothe, representatives ofthis city to enrerupon
509 - FINAL GRADE
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the above mentioned properly, for inspection purposes.
(We) ague to save, indemnify and keep harmlem the City of Capeiiinoandust
510 — FINAL PLANNING I
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haul dgmemt rose and which may in any way accrue againmtsviJ
Cl m con qucnce of the gin ago,,, ' permit.
514 - F INA P I C WORKS '
PCICA P{JNDERST SAND LL COMPLY'wITH'ALC NON -POINT
Issued by:
.REGUI'ATI rrr' _
! Date
-
sigwturco heat n - •••...•
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Re -roofs
HAZARDOUS MA RI ISCI OSURD
Wllthe pphsantorfruebuilding ant store or. handle haranloismaterial
.Type of Roof_ ..
-
as defined by doe C pertmo Municipal Cad Chapter 9 12 and the Health and Safety 1. Code
355
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13 Yes o., '. -'e.' t I
tV 1541 Iw. ta. l
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All roofs- shall.be inspected pnor_to any roofing,matenal being installed.
Wilding
Willthe air defined
emit
If a roof is installed without first obtaining n ins ection; I a ree.to remove
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contnmorfumrt
hazardous air contaminants as by the Bey Arca AU Quality Management
by Bay AirQmlity Management nt
Disnicty " , ,
all new materials for inspection_ Applicant understands and will comply with
❑Ye& 11 No ..: •
1.
-
"all non -point source regulations
I'have read flo,burcordal, mmeri5ls uporemems under Chapter 6 9 of the
Calif. builth '& Safe, tale Seoul 5 25533 and 8534 1 understand that
If i , does note rrtntty h una t t t t s my respo b l ty t notify the
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cops n th y{odic m m to rousubc n p' to issuance of C nIficme .f
Copan l ` ' ,
Signature of Applicant Date
All roof coverings to be Class "Bo or better'
Owner mnuthnoted agent Uett
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OFFICE - - '- -- - - - -