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CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:-
OOILDING ADDRESS:
PERMIT N0.
10362 BRET AVE
02070096
ER's NAME:
APPLICATION SUB DATE
JANET LOWY
07/17/2002
HONE:
SANITARY NO. CONTROL NO.
ARCHITBCDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
LICENSED CONTRACTOR'S DECLARATION
I hereby arm that 1 am licensed under provisions of Chapter 9 (commencing
Job Description
p
with Section 71XXd of Division 3 of the Business and ProfemmosCode, and my license is
in Lim0Tom)and effect.
Liccftse Clan Lin.
ADD 593 SQ.
-
Dale Contractor
'SDELL
ARCHITECT'S
I understand my plans shut[ be used as public mcntds
L P
Licensed Professional
TI
DECLARATION
OWNER -BUILDER DECLARATION
I hereby affirm
11. exempt from the Conlnnors License Law for the
following mason. on ]1131.5. Business and io COW): Any city of county
which requires a permit t demolish,
vers de or repair any structure
Permit construct, alley, improve,
re h permit t
prior to its ceased e, also requires the applicant for such permit m files signed statement
that provisions (Chapter 9
Sq. Ft.
Floor Area
$656'AOation
(commencingwith hereon 7000) of the Business CM)) 0f
nandtfDivision3
vii
ptond Any
that he IB exempt therefrom end the bassi for die alleged exemption. Any violation of
eged
Occupancy Type
Section 7031.3 by any applicant for a Permit subjects the applicant 10 a civil penalty of
not more than five hundred della. ($500).
❑ 1, az owner of the progeny, or my employees with wages. maintain compensation,
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e cored Inspections
q p
will do the work, and the structure is not intended or offered for We(Sec.]M4, Business
and Professions Code: The CourtraiLicense law does not apply m an owner of
102 -
PIERS
peppery who builds or improves daemon, and who duessuch walk himself or through his
own employees, provided On0 such improvements toe not intended at offered for We. If.
103 —
UFER
however. Ne building or improvement is cold within one )car of completion, Ne owner.
104 -
REBAR
builder will have the burden of proving that he did not build . improve for purpose of
sal`.)'
105 -
ANCHOR BOLTS
t]1, as owner of tae property, am exclusively contracting with licensed contractors to
106 -
SEWER & WATER
conrruci the project (Sec. 70414, Business and Professions Code:) The Comorcum's LL
cettse law tlan not apply to an owner of propery who builds or improves thereon.and,
202 —
UNDERFLOOR PLUMBING
who contracts for such praecu with a conuacmrud licensed pursuant to the Conareclofs
203 -
UNDERFLOOR MECHANICAL
L' ensu Law.
me�s,c�mryI osdd� .B&PC for thinreazon
204 -
UNDERFLOOR FRAME
arc
q/�Y2-e�l�
205 -
UNDERFLOOR INSULATION
T'G�SR�CFR NSA o OF-cuRA
301 -
ROUGH PLUMBING
I threby Nims under Penally of perjury one of the following declarations:
302 —
TUB & OR SHOWER
Iem and will malumina C.nirc.m.f Coaxial to self -more for wafter. Compero
303
ROUGH MECHANICAL
satin.. u Provided for by Section 7]1X1 of The labor Code, for the performancc or the
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work for which this permit la isro)d.
304 -
ROUGH ELECTRICAL
t] I have and will maintain Workers Compensation Insurance, es myuircd by Section
3 0 5 -
FRAME
3]W of Ne Labor Cade, for Ne peffmor. of the work for which this Permit is issued.
My Workeb Compensation Insurance carrier and Policy number am:
306 —
HOLDOWNS
Cama,: Policy N.,
307 -
INSULATION
CERTIFICATECOMPENSATION IINSURANCE ON FROM ORKERS'
308 —
SHEETROCK
(Taissection need no he completed if the Permit is fnrone hundred dollars(SIM)
309 -
EXTERIOR LATH
310 -
INTERIOR LATH
1 c)nify that i the Performance of the work for which This Permit is issued. 1 shall not
311 -
SCRATCH COAT
employ any pc any manner, azuaMro csuhjecl In the Wnrkus'Cnmpensalion
Laws of Cg' am
pl
313 -
501 -
ROOF NAIL
FINAL ELECTRICAL ENERGY
Hpbg
ce/` LICANT: I1. aeg 113 c t¢a sempunn. you should
cs 3cctmlhcWorkcr'sCompcnsa7ionprovisians hclaMrcWe,ynamusl
502 -
FINAL PLUMBING ENERGY
farhwim comply with such provisions or this Permit shaeem
ll M ded mvnkcd.
503 -
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
Ihereby isaed(See construction agency ((it perli,rmnnccof
504 -
FINAL BUILDING ENERGY
YND.Cm.
thew0rs for which Nis permit is issued (sec. 7(197, Civ. CJ
whichm pronati
505 -
FINAL ELECTRICAL
findersNamc
506 -
GAS TEST 19-
Lenders Address
1 cenify that 1 have read this.,plication and stmt that the above information is
507 -
FINAL PLUMBING
correct, I agree to comply with all city and county ordinances and stoic laws relating to
building construction, and herchy authorise mprescnmtives of this city to enter upon the
5
FINAL MECHANICAL
ahave-mentioned property for inspection purposes.
F IN(We)
agree to save, indemnify and keep hmmless the City of Cupenino againstliabilities, judgments,costs and espensu wainamryin my way ettne against raid Ciry
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5N
G �QPPLIcomCANTC
Of the ronliag of UNDERSTANDSthis AND WILL COMPLY WITH ALL NON -POINT
Issued by5
WORKS Date
SOURCE P TIONS.
Q0_'
Re -roofs
Type of Roof
an ppf!l/Cmfluw1O1
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle har4Nous mammal
az defined by the Cup)rtim Municipal Cade, Chapter 9.12, and the health end Safety
ode, Section 25532(a17
❑Yes,
All roofs shall be
inspected prior to any roofing material being installed.
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or'fut`ure building Occupant use equipment or devices which
mit hareNnus air connminanu M defined by the Buy Area Air Quality Management
all new materials
for inspection.
strict?
❑Yes
1 have read Ne haardnus materials requirements under Chapter 6.95of Ne Column.
nits Health & Safety Code, Scebons25505, 25533 and 25534.1 understood that if th, building
does not cranially have a mutual. that it is my respensibibly to notif IM Occupant of thc
mquirements wit est mpoorm issa eif4 CCNrcamof upanc.
Signature of Applicant
Date
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All roof coverings to be Class "B" or better
Owners t orieed gcnl Dam
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