01110116 CITY FG DOPERT^NO
ION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22265 CANYON VIEW CL 01110116
OWNER'S NAME: APPLICATION SUB DATE
SHEPELA JOSEPH C AND KAREN S T 11/27/2001
PHONE: SANITARY NO. CONTROL NO.
C ARCHITECDENGINEER: BUILDING PERMIT INFO
m- BL- ELECT PLUMB MF.CH
U
<<u CI_-U L---:1 L_]
S v= LICENSED CONTRACTOR'S DECLARATION Job Descrl tl'n
i¢N hereM1p affirm,hat 1 am liccnutl under provisions MChap,er 9 kommencing P
.Htw 'c<,ion]o00)ofDlv"mo3ofineBusiness and fe„mn,adeardm,Iiccn,c REPAIR GARAGE. /
x E bo n fail fors,and erre ''') ' Z
.p6� erase ygsi / Lie.n '/ F'INNNiLED
i 3 G
he_(( /n• 5 DECLAr N
.LLC ECT'S DECLARATI N
5 1 understand my am that]I,used as public record,
`Ear
i 6 p C Licensed Professional AUG 2 7 2002
c
as chat I a. oem,IBUILDER m the CNATION
=' 1 reason.
affirm,hat I am tempt from the Conueao Code:
Licence Law for,h<
H a following restart.(Semon 7031S.Business and ve.de o li Code:Any city or cuing' $3500
Y�o which requires a pcmti,to runs,run,alter.improve.tlemali,n,or repmr any swmurc BUILDING
yd}3 m _prun , q theapplicantf such permit fl signed statement
- -
that he :licensedp'rs ant t6 4W ponodons of me Contractors Lt enx La (Ch pmr9
- i , . , T(Iota gwith )000)of Division 3o h B , ndProfes Carl,) `t3 s " Valuation
Or that he is caemV,,here(oat and,he buss for the alleged ciampoon.Any violation
-of Section 7031:5 by oily applicant fora permit subjau Ne applicant m a civil penalty-
•of no,more hum five hundred dollars($500). 10tPN T' DATION ' "'' '" Occupancy Type
111.as owner of,he property,or my employees with wages as their ok compensation. 102 - PIERS
will do the work.andthe,waare'is nWinteni or offered for sale'(Sec.7014,
Be,incss and Professions Code:The Commcmrs Licenx Law dost not apply to an 103 - UFER Required Inspections' '
owner of property Who builds or improves,hereon,and who docs such work Almx]f
orthrough dfor his On cm ever.th Kildin that mpoWinnnv<meou are net intended or 104 - REBAR _
-offered sthe: wneirwevec the Navin ebim its sold-within-one he
did ane W mor ._.
go pm,<m"' w r• 105 - ANCHOR BOLTS
iompleaon,me owner-wiener will have rile hums nrpmwng tat,rte ala not Huila or
mprove for parpox of sale.). 106 - SEWER & WATER
_ . ase ne --prop r_._...._._.._...---- -"" h . -._.._anno -
" --'- --
oLauownernfine o g 202 "UNDERFli00R`PLUMBING
property.r.oat exclusively contracting with licensed ronvacm^,o ---
onswnthe prosesISee.appl to
Business and eProfessions bildsorThe contm<eon, 203 UNDERFLOOR MECHANICAL' I'
License Law does no,apply m an owner of property who builds or improver thereon, � r
1 _ ..and who contracts for such projectswith a com uctool licensed,pursuant to,he .....-
204 - -:UNDERFLOOR' FRAME
111 am &
tars License L.w.,,
Convac
exempt under Sec. " ' �BPC for this octrom 205 - UNDERFLOOR INSULATION
ow"et `Dd1e3 O l - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty of perjury.one of the following eeelaraions: 303 - ROUGH MECHANICAL
0 1 have and will maimain'a certificate of Conxm to self-insure for workers 3 04 - ROUGH ELECTRICAL
Compensation, a polished for by Section 3)00 of the labor Code. for ,he
. - Redormance of he work for which this perms is i weed. 3 05 - FRAME
111 have tl will maintain Worker's c "penmt Insurance -
,as q 'redbySection 306HOEDOWNS
37W of to L Coder thePerformance of to work m which this penA,is 3 0 7 INSULATION
ixxtied My W C pe : race came d PoIicy W,are.
308• - SHEETROCK
RTIFICA N E%EMPTIONFROM WORKERS l ' " IT"091--EXTERIORt•LATH'
MP ON INSURANCE,',_, _;- :_ ..
_ ---310-,-,- ':INTERIOR--LATH... ,
(rh s'scclion Had no,be complec` if the permit is for one hundreA dollars
(sllrowness.I 3117 - SCRATCH COAT
baomehrthis
bI ,permit
Work ca 313 ROOF NA-IL
1 c fury that' theperlorm f the work f pe ssued,l
shat mplov ylx o" 501 - FINAL ELECTRICAL "ENERGY
Compensation Lew,of California Date
Applicant -. 502. - -FINAL . PLUMBING. ENERGY
NOTICE TO APPLICANT
F - making ceerpaoeE< pr y -rnpulst
M1 subject he Wok rC..,mumnp rat of Labor Code you mus,
5
Ororthwwm<o ply' en.a rap nrat pemt nmltheda a ok a03 FINAL MECHANICAL' ENERGY
z � 504FINAL BUILDING 'ENERGY,
_
_ 'CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL •'
- '' I hereby'affirm,hat the i...bovneaion lending agency for the perfornanee 506 - GAS TEST _
Of
work forhich thispermitsissued IS - 309] C'v.C.1
L Q Under',Name ... .. .. - .. -. _.
507 - FINAL PLUMBING
Q z Lende s Address
-' -
wo I 1 certify that 1 have read this application and sude chat the above information n, 508 - FINAL MECHANICAL
E.,
correct I agree to comply with all city and cuumy.o dipancep and state law,relating 5 0 9 - FINAL GRADE
,o Wildingro , t ,a tlha by doiiu representatives of thistyroenter,
W ^eaw " ? mp^rf9 p ro p o 510 - FINAL PLANNING "1
F. 06 (W) 6 , dpn fy and ke pharmless the City ofCartoon,against
-Z lmbtl, y,eg t. eats xxswn which ywy are.,"ain't 514 - FINAL PUB IC/
WORK
U'z City
m pNT 11 ri R , or, ILL
AP,PL1`gil+'iT tl ERS' ND$ WILL COMPLY WITH wI.I'NOv ol. " Issued by: Date iZ
SO ERF NSr/ .,�—'
i"auto of eam/com etor •. ••.. • .D e Re-roofs
"' - 41 ',,',I";' HAZARDOUS MATERIALS DISCLOSURE'
.' ..Will the ipplk mor future building acenpam amen or handle havrdous ma,enal Type of Roof -
as&r, W by the Cupertino M n Pal Code Cn pm 9.12. d Ne Health and Safety -
Code.OYn25532( )' 0N14'' a- i I :C.•.l„(IS>i � ♦i f '.i Lv:tb �_� '... e '.
All.roofs.shall be Inspected.prior to.any-roofing material being installed.
Will the applicant orf to w la'd byte tuxequipment e< -«s which If a roof is installed without first obtaining an inspection, Lagree'to remove
it h.Will us it contaminants orrod eacfncdb)th day Ar ea AirDandifyeaccs hickrnern g p
°"d`" ' ' _ all new materials for,inspection.. Applicant understands and will comply with
ONO all non-point source
�Y6i,`•' regulations; , .
have repo the d u. erials eq a ems under ChBprer'fi 95 of the
Calrfom t Health&S y Cade: tions 25 533 and 25534 1 ua rshand that
if me ng dos cunenI ave sten et ijinrnyrer osibiiit nnmi the - -
occu
to the r mems icn w to issupo of die of
e
My. � Signature of Applicant _ Date _
tum aeaagent to All roof coverings to be Class "B" or better'-
�• G l .. _ _ OFFICE