02090195 cfrY OF CUPEWrINO
BUILDING DIVISION PERMIT 4CONTRACTOWINFORMATION
Bu14>6(BA50IsHENEY CREEK PL TOPOS ARCHITECTS INC PLRMITN®2090195
UACN]ACNBUE FRED C AND MICHELLE R541F COWPER STREET APPLIcAT`9IC`1/B)®s12002
PHONE:
(650) 327-7573 SANITARY NO.77 77 CONTROL NO.
ARCUITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Ip 0 j LICENSED CONTRACTOR'S DECLARATION g�y�
m u F I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing A D 288 SQ. FT 7�h 15p��r.7 1' Y
y¢6 with Section AMX)nf Divixinnlnl the Business and Professions Crude,and my licensers /f/J
F�4K License Class Lich
in full tome and effect.
N $ nate contmnm
ARCHITECTS DECLARATION ��
K z< 1 undecsland my plans shall be used as public records n
6p6U
It
Licensed Professional
LL 01 OWNER-BUILDER DECLARATION
ed<p 1 hereby affirm that I am exempt from the Contractors License Law for the
.a p O following massa(Section 7031.5.Business and Pmlcssions Code:Any city or eoumy $112000
K$E which requires a permit or contmal.aler,improve.demolish or repair any xvuaum
poor to its issuance,also requires the applicant lot such permit to Ills aligned statement
i< 'hat he is licensed pursuant to the provisions of the Conbacnrz's License Law(Chapter 9 33i12FY.8mo236A1@fl Valuation
al (commencing with Section 7W0)(if Division Sof the Business and Professions Code)or
we
pt 5 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not more man five hundred dollars(ssEBJ. PN N Occupancy Type
102 - PIERS
❑ 1.azhe work.and
peshime.or myemployeesoisewaguazMeiamc(See7 Business
will do me work.and the swnure is not intended proffered for sale(Sec.]04d,Business
and Professions Code:The Comractors License taw does not apply to an owner of 104 - REBAR Required Inspections
property who builds or improves thereon,and whodoes such work himself or through his
own employees.provided that such improvements are not intended or offered for sale.If. 105 — ANCHOR BOLTS
however.me building or improvement is sold within one year of completion,the Owner-
builder will have the burden of pricing that he did not build or improve for purpose o!
sale) 202 - UNDERFLOOR PLUMBING
'Les owner or Ote Prupeny.am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL
construct he project(Sea]044,Business Professions fessions Code:)The Comments',Lt
cense law does not apply to an owner of ImPeny who builds or improves thereon.and 204 - UNDERFLOOR FRAME
who contracts for such projects wit aeonvacmrls)licensed ppr:exam to me Contractor's 205 — UNDERFLOOR INSULATION
License Law.
❑ l a=e plpnderse, a&Pcmrmiareason 301 - ROUGH PLUMBING
rte 'Do 0 �9 302 - TUB & OR SHOWER
11 WORKER'SCO E s TION FRLAR 303 - ROUGH MECHANICAL
i veandyalermpnder ainaCenallyofpuConsincoflheroBowing nwokea.Cms. 304 - ROUGH ELECTRICAL
❑1 have and will maintain action 3700 of Cnment r Corensu¢for Workers ce of th-
satinn,as Provided for by Sermon 3710 of the Labor Ctdc,for the performance of me 3 05 - FRAME ,
work ser which this permit is issued. 306 - HOLDOWNS
❑ 1 have and will maintain Worker's Compensation Insurance,az required by Section 3 0 7 - INSULATION
3701 of me Labor Code,for the performance of the work for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy number am: 308 — SHEETROCK
Carrier: Policy No.: 309 - EXTERIOR LATH
CCRTIpICA 5FCOMPENSATION1ON INS RANGE ERS' 310 — INTERIOR LATH
('(Tis section need nor be completed if me permil is future handled dollars($10d) 311 - SCRATCH COAT
11f1C5ily 313 - ROOF NAIL
Ieenily that m me pertnrmamcn IIIc work redwarn this Permit erssnonFrosnino, 501 - FINAL ELECTRICAL ENERGY
cmployany persnn'sa yman m�lc� u 'fbl c tcrs'Compcnsalion
lawsofca W 502 - FINAL PLUMBING ENERGY
Anvheam c. fi prL�
No l tk L :Ila r akmg rs emficid rExemplipn.yousnpuld 503 - FINAL MECHANICAL ENERGY
koomir xNjoct to the Workers Compendium provisions of the lame Code,you must
pz forthwith comply with such provisions orthis ermitshall nedeemed mvnked. 504 - FINAL BUILDING ENERGY
Z
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
F
I hereby affirm that there is a construction[ending agency cor the FOrlormance of 506 - GAS TEST
C > the work nor which this Permit is issued(Sce.3097,Cm.C.)
Lender's Name 5 0 7 - FINAL PLUMBING
0
5 z Lenders Address 508 - FINAL MECHANICAL
U O 1 ce,fify mal I have read this application and state that the arrow information is 509 - FINAL GRADE
CnrtG'l.1 agree to comply en all city and county d more ccs and able laws relating
U building construction,and hereby sutho ourepresentativesofthiscitytoenteruponthe 5 FINAL PLANNING
amoc-oncalmned proNny for inspection pntlwscd.F 14 FIN PUBLI W RK6 0. (We)agree m save,indemnify and keep harmless the City of Cupenino against
V) limilities.judgmenoccoeu and expenses which may in any way accede agains.said City
U Z A cPLICAN cc of DERSTAN sal this permit
APULICARFGU LATIONS.NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
gnathre of App manvcommcior tip G Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant nr future building occipital score or handle moodous material
s defined by the CuPenino Municipal Code,Chapter 9.12,and the 11a111 and Safety
Ic,Scninn 25532(a)]
❑Ycd >(Np All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmardoes air contaminants as defined by the Bay Area Air Quality Management
Ui.arinl VWall new materials for inspection.
❑Yes .
I have read the hvurdouv remonal.stcquiremenls under Chapter 6.95 of the Califon
Iia I Icalth dr Safcry Gds,Scctinnv 255115,25533 and 25514.1 unJccsbnJ thm if tM hulloing
Jre not currently haw a tenant,that it is my responsibility m angry me n'cupnnl of the
rC a-msec \w t' mLLst ctp ((Ill issumcc rfa Ccmfico of Competency
Signature of Applicant Dale
carter or authodecd agent Opmc All roof coverings to be Class "B"or better