01030183 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
944 MC CLELLAN RD # 4 PSG FENCING INC 01.030183
OWNI?R'S NAME APPLICATION SUIT DAPI[
33 N IOTFI ST 03/29/2001
41 HONE: SANITARY NO. t]GNgHDI.NO.
0 0 O ARCHITLCIAzINGINEER: BUILDING PERMIT NFO
z ❑ B 12LECI' PLUMB MECH
u U C J 1-1 U 1-1
FG n LICENSED CON rRACfOR'S DECLARADON
oo, IM1emb uflirmthatlumlicen,cdunder fChaner9 em• JobDCscripli ❑
Pnrvisinnsu 1 (rnm'In b
�ml-w ot� 11 ISectiun]INJfpnl i' n7nl Wp Businexsand Pndusslwn C,alu.an,l Ylicens '
�x=JJ i.il,r"°I''r::" L7� T ND FLOOR BALCONY REPAIR.
2 Liccns[s'��� / Lic.a I-
u 777 A CIII1'ECwo
I"5 DLChARATIO
S I undenwnJ my plans shall be used as public real ds
EKai Y
ca a p O LiacnttJ Profc,vitnai
OWNER-BUILDER DECLARATION
to=°m I hereby affirm that 1 am exempt from the Contractor's License Law fm,he
I-Z¢ following reason.(Section 7071.5.Business and Professions G,de:Any city or county
SSI
which na,une,0 Perot,lt i improve.dconolikh.o,rep' y;tructure
to Cc� On
on I ha y .,h [,N ca t f r. cM1 la u I '6 d't Icmem
e.3- ba,In, dP sun a ,h I nn ran C bacon's L1 (Chapter9 Sq. Ft. Floor Area Valuation
(con 'mg with S"lon,7111X00 Div mJ of the 11s nd Profimu Code)
Inacnp Lal, exit n
r Ina,lin In rapt thaetlmn 11.111 it,,nuns for the alleged usumpdtan Any vlolnam, ?
ofSadnu]11J ll by any dre doll ror n pLYmil nunjccfc ran applicant m u civil pnndty
tr m„Innen man five n,mereJ finnan IEs(XB. APN NumberOccupancy Type
❑ho ownerof the rrapen9.ormy,mrloyeex is ith wages as their sole owr, u,ion.
will do the work•and the emuamre is not intended or offered for sale(Sec 7(3m,
Business and Professions Code:The Comraaor's License Law does not oPPE,to an Required Inspections
ow r of fnnpeny who builds or im,rovo,hcreon.and who Js$=�'p01rg,rpyl
r through his own employees.p,ovlded mat such improvenim. FIRM, E® 101. — FOUNDATION
arfered for sack.If.however,,he building or imrm,,nom is sold within one year o
m„pmc rodnn.rap°wner.buddc,will navp the burden of pining mat he didnot�� Ja 1.02 — PIERS
tllr,tvr,rarpnxam'xale.k M1 2001
103 UFER
❑I.a,nwmr of Inc Pmpcny nnl cin,imc ply d Pod O,i,wet,licensed enmmnm'I m
n,cs, tea does rape.7044.H�mm�s.aneerty what c,.lea'np,eC,om+myapm', 104 — REBAR
and who
Law does nm apply man owner al.contractors)
who supra m im04jIL
and rant rs Li Wo for such Pmjeers with a ctmmnor(il licensed® n N�` 105 — ANCHOR BOLTS
Contractors
1 am`t,chnpi`u�derSec. .It K P C 6,r his mason 106 — SEWER S. WATER
Owner nide 202 — UNDERFLOOR PLUMBING
WORKERS COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL_
I wreny anion ander lvenally of,cjury one nt lop hent»'I ng deaarati°n.: 204 — UNDERFLOOR FRAME
7 I hnvu and wIf ucd,tnuin a Celdnewc of Cnmmul m m11:inwlm G,r Wmkcr's
:m,meml,rm,, as pn'vi,cd rm by Sadm, 77(X1 it rap Lou... C,Ide, rm me 205 — UNDERFLOOR INSULATION
�perf/orJmaacofinewmk l°rwhich n,i.pennnixi.wmk 301 — ROUGH PLUMBING
�(I have and will maintain Worker's Con,,,,,%%tion Insurance,m rcyui,eJ by Section 302 — TUB &� OR SHOWER
377MI of he Labor Gale,for the perRmnance of the work lin»hich this Penni,as
issued.My Wmkds Cml,leasadtn Insurance carrier awl Policy umnBmr am: 303 — ROUGH MECHANICAL
C...ie=L/u—1 ""nr"°'-1� 304 — ROUGH ELECTRICAL
CLRT II'A O UP-'%IiMPr10N fROM WIIR
COMPENSATION INSURANCE 305 — FRAME
('I hi, .,i...,mcdnnlbce°Illplctcdirmppenni,isrirm..hmadmddolla^ 306 — HOLDOWNS
($100)of losO ,
1 ccniy that in the Iter minince d the work for which this permit is issued,I "07, —
INSULATION
,na)net mnploy any petro,in any tnanmn w as n,becma•soh}pct m he Worker: 308 — SHEET ROCK
Applicant
pple canation laws of Culifurnin.nam
NOTICE 309' — EXTERIOR LATH
NOTICE TO APPLICANT:If.alter Compensation rah Cerwi,io sate of Latin,Coule.n.you should
femmes comply with
Workers cnionsattmn Permit sha nnnel.onedCole.yea max, 310 — INTERIOR LATH
Q Q rinhwith amply with sod,provisions at permit mull b:J«Ince rcvukN.
Z CONS1RUCI'ION LENUINGAGENCY
3]:1 — SCRATCH COAT
a1 hereby m onfl at them is it ctn„mmille Ending allIncy fill the pribltnance 313 — ROOF NAIL
r id tic work lar which Ihir I .,is Ix,ucd(Sco.3097,Civ.CJ
p LetWc„Name ,nmir 501 — -FINAL ELECTRICAL ENERGY
7 LLmecr',Addr,, 502 — FINAL PLUMBING ENERGY
V Q lemiymmlhave read,nisapplicminn and s,am that thcabove information i.a 50? — FINAL MECHANICAL ENERGY
Lsa t.. ttmod.1 agree n,comply is i,h all city and county wdirmwics and s,am laws,elating v
O t.� wbuilding construction.and bmbYamhorimmpresentative%otnhis61Yin enter upm, 504 — FINAL BUILDING ENERGY
4ti ,he abover,mntitned ProWnry fm impenimt Parynsen.
rA, (We)agree it)save,indvtnnityand keep harmless the City tit CuWaino against v —
m Irablhde,,judgment%.co.is and.,,,dws which may in any way acme against said 505 FINAL ELECTRICAL
UZ G,y in anseya ace abbe granting bund.per,n'tt. c
API'1.1 \N'1 cc DS WILLCOMPI, WITIIALLNON-POINT X06 — G 3'-�EST
SUU iRE JLATLON . l Issued by: Date
S.g line I-tIL I :m matin f�11tp Re-roofs 508 — FINAL_ MECHANICAL .
IAZARDOUS MATERIALS OISCLOSURH
Will be (carat lumen buildingt'ccupam.mm or handle h:vundum, incrial Type of Roof 509 — FINAL GRADE
m defused by the 'upcnino Municipal Core.Chapter 9.12,and the Ilcalth and Safety -
Code.Sm,i.25532(a)” ] t,I I Nth
0\'es �n All roofs shall be y�101? dee f Cl [tAQ n ,.[�" nghL 'l� [;et[1, installed
Will the at,Nleant°rfuture building occupant use equipnumt or devices which If a roof is,installed iv hout 5ht'Y1H�ain1'n� 'hSpeblYd 'T3gee to remove
land,emanons an contu Hurons us Jeli,md by the Bay Ana Air Uuxlity Management
ni,lri<l1) �N all new materials for inspection. Applicant understands and will comply with
6 yes all non-point source regulations.
Inave read the le-ad material,ttnryiammnn'undcl Chapter 6,95 of the
Calif°ruin Ileulth h S:dade.Smtions 25505,2553]and 25534.1 wrim y Coand Lau
it tv,kidding ducenm anent,banen temml,that it i,my responsibility u,antify the
nn,
`war
a rnyuircmyyy^^^ny�'�nus M mel prior m issuance of a Ccnifcate t(
Signature of Applicant Date
»ner m, ed a ,t Date All roof coverings to be Class "B" or better
OFFICE