02080003 CI BUILDING DIIVIISINOONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20803 ALVES DR BLACH CONSTRUCTION COMPANY 02080003
OWNER'S NAME: APPLICATION SUB DATE
YMCA OF SANTA CLARA VALLEY 1650 LAFAYETTE ST 08/01/2002
I HONE: (408) 244-7100 SANITARY NO. CONTROL NO.
COO ARCNITECTtENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
has CI CI LJ L 1
O Zy i LICENSED CONTRACTOR'S DECLARATION
h o 1 hereby aRnn fat I am licensed and000000r provisions of Chapter 9(commencing Job Description
<-F� with Sec�Tfeo40(10)soflysnim.3 f,ha Bl!•g,and�Pe..'r i�o{ns tC�oee.and my license RELOCATE 2 EXHAUST FANS
zasa License qas, Li�c.pa /mo�i{,{t Q-T]C.D
X a. Data 0(j'-(-6Z ARCHITECT'S LARA1'ION Co.
"' S understand my plans shall be used az public records
oc
Rao Licensed Professional AUG 0 8 2002
OWNER-BUILDER DECLARATION
1 hereby idiom that 1 am exempt from the Contractor's License Law for the
,_Z< following mason.(Section 7031.5.Business and Professions Cade:Any city or county 10000
0 which requires a Permit toconstruct.alter,improve.demolish,or repair mlysWCNR BUILDING
on
.,Pd.,M its issuance,also requires the applicant forsuch permit o file a signed statement
14vbe'Islinnpuvant to the provisions yisions of Contractors License Law(chapter �s �sf p v Valuation
(commrriugBw� a
ilh Sccnon,7000)of Division Jof the Bu3ipessand Professions Code) t..¢�r"s`t`j'3LtQ}�`r(J"(J'91f._di:)'s2.tl..s''' '
or thai h6 is exempt ferefrbm'and the basis for the alleged rRentimad.Any violation
-of Smion 7031:5 by any applicant for a permit suhjab the applicant to a civil penalty-
ofnumorethanfivehundredaouars(s500). 101APN ATION a=xr-ur`o Occupancy Type
❑1,as owner of the property,or my employers with wages as their sole compensation. 102
- -
will do Thework:and'the'swcNre Is not a-intended".,offered'for ale(Sar:
'Business and Profession,Cade:The Om armrs License law docs act apply to an 103 - UFER Required Inspections lo.::a.:� r=
owner of property Who builds or improves themon,and who does such work himself
or through his own employees.provided that such improvements tintended or 104 - REBAR _
-oReand for We Ir however-the build i n- -old one f
It goburden of
yeldo 105 - ANCHOR BOLTS iarau l.• .i L.,, i`e:,;,•.O
iamp a ron,the owner b.,mer will have the burden of pmv,ng thm he die not Wild or -
mprovamrpumnseof,ale.l. 106 - SEWER & WATER
with licensed commaors mUNDERFLOOR-"PLUMB --'"'---"--- ---.—.--__—
bas owner of thepropcny,em exclusively contracting 2'02 - ING--"
- _ onswct the project ger,704J,Business and Professions Cade:)The Contractor's
__-- Limmelawdoesnotapplytoanownerofpropertywhowudsorimprove.thereon, 203 - UNDERFLOOR"1 ❑andI-who contracts,forsuch.pramst with.a comruito
rt1 a p.rt the ' ---UNDERFLOOR--FRAME--------
...aMECHANICAL,.
'ICAL.._—'--_-.._ ._. :.a
_Cnnuactor Lnto 204—
a p derS reason
_._....-
> ' t_ Ba&PCfortn ren 205 - UNDERFLOOR'1'INSULADION
ow er " file r ter•,:..,. f 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION
Irmi,MerPenalty,afpeerrvry -e of he '-- 302 — TUB & OR SHOWER
Ihcrebr
ga I Tort"`- 303 - ROUGH MECHANICAL
=G, I naK'a e'wirma8am':'cFmfi.ile of'coi.e to self-insure for Worker', 304 - ROUGH ELECTRICAL
Cmrpensmion:-azlprovided-fim by-Section 37W f-the tabor Cade, for the
parr.inns ee ofthe'wark rot whi<b dt�a p<m,�t is a.�,pe.:;,, 3 0 5 - FRAME
❑1 have
wand 11 malts work i C mpensat a 1 ranee az reg red by sac(on 306 - HOLDOWNS
3700 r f hbo'Cod f r f pcdomunce of th" rk fo h h this pain f is
ssdcd My workers C pe at on Insure d Pol cy x are _ 307 - INSULATION
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