02040100 (2)Bt1IIAING DMSION
BUILDMOADDRESS:
OWNER'S NAME:
ERIC HO
PHONE:
G 0 ZO ARCHITECT E GINEER:
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t vi LICENSED CONTRACfOR'S DECLARATION
z : C 1 hereby aRrm that 1 am licensed under ptovisitem of Chapter 9l commencing
mFy with Section 7") of Division 3 of Ne Business d Pmfessimas Coda and my license
x g _ rs in f II rte end2Rect.
Lt parr Li. 5� 75sa
t, a D� Contrut OPT
Cut -
t, 0 �^- ARCH ll be used
as puARAicON t
u y 5 1 understand my plans shall be used az public records
a p O LK.— Profession,
OWNER -BUILDER DECLARATION _
I hereby affirm that I am eaempt from the Conuactor's Licerne law for the,
F ? C following reason. (Stenon 7031.5, Business and Pm&sslum Cade: Any city or county
s ¢ which requires a permit to conswcr, alar, in tae, demolish, or repair any swaure
a, 3 $ -Pn, to Iss issmnea, also requires the applicant fors«h permit to ale a signed uucmem
that he is lictdl{d ISwiujnt rolda P101{slums of rhe Conaanors License Law (Chapter 9
(commencing• willSOction ]OPD)of Di%ision 3 of the Busirws and Profasioris Code)
or than he is eaempt shefefrom and the basis for the aue..4'.'AA....: ._....:_,_:
❑ 1..., owner orthe propny, 0, my employees with wages as their ale mmpnvuan,
- M lit the work: wid she mrocture is eat finened or bR ted fat tittle (Sed. -704f;"
Business kiid Professions Coda: The Conductor's Lice . law does . apply man
owner of property Who Wilds or improves thereon, an who tl«s such work himulf
«duouggh his own employees. p ,bled that such jmprewromms an nu intended «
off ed fo - 1 .1(h ,the building prov.mem is sold within one yeti of
F66pledon, the owner -builder will have the b The- of paving has he did not build or
improve for purpose of sale.).
........e ---.:..__..........
ly .._.... licensed ❑n mownerbLthe'p(S..7(, 1. ,elusively with ll,-) tl Coaomrs to
comwn the projttt (Ste. TMA, Business and Professions Cade:) Th. Conrtacmr's
- -
License Law does not apply so an owner of pmpcny who builds or improrrs thereon,
.an.wM.<owacts.f« suet pnitans wish... conuacw(s) IieervN.puusuans.w due.
C«na Ms" Lineae Law. ; .. .
❑lam eaempt.. dide.Ste; •.. - B&PCfar than eason
owaer'.,::- "Dam ,.r.
WORKER'S COMPENSATION DECLARATION
1 hereby air. under peralty of perjury no of the following tleclantiort: -
^.: ❑ I have'and M"'Mainoiti a CcniEcate of Conserv to self -mann, fm works,
S Compcnerrim. 0 provided for by Section 3700 of me Labor Code: for'Ne
Perfdununce ofihe work f« which Nis parotid u issued.
O 1 have aril 11 maintin.W"" Compeh OldenIhiuiina. as requited by Section
_ 3700 of the Labor Code„for the p:tfo MaO,c of dh -M rk for which thus parotid is
;meell; My, Workers Comy,muldon Insurure carder and Policy number uc:.
C�ler MrYS___.� �� ✓_'"dm.�n ::.414 I)l a f.;''..
COMPENSATION 17JSURANCE ,
'tThis umion mead da be kompicied if the permit is for one hunded dollar .
fSIt10)«less.)
: �' .';l ceryfy that id uta perforrpanci or dic'wdrk }urs which this permit is`issucd. l
shall' nor employ any,persbn,in any manner so az m become subject m th'e Kbflicii
1 Compensation lives, of Celifnmia. Dam_ - ,
empcnsmron provisions of the tabor Code: you muu
Z 0
forthwith with'iubh provisions or this permit shall be deem ed evoked.
H rA �,CONSTRUCf10N LE1,1DL4G AGENCY
I hereby afl'rtn'that there is conssmd c�' o ]Ind. g agency for the peA'orman
W.. of the work for which this permh is issued (Sec J097 Civ. C )
G (a Benders Name
;)-Z LenderlAddress
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ceNfy than I have rend Jilt application endstam that the above information is
G Fr coned 1 ogee se mtoP.ly with ell dry and county ordinaocn ansate o ws relating
V' ro building cunsuumian,and h'eiebyauthoriuepmscnmuvis of this
W na-bona
city to pact upon
'he.b ned property for inspection puryouz _,
aF.. 0`1 Iiabiliti j(we.dgeetosave.lndcsntlify ind keep'hamJess the City of CopeNthoegainsd
3 gmenm, costs and -sparser which may in any way ecctueiegainan said
V� APE 1104.\qon a of:�-DERSthe O51;4\'bf'_'LLeC0311'L]s tsYTH etI.L .\'0\. L\'f"
RCE R� 'ATI . S. .
... ... / a
Sig'itatrthf AP m rector"..L.:_1''••.' ,..: .. .Date '.
RDOUS MATE7UALS DISCLOSURE
Wm rheapplldm tee future building«rnpont snore or hanleharaidous material
azar.,S by the Cupruop Muoidi Code, Chapter 9.12. and the. Health aniatcry
Cne. Spann 25532(.). -
❑Yo' No -
3Pu1 th apphcent o ban (ding ac pat us, equipment Or de es which
aunt hawdo.s .1a is ed b) Ube Aran AirQely Management
District?
0 yet.
flu
I. haw en the hue' out muesials 'Mranu is miler Ch ipw 6.95 ofThc
Cal�foraHealth & Safety n , Sections 15505 25533 an 25534. 1 understand than
if dhe building dnes not currently have a tenant, Nat it is my rtepom bihry m omifythe
oc. P I the equirtmcou wpiN'must be met priocm issuance of • Certificate'of
' OccuPanc -
Owner ter aria. agent w
Data
ION INC
210 SAN JOSE AVE #23
(408)294-6763
02040100
'Alt,
04/18/2002
BLDG ELECT PLUMB MECH
Job Description
UPGRADE SUBSt�—�,,FppL//ppO,,O��ttR, ADD GAS LINE.
FOW@7bYe LED
JUN 21 2002
I3dJIL®1RICa $10000
VaI
106"`-x"8ff t & WATER Occupancy Type
RTNC'
301 - ROUGH PI]R MpWO10spections
..3 Q2 . -_ _TQB DR-,
_..
502 — FINAL PLUMBING ENERGY
506 — GASTEST
507 — FINAL PLUMBING
i
Issued by: Date w
Re -roofs '
Type of Roof
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'reinove
all new,.materials,for ,inspection. Applicant understands
all arid Will -comply with, -,
non -point source regulations.
Signature of Applicant .. Date
All roof coverings to be Class "B" or better
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