02080169 CITY OF CUnPERTTINO CONTRACTOR INFORMATION:
BUILDING PERMIT
BUILDING ADDRESS: PERMIT NO.
10231 BUBB RD 02080169
•93�I�A'TEO DEVELOPMENT CO. APPLICATION
/29 /2002
r PHONE: SANITARY NO, CONTROL NO.
M-O ARCHITECDENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
z v 1 n<rm ram,mat 1 am nremaca.wer Job Description
o z:o hereby pro Pimns.fs,Coda.and my Horing TENANT IMPRVOEI ���.®
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with Section of Division Sof the Business and Rvfcssiom Code,atWmylicenu
m f is in full force and effect.
z s a License Class Li,x
a,is a.L' Date Contmrmr 2003
a a0 t�i: ARCHITECT'S DECLARATION
y 'A l undo da Ions ahaY'bc usee as public rccnNs APR 2 1
E:
0 �YEf4 d Professional
1 OWNER-BUILDER DECLARATION
=' I hereby affirm that I am exempt from the Contractor's License law for the owBUILDING$3000
afollowing reason.(Section 7031.5.Business and Professions Code:Any city or county
E o which reclaims a Permit construct,alter,improve,demolish,or repair any structure
z .at rcs
qume applicant for such Permit fl g dominant _..____
d3- that KgsDetailed pitpmutomeprovisionsofthe Contralto License La (Chapter 907 can 1 Valuation
(co m g ,lh5 .o ]040)ofDvismn3ofineBun wP re nnscode) I�'.{,'.;y"t'3,5 PbLb it � etie�� 1 �L.'`s:
or that he A exempi thfrefmm and the basis forme alleged exdmpuun.Any violation
of Section 7031.5 by any applicant for a permit subjects me applicant m a civil penalty
of not mom man five hundred dollals($5001. 101 APNIN9I9k�9ATION Occupancy Type
❑1.as.wall of the progeny,.rmy employees with wages milieu sale compensation, 102 PIERS
will do the work.and the structure is not intended of offered for sale(Sou]oat:' 103 - UFER
Bminei and'Poidessions Cak:The Contractor's License Law does not apply to an Required Inspections -
owner of propeny Who builds m improves thereon,and who does such .,it himself 104 - REBAR
or thmu h his awn employees.provided Had such improvements au not intended nr __
8 p n 3,no of
drcered or sale Ira me Wadi roof pont le :mdnot 105 =ANCHOR--BOLTS I -
completion.oemcxwn h 'IJ will have burden of Pro+' gm that notb ne.r 106 - SEWER & WATER
improve for puryou of role.).
oY;:'Owneror�6ropely,amexciu.iviycontrartingwthlice�edcon�ci�ta -- ---UNDERFLOOR-PLUMBING-------- c-_,.:.-1, CF: ''rti -
_
construct the projm IS=.]094,Business and Professions Code:)The Comracmrs 2 03 - UNDERFLOOR MECHAN*I @AL '•'m ='I'
License Law d.ea nm aPPIY ro an owner of Propeny who Wilds or improves thereon,
.P.0 ...and_wLicense
foe such.projects.with.a.commcror(s)..liccnsed.pmmnm.to me. ___ .._.__2.04___. -UNDERFLOOR-FRAME---- --------------------- ...._._
Contractors L<en la 205 - UNDERFLOOR"'INSUL7�TION
❑I ee pt anile -------- B&pefor tai..reason -?. ,
301 - ROUGH PLUMBING
.. WATION DECLARATION 3 O2 - TUB & OR SHOWER
�•� 'hercnranim, JrPon ayy.rpefry''e.nnermlawinga«Lmri.�::-- 303 - ROUGH MECHANICAL
❑ I haar'and will maiii6m n Certificate Of e.num to:elf-inn..for worker,
304 - ROUGH ELECTRICAL
Compensation. as provided for by Section 37M of the Labor Code, for the
-- - - 'performance of work par which mi.pest is issued. 305 - FRAME
- - ❑1 have andillmom em workers Cart swi all on Iowmnce,as requircG by section 306 - HOLDOWNS
- 3]fk)or the ISWi Clad,for the performance or me work for which this permit,is
307 - INSULATION
s d MY WCBRYIC pe i 1 zu ac and P I
3.08 SHEETROCK'._.
Camert Ft`. ai.1 't IP
Policy No.: ...:7 I \. .r1.
FlCATION OF EXEMPTION FROM WORKERSI t t..� r. 30:9_ _.JEXTE'I�'IORiAli TH'� :
COMPENSATION INSURANCE„ - - 310" _---j'NTER'I OR—LATH "- ------
IS loff
rnlcsa 't 'needna,be ampleteddmepermit isforan,hundred Johan 311 -SCRATCH COAT - C `t. +•;, e
._:7 n[enh kr le w -si- - ....- .-.'_3.:13. ,:_.,_.ROOF•-NAI_L:,_,.. - .' .__ --._._ ._,._.__.._..._ . ..
sn II II nry,, the yerr�in which n m 1 501 - FINAL ELECTRICAL ENERGY '
G mPensm AP IC Cl a .d'�wl°br°�`t�" _-... _.5.02... -._.FINAL .PLUM13ING. .ENERGY..___....-. _
.Ay m�1a9a>!
•NOI/QF TO APPLICANT If n mkt gvilI-nfam rE pti you should 503 - FINAL MECHANICAL" ENERGY
Z beA$pe'object i the W k r' Compensation pro ni of dr LaborCone you must -
O O roan th comply nh suchp isions or this permit shall Im deemed resulted._ _ 54 = .,FINAL_ BUILDING ENERGY_
a 7 " CONSfRVCTION LENDING AGENCY '..`� 5... - FINAL ELECTRICAL - -
�' 1 he sty ffsm that them n t a ding ag ry for the performance I
',Of works' nthm pandit issued 309] Cis. 506 - GAS TEST + f' '
:Ty.q Lear Nam 50.7_..=--FINAL-�PLUMBING .,
z tend r Addrc.
UO nrym'tlna meant pp!<t eattmatm e. nr- nia jOrFINAL MECHANICALI comet l ag t reply ph 11 c ly a J o Iy d tic d o t I s r rating INALGRADEO. pctbulangc t ion dhinti th iA p taivc rte tygandSakty.
0 _ INAL P NG
�,,, fsl me W ed property r poet n P q
` 0. (We) gee to s se,Indemnify and keep harmless the C ly of Cu51 - INAL B RKS
L (n liabilities,judgments,costs and expenses which may,in any way acw
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City in
'b EANT RE(USDERON!i [A�Dr0.1LL<CONPLYWITNALLhOIssuedb0 ERE( ILkTIONh� yDate
loIjgn1eawc mrict r Re-roofs
HAZARDOUS MATERIALS DISCLOSUwllme pplicmorft Wld gacco, ton, handlehi=a .Type of Roof.. _ _-'asaf dont CliPen Mncpal Code Chpt 912 ndibeH y n3 t a a.�`; _ '. �- --r
Coda S❑ecY 25$1211 1�N,.1 sl;.:t,UZ,xt1 iI`4i ,sit
I i . 7v orf , •
all new materials for,inspection. Applicant understands_and will co
All roofs shall be inspected prtor-to.any ioofin material being installed..
Will m pplic t f buildingOccupant equipment Je ces h¢h If a roof is installed w)thout first obtaining an In$ ection, f a ree'to:remove
m.hazed cont ,s sidelined by th B y A a A Q I ly Menagerie nr g p g
District? )VO a- 1 P PP reply,with
❑Vc
all nofi-point source regulations.,r,., ; ;'I ,'r+
I have mai harardous mammals rola remems and Chapmn 6.95 of the
Qat fomta Hwlth&5 fety Cale.S«tions 25505,25533 and 25534.1 Memo d that
.]f Ne WIlJ ng d«snot cueuntlYh vea¢ mtFm tis my.i ponsiofa Cen ficaie'ne - - - -- - - -- _ - _
occupant of the m4ii mem 1, h must W t y 0T to issuance of — -
rr- upacy jp
. :v?C ''.. ''.-'.d - �OZ. .._. . .---Signature of Applicant --- - - --- -.. .. .-.�._.. . Date
nr'
tie moumorizeda .._ .....
g I, Dae: All roof coverings to be Class B or better
-
- _.. ... . .. ._. . :.- _ .-- OFFICE--