01090120 OF
TINO
CI BUI DING DrnSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA BLVD HOWARD WRIGHT CONSTRUCTI N 00. 01090120
OWNER'S NAME.: APPLICATION SUB DATE
KIMPTON GROUP PIER 9, THE EMBARCADERO 09/28/2001
HONE:
(206) 447-7672 SANITARY NO. CONTROL NO.
e¢zARCHITECLENGINEER:
O O BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
azo
- Hz LICENSED CONTRACTOR'S DECLARATION JobDescription
5z-o ' I hereby affirm,hat I am licensed under provisions of Chapter 9(commencing
_tdo wid,Seelam7")ofDivision 3°rmeBusroessand Poefzaai°n.Cme.and mylicense TEMP. PERMITS . EXPIRES ON 10/28/2001-
is in fun form and effect.
c te 6 License C1 is 1�r Lie,.
Dale `1�Z�I"' cmniat or
ARCHITECT'S DECLARATION
- 1 understand my plans shall W used as public records
t 6-p O Licensed Professional
- o OWNER-BUILDER DECLARATION
1 hereby affirm mat 1 am exempt from the Contractor's License Law fm the
C?a following revson.(Section 7031.5.Business and Professions Code:Any city m county 0
Z F O which req pe 1 t wn,alter,improve demolish,or repair any croacturna
up13m -Prwrtou issuance.also req thepplican,far such pew.it file a signed sudmitri,
that hes t' - ri ed p t t the P ve
ions of the Contractors License law chaps 9 __.
- _-- -- - _ - - ---- -- "'
(cote g the cion?000)ofDivision3oftheBusinessandpxfesstoasCode) '''�ijot � 13.§,9•dT�r '®at'r;�, - 4 t., 4 Valuation
or that he s exempt Nertfrom and the basis for the alleged a{emµion.My vm iand _
of Section 7031.5 by any Wittman for a permit subjects one applicant in a civil penalty '
of not tome than rive hundred dollars(%500). 10 P �• Occupancy Type
❑I,as owner of the property,tar my employees with wages as their sole compensating
will do the work,and the swcture is not intended or offered far sale Sem ]616,' "-
•Business and professions Code:The Capitaetm's License law does non apply man 10 - 1 eq a nspec
owner of property Who Wilds or m pmm,,thertog and who noes such work himself
or through his own employees.Provided that such improvements am not intended or EBA
-offend for sale:1f,however.the Wilding or improvement is sold within one year of '' - - -- -- - --
completion,me owner-Wilder will have the burden of proving that he did not build or 5 CH
impmmforpurW"0f de). 106 — SEWE W
❑Lad owner of Ne propcny,am exclusively convening wird Imrnsed convectors m202 - UNDERFLOOR
onswe th
Lice Project(Sex.] ,Business and Professions Codc:)The Convettors .
- tie wdoes n,itapplytoanowner ofproperty who bwldsorimproves therton, 203 — UNDERFLOOR MEC IC `
and who conducts.for.such projects with,convectors)licensed pursuant.to the
an mrauca-- -a-
C3, 204 UNDERFLOOR FRAME
ate exempt under . ,B&P C for this mason205 — UNDERFLOOR_ INSULATION
°am 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECT.ARATION 302 - TUB & OR SHOWER
Ihereby amrmunder pcnaeyofkdr'yoteonnafollowing declarations 303 - ROUGH MECHANICAL
t ❑ I have and vete maintain a eby Se ti Of o m Labor for warkshe 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section J]Ou of the Labor Code for the
Perfaesvna arae w0a for whim mva pcmd,fa iaauea. 3 0 5 - FRAME
" 0 have a adwill maintain Worker'sCompensaiian5nsamrlce,a,rtgmmdbySemon 306 - HOLDOWNS
17W of he tabor Code for the perforrmrice of the work for which ten permit i,
'ave a Myw Works,',co a r 1 ra a and Palk be - 307 - INSULATION
L 2v M i'Geary .WC2of�1004131O11 . 308 SHE$JROCK ';
cEI;n ExeMpnoNPT<oMwDRKERst - '�`}`' 'r 130'91-=I)EXTERIORc LATH '
COMPENSATION INSURANCE' "" "
m be
31'0; _;INTER'IOR`LATH
f
_......_
ct on need ncomptctee tf,ne pcwi,is rte one hundred dollen i'.
fs!m> Th«,.), , 311 — SCRATCH COAT
>nqu t
Ioythat in 14pair - ._one orkfor hient'his parmo,iI,nsuw'1. .... . ... "3.13- "ROOF- NAIL
Compensation employ y°c,wm in y °r ° m b"'°'"e bJeLt"he Wake, 501 — FINAL ELECTRI CAL 'ENERGY
n Laws of Calipands Date
_ IntL
NOTICE
502 — -FINAL..PLUMBING ENERGY
NOTICE TO APPLICANT:IL otter makmgohis Ccmfi<ete of Exemption.you should -'
z become u
subjecotM1e Worker's Compensation Provisions of the Labor Code,you must
503 — FINAL MECHANICAL ENERGY
O p fdnnwiacamplywhnsacnperm
at mre
hedecedvaked. ...,.5.04 - FINAL BUILDING. ENERGY..._
E%i�,i iCONSTRUCr10N LENDINGAGENCY 505 — FINAL ELECTRICAL '
- I he by aRrm tit t Nert's a conswcuon d ngagcnry for U,e peifomuitce
W ..
Of work far n h this Renoir is issued Ser-309] eb_C.) , 506 - GAS TEST t
(� lznd Na
a mer:pact 507 FINAL PLUMBING
�'z
v m(ythat lhave adm pplicat ds ¢that theshow,mption His 508 — FINAL MECHANICAL
tz E.
cancer 1 g an comply with, 11 cal and my mifinumma and state laws relating 509 — FINAL GRADE
to building consduc,lon.and hereby emhorize mpm,cnudsti of this city mercer upon
:�e-w the above-rasmianeepm,ft,far m1pechanpm,,es. 510 — FINAL PLANNING
r-.pa (W,)agree to save.indemnify and keep harmless the City of Cupertinoigaiw
(i"]' liabilities,judgments,cos s and expenses xhich may in any way secure jgalns,said 514 - FINAL PUB I C WORKS
t.>:rZ. City m consequence or rhe Bmmin6 of Chia pewit. '• • 1 1. '
APPLICANT UNDERSTANDS AND WILL COM Ly ALL NON-POLNT' Z$
'ou cE R LATION '.''n 9 Z p Issued by: Date
Signature Or Applicanticoatmctor . ....-:.. ..Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ' ":
wB the applicant",future Wilding occupy t Hort or handl harmends materiel Type Of Roof-
. . nsdefned by the Cupen :
M pal
Cast Chapter 912.and the Health Safety yp t.;
COYes 255321x)^ ° it l M., tir.f •TL-f 11' .. Is{'^.5 1 '•
-_All.roofs.shall be.inspected prior,to any roofing material being installed.._... _
Will the applicant 0 Tut Wilding eBayAeaAir t0 a eswnm If a roof is installed without first obtaining an inspection;IBgrefdtaremove
emit h tl come ¢as defined!65 iM1 Bay Arca Ar Qct 1 ty M nngcmem g
Data t -- all new materials for inspection...Applicant understands and will comply with
all non-point source regulations. ., :;o
- I have d the hoard us da m els requ -nd under Ch M r 695 of the "
Cehfom a
Health&Safety Code Sections 25505 25533 d 25534 1 u desund Nat
tf,the bu id'ngde not curve tlyh a tna ttbatl . y sp sbltyto notify the
bccupa t f Wrequirem ts l,a�uet M in t p'o t0 rsxuanc 7 a C ndcaro of - -
p „
_t nature of Applicant Date
on a age t Date All roof coverings to be Class"B”or better ;7:1
OFFICE .. .. ._