01120081 OF CUPE
CITBBUILDI C DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10050 S DEANZA CRITCHFIELD MECHANICAL INC 01120081
>,WNER'S NAME: APPLI ATI NSSUR DAT
_UPERTINO HOTEL ASSOCIATES, L 4085 CAMPBELL AVE 12f28/ 2001
1 PHONE: (415) 321-7801 SANITARY NO. CONTROL NO.
w O p ARCHITEC)INGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
y i LJ U L_J
y" LICENSED CONTRACTOR'S DECLARATION
z fJ,r,n 1 here) firm that 1 am licensed under provisions of Chat 9(commencing .Job Descri ti
0
°�—° q °" g MECHANICAL PERMIT-138Sp7T SQ FT
F=t�w with 5«cion]000)of Division 3 of Ne Basin,.and Professions Code,and my license
a«yy j
is in full force and effect. Lic.; 54 10"( 208850 LESS 70276 GARAGE
s«¢ License C k t
X 3 Date I�.� fL Conwcbr .c. c
,T!^ ARCHITECTS UECLQsRAT10N
C=° 1 undersand my plans sM1all be mud as public rccoNs
f�Y
t«nL
O O acnud Professional
c X><a OWNER-BUILDER DECLARATION
w- I hereby (Sect that 1 1. exempt from she Contractor's is License Law for the
t-Z C following reason.(Section]o3L5,Business and Professions Code:Any city m county,
F° which requires o permit ra canstrve ealter,improve,he urnit 1,or repair any s..a.,
n 3 se -•Prior to its issuance,also rtquites the apPiiwrt for such pumin m Ele a signed sutemem. - . ..-
metheiishceyed pursuant to the pmvsiens Of the Contractors License Law(Chapter 9 S FCFIoor Area Valuation
(commcnciolwit Sectipn�000)at Division 3 of he Business mi Rrofessim,Cade) I_ ji'sY ti :x Q"t l J(y r' 1 j ( ^, .
or tha he is exempt dOieir'om and me basis for alleg6d exemrylod.Any violation '`a
--of Section 4031.5 by any applicant for a Permit subjects the applicant to a civil penalty 37
, J
of nor more than,five hundred dollars S500). APN Number r ::, , . . Occupancy Type
❑I.as owner Of the progeny,or inY employees with wages as their sole compensation, 203 — UNDERFLOOR ME HANICAL
-'will'do'the work,-and'the structure'is not intendedoroffered for sale(Sec.70,44." - "----- - - - '- -- - -- ! -------- - - ---.._-.-_ __
Busisiess'and-Professions Cade:The Connector's License Law does not apply to an 303 - ROUGH ME0*UagAkctions
owner ofy Who builds or improves thereon,and who does such work himself 503 — FINAL MECHANICAL ENERGY
or throughh his his own employees.provide)that such improvements art not intended or
- ___..... _ ,,._.... .._.___.. ..__,_.L_...
o, erect or salt lL M1owcver;t)e building bi improvcmehus sold�wiihiri ode year of 508 — FINAli
improve far the owner wilder will have 0e burden of proving that he did nut build or
improve for purpose of sale).
11
. 1 the- o
.. ..... ..._._ ..
` I
. ,. ..,,I•', '
pany,am exclusively contracting with licensed contractors to
construct thep 1 (Sc.73 .Bustsand iCodThe Cont s
U d t ply t ..ar of property he btidimprove,theemn.
and-who conra¢fo cb proleas with prowntenors)licensed Pursuaml .the
_.._..Ir-.�
' : C m tors License la ., 1�i ---- - -- -
❑Iamexemptunder See.' ` - "s ";B&PCforthis aason
Dwne;•" ..r�.,but.-" AUG 2 0 ..2002 . .
WORKER'S COMPENSATION DECLARATION
" q I hembY affirm undo pena6o(
_ y perjury one ofthc.following d«laations:. .
13BUILDING�
:[1 1 have'aind ssilFra.misin a Certificate of Consrni'to'self-insure for Worker's
_ Compensation:-as.pr-provided for by-Section 37W of the Labor Code. for the
rfonanee of the work for,,hlch thi[
� n ....`., `. .. pcmdt is issue)..,
❑1 have imc;kill i iniain korkcr'i Compensation lnsu6nca,as lequimd)y Sation
3700 of the Labor Code:for the performana'of the work for which this permil'ia.
is d.My W kers C pe 't n I eu unJ Pol y inher6m: _
5 _
rPnuay n .�.`i N R"I(•,_4' '0 2 +, ..._�_,......_......
Jt I ERTIq TICgTlprypp EXEMPTION FROM WORKERS" ke: r
COMPENSATION INSURANCE'n. ."f x`
-- _ _......•- � �.-.__.�....__.•.....xtt .----- --"—___---_._... _
k mii section need not becomplcieJ f the p '
eva Is for one hundred dollarsits ` '° '_`, vUt
.s
(SI W)nr lcz[.) `
p ,
' 1vicnify that in the performance Iter rk for which tern pc nt'sisud'I
,hall t mobs enYpcmn n any mann s to become subject to tM1 Worker' '1 �....v d
C
C pen. tion Laws of Califom,'Date
;NOTICE TO APPLICANT.If. 0 r making this Ce"ificale,of Exemption.you.h Id ,.,T•'• ,.., ,,,�.} l --- -
ZToner 'ter bj«ito to Woke C rope t -p 'ons of ter Lobo Cad y .t
Z
p ply with such Imikimr,01 this rannit,hall be decand evoked.
0.1
1 heti by (firm ter t thr 'a mon t o lend n enc fo ter :
W:Q of the k(or which th[pe t sissuetl(Sec J09) CieCl �• '
U � a,lttmfy thallhav rt.J this epphmfor and gam theuhe above informal on is
f r`F cnrcen:d ngre<ta comply with all city anti county ordinances and smte laws relating
':�cY, to building construction.anJ fiemby'amhorize rcpresenutiGes of this citymenlcrupon
}':W the be a J p pcnY f n..pen p tip,
'r:.'Lpnce cmaynanyy gagainstVj i...sid
u.z Gt OZ�
q: pPP11CsJNTgUNDF ITAgD$AYDWILL<CObIPLY WITHALL NON�W N r,
g_ Issued by pOu�LR(j�'RErtAu— R s�� p n ,O Date
Si fAppl t m;_ n V ' fig— Re-roofs
HAZARDOUS MATLRI S DISCLOSURE
> It I Will the ppr -W future ba-la g«cupa t re.1 handle nmWao. 't 'm . T e.of Roof.
sdefired by tier C psnn M n p LCrd Carlin 9.12 dth Health dSalary
Yp v--
Cade S cng04553 (al -'-^---
OYes' r�No s'3f t f t I f 3Z 4 1 k 1 t
r All roofs shall be inspected prior to-any roofing_matenal beinginstalled.
Wil theapplianto f t building« para use P a - <[ n n -If a roof is installed-'Without first obtaining an`inspechont,•I'arsree,to'remove
mil h dams contaminants as defimed by the Bay Aim A Q Tty Marin nt
District?,oYAN. all new materials for inspection . Applicant understands and will comply with
,. . ._all non-point source regulations .� .
- I,ha read the hazardo materials q treat nts under Ch p¢r 695of the ' '
Cal f nus Health&S fey Codc,Sections 25505,_5533 and 2553 h I ter 6.4artd that
if the buil ding Joes not cumntlY hasearanam:thus it is my responsibility to notifythe
& Pant I the , n hr Is u t b t p br to is nee bf Cemfi<a¢of
Oc up' y
`•��✓( /A .. ./� Z�/`/�'Z_ Signature of Applicant .. ,'
^ �Z, Date
_f _ ._...
}^" r Or..the, a ag�t oae, . . All roof coverings to be Class B' or better
, _... j. .. "- OFFICE