01120058 CUPE
C[sun OF
G DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUJ V.S ff :. DE ANZA BLVD PERMIT NO. 01120058
° 154AMI2EAL ESTATE PARTNERSHIP APPLICATI
PHONE: SANITARY NO. CONTROL NO.
Q0 O ARCHITECTIENGINEER: BUILDING PERMIT INFO
s to- BLDG ELECT PLUMB MECH
`<o''. r 1 L_ l=7 LJ
a.
LICENSED CONT'RACTOR'S DECLARATION
z 5 y= Job Description
5zu,e 1hereby01ofthat 1amoftheduMemprovisions ofChapter 9 n,Cocc.andmmecense 3 NEW SIGNS
wt-tu xith Seaion]IK)Olof Division Jof the Business and Professioro Cope.and my license
r m S Lin full fool and cffcc 1 '5(0
E-0
16 License lass _ Lie,N 0 J�w"�
aO a.V Dam�— S DECLam /sJ
Orn 3- -� ARCHITECTS DECLARA ION
� 1 underamntl rip'plans shall be used as public records
r
v25p O Littmee Professional
c.
OWNER BUILDER DECLARATION
X" I hereby affirm that 1 am exempt man the Contractor's License Law for the
w $0
C?< which re requires
a.(genion]03L5.Business and Pm,demolish,
Code:Any city orloome
ZO
which requires a permit in runatiun,ahcr,improve eanmliah,nr repair any structure
i3w trioti I q .the inions o for suchpermntic Law statement.
Nath i licensedpursuant th p
sion3eeommctses, La Cer9 y� g��®r.t>rJpi Valuation
ort he
,nbat t ouna ofDivisionTot the Baine.sortProfessions Code) ..1.A�.T t .
or that he is 31 5 by
taerefmm and me bass for the alleged eximpnt to Any violation, -
of Section70315than v any hundred
o for a permit mhjecu the applicant to v civil penalty l 014PN
:mrnrn mare man fixe nrnaree dwmrs Isswl. I'DAT I ON Occupancy Type
EI 1,as owner ofdre n.ormyem lo-eesaaithwa es as marw1ccom 103 — UFERwill do '
Prate Y employees g compensation.
Business and Pro and ns mdura is not Contractor mor s Li or a eredLaw far amr apply RW. 104 - REBAR
Business and any W fans Wilds
Code.The over mention.
nti License Law does not apply to an Required Inspections t
own
a of pmpmy What builes.p improves ad such improvements vem does such work himself 105 — ANCHOR BOLTS
or er through M1 employees.provided m, r p em t. rc of "ended or
g p not . 3.04- -. ROUGH' ELECTRICAL..._.. . .... -.... __._ ...._. ._
offered for. I If.he '- in b Idin� tis sold within '
improve for purpo of sale.) will have the barren of Dtaving that nedid not bu'le or 505 — FINAL ELECTRICAL
—514' FINAL-PUBLIC' WORKS
Las owner of the progeny,am Business
d Practing with Coded
The Contractor's m "-
conswn the project(See
appl to an owner of and Rm(uvmb ills or The Contractor's
{, License Law does .b apply man owner th contractors)
who solids m inpurnm thereon, '
.and who r',License L such projects wiN.a comm�or(s7 licensed pursuant to the
- Contractor's License law.
❑I am exempt under Scc. 'B&P C forams reason
Owner Da¢'
; WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(� Nt ❑ 1 have and will meinwin a Cenificate of Cons nt to self-insure for Worker's
Con se t provided for by Section 3100 of the Labor Code. for the
performance,oithe work for h hths perms is issued. `
gI h d 'II ainm Work Compensation I an
Bee s required by Section00
about Lab" Coe, far the garrorma tt of the work for which flu permit is
si.su d My Work Comte m o 1 um d Policy n be e:
_ _
•Curl�"S-IK F(ly,; ,Poo yNo.i"71U'�l'O[[rX�b .... .::... .-_..,_.._ _,: - -.
%1 a:: CERTIFICATION OF EXEMPTION FROM WORKERS. '•^vs e." ',i i t- •,�� '� Is
COMPENSATION INSURANCE"
(This acaiod need not be completed if the permit is for one humbed dollars
-
1 ttmfthai n the Romance of me work for which this -- -- -- -
'shall•rat employ ern an subject
to
Worn 1 Id,t .. i_ .. .. -
'C6niteasation laws orf Califomia.any an as to become wb)e<t to the Wnrk<rs ,
'Applicant
NOome xmb c,m the WiskerL afteoperodom pr Cenificate the Lab r ion,you should
become smompm the such po Caorts or this
provisionsofthe Inborn Coee,you'mdsr
Q �
forthwith comply with such pmvizions or this pumiuhall be deemed rooked.
CONSTRUCTION LENDING AGENCY
hereby
ria
i byy atiirm Jar there,is.conw
snion lending agency for the ierformnceLacridee ,
xs Mone hmh th -parent-s,issued 1p c.3097,Civ.C) t "'
�_� z 'lindcr's Addmsz" I
y II agree mar I nave read thin city
and on my orate that the above laws T sti g
E. to Wilda.1 agree to comply d he all city end county ordinances and catty laws erming
'O V theaWingeonaned praneheminspecby °on representatives nr anis pity to enter apo"
LC. the ebo ffr)agloned property ram inspection purposes.
E., G '(Wjudgme ts.cost indemnify and which may in thewayreme agaima strati
V) liabilities,judgments.costs and experts which may in any way.arae.g.1 svd
;City in consequence"of the graining of this permit: .-' -' n
APPLICANT UNDERSTANDSAND wICLCOMPLY WITH ALL NON.P6dNT 1
' SOURCE REGULATIONS.' . . . Issued by: Date
Signs.care vfA,phr.m/C.mmrmrUate: Re-roofs /
HA] RDOUS MATERIALS DISCLOSURE
Will me applicant or fuldre buJe'ng occupant store or handle hmudous ma¢tlal
..Type of Roof
was e f n d by the C.,pernim.Momirmal Core.Chaprer 9.12.and the Health and Safe,,
Code S t 255]2(.)
o "
is\ r a. o'•: ;..y, s ;._�." \. ' ..
Y L All roofs sh'a �be inspected prior.to,.any roofing.material being,installed..
wn the applicant future building occupant equipment odevices wn ch If a roof is installed without first obtaining raurins echo l I'a fee to remove
emit h zardo.a r conmrtunams as defined by the Hey Arta A Quarry ry Managcmem P g
Air 11 "Dinner, - all new materials for inspection.,Applicant understands and will comply with
❑Y<s Sd D al no -point source re 'ulations.
I ,..,:.., . . .
I h c ad the hoard material, equ t. order Ch pt r 6.95 of me.
Calif - aHatom&Salty CodeS i x2550525533 d255361 d tand dual x
fineW ld gdce ntc JYha tenant that l- my repo sbltyt amity the i's ���I' f _O '
ce<up , f Ne gmrt t hens mus ,o uance f a Ceri ficem of
pbc et prior. A I
Occupancy.
I� d1'
'';- - Signature of Applicant _ Date _
12 '
"7 J-. amhn"aeaa�t •Dare,,. Al] roof coverings to be,Class "B"or better,
OFFICE