02060089 OF CUPRRTINO
CI BUILDING DI ISIiONPERMIT CONTRACTOR INFORMATION: t e
'
BUILDING ADDRESS: PERMIT NO.
10500 N DE ANZA BLVD NORTHWEST SIGNS 02060089
alOWNER'S NAME: APPLICATION SUB DyTE
CIMPTON HOTEL CROUP 325 WASHINGTON ST. 06/14/2002
- PHONE: SANITARY NO. CONTROL NO.
I. (831) 469-8208
F
ee0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
QUO BLDG ELECT' PLUMB MECH
y<n I_7 1'-'1
Z 8 oNi i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z-G 1 hereby affirm that 1 am licenced under pmvi55inns of Chap¢r 9(commencing p
p,.,t_vu withSecti°nT(1001ofDivision3oftheBusincss Icoimr,CC c conmenentt AWNINGS ��t�fi ,Tn ��®
�t4 ninful[1M�£and �p� NA
d,m a License CI 'c Lic.
i u Ude Comms or I
tail 3 u, ARCHITECI"S DECIA DEC �+ "a
ZOO2
F u.O do J my plans Nall be used as public records
�r
wp O Lmenscd Pmfesaonal
a�M OWNER-BUILDER DECLARATION BU19..®'N
1 hereby afirm mm f 1 am exempt from inti Corays License Law for the G
H?a following mason.(Section 7031.5.Business and Professions Code:Any city or co am, $20000
ad O whichrt.reg ' ap most toconstruct, Itimprove,demolish.car par any m trt
i 3 g _.p t t s an IsA res theppl tI suchp tmsu TI signedsort rnt
that be' Icensedp,xat t'thep ro of the Contractor License La (Chapter (., t�OC,�,aea p ValUatlOn
m mens g . th Sect 700M ofDr Sof th B inti and Prof ,onCod) '`� 'y.'31�� .•U(Js_7 Pwit!1•'�j.�l t�Z '
or that he s exempt a0efmm and the basis for the allaged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicantto o civil Penalty.
°fnotmomthanrivehundreddouars(S5W1. 101APN} ATION Occupancy Type
El 1.as none, f,h.progeny oe my ,ply In wages as m 'r: l p tion, _ .
wil[dothwork,and mm BIER
e structure,s not intended r offered f Ic(See ]Oil;'----- ---
Business aa PfbfcssiOos sae The Contractor',License Us,does not apply to an 10 3 - UFER Required Inspections
o fp peri,Wh b Id. pro . tM1rco dwbod such work h'mcelf
o m ghhis employees.provided tht nimprovementsrmendedor 104 - REBAR
offered'( sole.-If.- how - theWilding or mp- " nt sold th ne of,cis '_ '--- _ "- --"- "- --' - ---_ _.
105 - ANCHOR BOLTS — _- -`-
a pl ion the owned hJdcr will have me burden of Proving mm he build or 1'� � �� t ,s ,
inpmveforpu,,.enfsale.). 106 - SEWER & WATER
oi-im p me u iper . mexewa elr trir aa manoo -_.-202 UNDERFLOOR PLUMBING "
__......_..
co w t the project(See 7144,Baramss and Proteva,ons Code:I The Contractor's - 3Li
- t t
alaeae Law does not apply m an owner of property who wilds or improve,thereon, 203 - UNDERFLOOR MECHANICAL '' t
am tors uncle Law. with a ro tr m rI licensed Pursuant m he 2 04' ---UNDERFLOOR--FRAME
and who contacts for such.pmlecu
01 P 1 B&PC forms as
205 - UNDERFLOOR 'INSUIPTION
owntr W Date ' 301 - ROUGH PLUMBING
' ' ORKEft'g COMPENSATION DECLARATION
- .� Ihereby affirm under 302 - TUB & OR SHOWER
peaahv nt perjuD one o(me fnlmwmg eenlaatmnx: 303 - ROUGH MECHANICAL
❑ 1 have mid will main'tain a Cerificate of consent to self-insure for worker: 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor code, for the
r perfnvnanceofthe workforwbchthisPermit isissued, 305 - FRAME
- ❑I na.<andwill mCi Cold inVorkei a Compere don ln.uana,ax r�qu;reed by s«,;un 3 0 6 - HOLDOWNS
3TW (me or 7 f the Frontal f me work(or h h th s pen t
d Myw r ratio .oto n n aPnr Y ware 307 - INSULATION
C - Pdcr — - - - 3.08'" -'_SHEETROCK' ---"" '
ati _.T,p._. __. . ..
r, CER IFICATION OF EXEM IOU FROMiWORKCRS ^ e„'✓,.t 3, f ' 11 j f `• t >_-
_coMPENsnnouwsuRANCE '�.• t 309 EXTERIORALATHlIN-
310"=-:`INTERIOR`LATH— — .----
"t (Th inti need nm be complet d if the permit is for one hundred dollars _
(s Hxn nr[coed.[ 311 - SCRATCH COAT
I earn 1.1 dm-perm, of :lki 1u,h hi Pe t :'aaued i --313-'-'ROOF--NAIL _ -- - . _
soh” ' PILawefCalf.oa.son in Date Farnmer so"`° -cN" '"bJ0e1OtheWorkers 501 - FINAL ELECTRICAL 'ENERGY"
motion -
Appheant " 502 - F-INAL--PLUMBING..ENERGY...
NOTICE TO APPLICANT:11,after making this Cenifinte of Lxem tion. ----- - - -�. -
wconmmbjcctmtheWorker'sCompcnsauan P y°"'"°°''' 503 - FINAL MECHANICAL"ENERGY
O Saliba, Acont I with such Provisions mf me lawrCae,you must
z O comply nviainnaurmixPmdtrnaub dideconedrc.nkea 504...- FINAL BUILDING ENERGY....__
,' - - CONSTRUCTION a .
CENDrvcncENCv - 505 - FINAL ELECTRICAL
1 he by affirm tothatthemis . vase lending agency for the perfotinanec
W of Limit,,Name work mewbnbms- -- r esncl(see.3 .9 Cl,c.) 506 - GAS TEST -
Z) z Led ,Ada s 507 - FINAL PLUMBING. :. . .-- --- - -- .... .-- -------'-
U O co1 mfytocomp am', ppli t tJ tl than b f n'f is 508 - FINAL MECHANICAL
2 l g to compmail
with all q J c o county d nc tt ria Ia sMonag
OU roint Wilding nudt and thereby monrepresentativesofthscitytoenterupgn 509 - FINAL GRADE
} rte} the almse-mentimcdp pwdy Sur inspect pup 510 - FINAL PLANNING
liabilities. )agreetoed e d nify dk ph ml .`Ine'Cty of Caption.a,ium,
. judgmcnts.cost,aM 5 way me agrunt ainst sad 514 - FINAL UB C WORKS
U z C sed e a,I'llnru an
APP
UN"
USA\D WILLeCOMPLY WITH ALL. N.-01, T
Issued by: Date
' HA,\2ARDOUS MATERIALS DISCLOSURE -"I.old Re-roofs'
as defirWill be a c icom as f tun.w Idibg ee ppnt'gone I,,Handle Wardsmmenal - „Type.of.Roof,
ed y Tema Municipal, Code Chapter 9.12 e d H Ia d S t ty .
GhI EI -1.1 a) -- ........._...._
❑te. t , t,
Al] roofs shall be inspected prior to any roofing material being installed.
"'i n PST I nyyyyyyssssssl� 1' ' e p a n n-` If a roof Is installed without first obtaining an inspecuoh Pagree to'remove
n h it rnm nfindd by th B yAnai Quality llana%c em
District'
all new materials for inspection. Applicant understands and will comply with
all non-point source regulations:
1 h h d the idari us m rerial eywrcments and Ch Chapter 695 of Ne "
Cal forma Health&Safety Cae.Seri ons 5505,25533 and 25534.1 understand thin
f th bt Id g J not ay have a tenant that t'. Fly aspuns bil ty m mnufy the' - - - -
depat f h 9 al le e'p to issuance at a C nil, t f - - --- -'
u ti
i Signature ofApp]icon[ Date _
r'at onze agent to All roof coverings to be Class `B" or better
.,
•• .., . _. OFFICE . .