02040141 CITY
BUILDI G DIVISION SINO PERMIT on CONTRAcirok moitm
BUILDING ADDRESS: PERMIT NO,
10525 DE ANZA BLVD 02040141
OWNER'S NAME: APPLICgTIONS BDAT
,dhABC DEANZA PLAZA PARTNERS 04/ 25/ 202
PHONE: SANITARY N0. CONTROL NO.
COO ARCHITGCTIENGINEER: BUILDING PERMIT INFO
1z �--( BLDG ELECT PLUMB MECH
`N<L Li CJ L'J U
LICENSED CONTRACTOR'S DECLARATION
5 ' I hereby rntm tent I am licensed ander f Chapter 9(commencing Job Description
provisions ° g TI-FIRE ALARM p
sot •� with fall pan]000)afect.Division Business and Professions Code.and my
fain fan lass and affect. 623 2�'
¢c< License Class f.i U Lic.e
O c U Date 2s Mr ] uol Camara
a ara<mr =3 -
u O ARCMITECfg DECLARATION a
� I underetaad rap,plans shall be used as public rccmds
Y
OLicensed Professional
_ OWNER-BUILDER DECLARATION
it,
I hereby affirm that 1 am exempt from the Commando's License Law for the $300 O O
t?< following reason,(Section 703 1.5,Business and Professions Code:Any city or county
F F O which requires a pemtit(o conswn,the,improve,demolish,or repair any svuctnrt
taj3m •Psior to its issuance,also requires the applicant for such permit m rile a signed statement-
_... ,�w�3,.�s A�.
rLmhemicingis itSatint7000)ooCis vmoound the the Bucmh is and LittnxLaw
onscal9 �-Y6Va.J19r.W�.-. Valuatlon —
(c°mmcne a aicaNSeuion]000Jo( ebasis or the legedearemp Professions Code) t- t,1 E3,
or that M1e'is"31.5 bi therc0om'and the basis for the subjects
the uhcant to Any it Penson: -
-af Section]D31.5 by any applicant for a permit subjcns the vPPlicom too civil penalty
.uf not main thin five hundred dollars(S5W).
10 3k1NN P91FIftr Occupancy Type
0 Las Owner of the property.or my employees will,wages as their sole compensation, 304 - ROUGH ELECTRI AL
..Bufaome'woik:end the masCode:TeCabiidoatled;nseLawdoal esasera cnoa4,; 505 - FINAL EIR e'r lta cions".: .'.'ter•'-�
'Business-and'Pny Who b Code:The rev.thereon,
License Lew docs not apply to on
owner of pmpeny who Wilds or improves thcrcon,and who does such work himself
othrough his o however: prodd}I t h Laren t arc intended oofferedr _-. .._._.__ ..._.-_.__ .._.-.._......._ .._ _,...
completion,
for -le ow however:thebuilding t pro a tis soldwithin- not yearbuild of
improve
the owner-Wilder o wdl have the Wrden of proving that he did not build or " " •- G "
improve for purpose of aal<J. .
_ -__.
❑I es Ownerf the parexclusively contracting with licensed contractors to --- - - - _ --te -- -- - ---
conswct the project(S 7(144 Business and Preficassionar,Code:)The Contractor s s
License La d e thereon.
and ho,*.Licca fo h p 1 u M a.c t t r(),Ic mctl pursaaat.t tM
of apply fp pcny hobuld pro
Conuacto s Ltc Lo - --
❑Iame emp. . src $cc ''"a B&PC forlhisZ7 vernal
'01-
"' WORKER'S COMPENSATION DECLARATION
'i be. atfrm un der penoitY o!perlury ane o(the follmving dedantions:-'
�l•l ha4e and will maimein ecCaiiGcate of Consent io self-insore for Worker's ,
,Campensationrvs provided-for by Section-3700-of the Labor Cade, for the
performance of dud work for which this permit is issued.
❑I Mve•arid will mviniein worker i Cgmpcnsationslnsuranee;as required by Section
a 3700 of the Labor Code;for the saRomtance of the wode7nr which this mit perix
re issued:My Worker's Compensation Insurance carrier and Policy number ei "
Come rl .}pi.Pol yNo 'y r:. -_ .._...., e.-
CERTIFICATIONOF EKEMPTION FROM,WORKERS -1 1 a
.. _.n::..- ^..::..COMPENSATION INSURANCE.':_'_ : . ... .
(Thusemion need not be completed if the permit is for one huttlled dollars ',f `nlrC:i.'1' ,p,.r,�a;!'•.� ;L�k•ll',;;j;l
SI00)W lass.)
1 employ
Nat in Ne perf a d fo k for hich th s perm t rte issued 1 ( ,.
shell i employ vny_pe alt n any atann< sari,to bk-me subject io the Workers - s
Comp war. I' -- of CaLfomie.Dare' - ' ^ - ' - '
APplc t - .._- .. . ..._._ .. _ .. _._.
.NpTICE
z Q TOPL"ICANTIf after making thsQof should
Z bac a subject (tie Ler s Co pn l n p ll... to UW,
CW,you must
fainhisids Comply With such provisions or this permit shall the,d ed
re ok d.
I-,r h r ''CONSTRUCTION LENDING AGENCY - " --�- -
a > IA by SR nth tth rtue wtonl dgge cY for the performance ,e r:lf•.:
,�, of Ne o k fo h ch th pertnd "
U Q (,._':},,1 ccnify thm 1 Mve read this vppli<ation end sate thm tM above infomwtion is -'
0;U ebrma.l agree to rnmply,wiN 4Bciry and county ordinances and vete laws relating
RU rob Id gco t ciion a tlhe by thorax prc t Ives (th ctyt ter upon
�.,, the b e m -ctl property f tt ti puryox
t:46 t W) gree m se a mdethn fy e d ke p harmless Net ry f Cupcu o alienist
U y liab ht u 1 dgmequ,costa eM espe s. h ch may nny y ace a ga s said
U'Z City'm consequence of Ne grant ng v(this pemut - - - ^
:APpL1CA1TLp'DERSfkhv 1p lVILL CO\1PLY WITH ALL hrO\PdLYfn ' q S
sa CI)LATJI
k7le$ '' ! Issued by: Date L.•
Signature
itPAPP' UC aor (pate. Re-roofs '
".Fa US MATERIALS DISCLOSURE -^v
WII the eppliiant fume W riding occupant stale or handle hvuEou-matrsral Type of Roof..
-
res,
def d by th Cupcn o M <pal Cod Chapt r 9 12 and fl Nealth rad Safety
-
All.roofs shall be mspected.prior,to.any roofing matenal.being installed....._.
.11 thq ppLcamOrf.sore W ldingocc pmrux equipment cirdontts wMrh If a roof is installed without first obtaining an'inspecttoTi,Ilagreeao remove
emit hared s au camam u az definrd b5 the Bay Area A Qual y Management
all new materials for inspection., Applicant understands and will corn ly,with^
n
all non-point source regulations „...
- I have mad the ltavardo s materials q trtments uteri chapter 6.95 oKtoe _
Call(orme Health$Safety Code Senlane 25505 25533 and 25534.1 understand thad.
if the building does not cu dy h tenant Nat t _ -
y aspens b l ty to tifY,ihe - -
okuprou of the quire.rats hich mus'be met inner to issue ce of Cemfi6te of
Ocue .,
Signature of Applicant ... Date _
o M e cent
Data :i,, All roof coverings to be Class "B"or,better
.OFFICE . ' . ,.. ._,...