02020064BUILDING DIVISION PERMIT
BUILDING ADDRESS:
OWNER'S NAME:
CDKEN KABIR
p oc p ARCHITECT/ENGINEER:
U
aZ
C Z LICENSED CONTRACTOR'S DECLARATION
Z y C 1 hereby affirm that I am licensed under p visions of Chaper 9 (commencing
m with Seaio ]000)o(Dt -zion JOf the BUSin s d Pofncimmis Code. and m ycenu
is in full me and air, t 2
s, ca V Licdn Lic. — ✓ y
Comm< r
_ u u. t' ass ARC 1 Cr'S DE RATION
�uj r 5 1 understand my plans shall M used m public records
6 p Licensed Professional
OWNER - BUILDER DECLARATION �(
t� w 1 hereby from shat I am exempt from the Continuator', Lic lest free the
t ? <
following reason. (Section 7031.5• Business and Professions C yc my
Y F ❑ which requires a permit to cnrtstmct alter, impro derd�sh, rrcp, boy sin¢tum
irs{3$ .prical. its issuance• olsoequires theapplje RA1uo Glcosignedsmte7ne`nt
that h& ii lirtnbA v„ra6nl m the n.n,. f t .L.,.r..:.lrt..,...d
wages as t5dr sole cempemasisn,
I or offered for sale (Sec: 7004;
jcenm Law does not apply to an
and who does such work himself
of proving that he did no build or
- u 4 as nwne ja the property, om exclusively d Professions with licensed cc directors to
construct the project ISce, ]044, Businax and Professions Code:) The Contractors
—_ - Licemc Lsw door not apply loan owner of properly who builds or improves thereon,
_and who consmcts.for such projects with a contmcmrfs).limmad pursuam.so the
Contrutors License Law.
Diem exempt under See ,B &P C for this reason
_ Owner Dine
WORKER'S COMPENSATION DECLARATION
I heeby afros under penalty of perjury one of the following declarations:
0 1 have end will maintain a Canlficem of Germans to elf-i ... re fm Worker's
ompeneation, as provided for by Section 3700 of the Labor Code, for the
rfo rnerm of the work for which this permit is issued.
01 hive and will maintain Workers Compcnsmion Insurance, as ".mail by Satlon
3700 of the Labor Code f ithe Performance of the work for hich this parmid is
issu My W ker's Compem t n Insurance ca rand Policy number ere t
a. °57'1. ft11T 111314, all, ✓ 'I'
,'1' - 'CERTIFlCATI NOF E%EM f FROMWOR %ERS
COMPENSATION INSURANCE
rnus'sccilbn need not be completed if the permit is for one hundred dolh a
(5100)or less.)
1 cart fy Lim the performance of the work for w6i h this pram t s issu
m ed 1
shell ra employ o run in aav mihu4r so is to becomss.1 acs noun Workers'
2 "'' i11" ' ' v'I CONSTRUCTION LENDING AGENCY- ^"
f I he by M. Nat Wee cmistrommi lending agency for the perform c
arrive ink for which this permit is Ixsded (s 3097, Ch, C.)
F,Q Latrines e ' .. .
Nam
.Z Uirda Address'•. .
1 unify Not 1 have end this application and stale that she above information laws ba g
- W - Ea to building 1 ecru to comply with all city oat county ordmives aand sum laws elating
wV the slaDingconanuctiomand heor inspection Para afire city to enter upon
��srW
the ebo(We) agree to Property demify and Ito Ics
In mjIdrte to save, indemnify and kelp harmless the'Cirybf Cupeninb against
LLII Vl liabilitiu, judgments, casts a d expenses which may in any way acme agaimt mid
Ciryineome�t�enceortheg min Nofehis pernmt'
'cool' sraN711.INnFas +an lc e n wn s.tm vlu fir se r seise ontvT
rt«
igribme of anUC nwcmr " "' e
1 t " - BBFI6 MATtRMbG DISCLOSURL
Will the app a s om fmua Euilding no'.. alorc br Aandle haukoua material
iclal •m defined by the Cofounders Municipil. Code. Chapter 9.12, and the Health and Safety Code`Semmn 25532(it Will the applicant o f e building eceupmt se eq pment or devices which'
rote Its our air contaminants m defined by then Area Air Quality Management
istrict?
D No
1 have reLuildimgda�nrm d Ne hsuancei meteri reporemmta undo Chapter 6.95'of the
Sefery Code. Sections 25505: 23333 and 25534. 1 understand Net
' scantly have a tenant, that it is my responsibility to notify the
ir ants which must be me. prior so issuance of a Certificate of
oce
_ Data
CONTRACTOR INFORMATION:
(408)309 -5981
:RMIT NO.
02020064
PPLICATION SUB DATE
02/19/2002
4NITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
TENANT IMPROVEMENT.
(GROCERY STORE)
y i:Skl .
102 - PIERS--- R-eq-iired Inspections,'
IERS- RequiredInspections,'
103- - -UFER--- -- - - - - -
104 - REBAR`
ANCHOR -BOLTS---.- __ -... ... __ _......- - - .._...._
106 - SEWER & WATER f it
202 _
UNDERFLOOR. PLUMBING__.
_- U
- UNDERFLOOR'..MECHANICAL
204 .- U
UNDERFLOOR FRAME
205 -
- UNDERFLOOR INSULATION
301 -
- ROUGH PLUMBING
302 -
- TUB & OR SHOWER
303 -
- ROUGH MECHANICAL
304 -
- ROUGH ELECTRICAL
305 -
- FRAME
306 7
0 ,. 130,7- i- ,i- 'tINSULATION•r
8._-SHEETRO- CK.�..___._- __- ._.._._ ... _ --- . -...._
309-`_`' EXTERIOR LATH,
310 - INTERIOR LATH
311' - SORATCH,:COAT
313 - ROOF NAIL
501'= FINAL- ELECTRICAL- ENERGY '.
502 - FINAL PLUMBING ENERGY
503 - 'FINAL MECHANICAL -ENERGY,--:;;:- -
504 - FINAL BUILDING ENERGY'
505 - FINAL ELECTRICAL -- -
506 - GAS TEST .',' : t.. .
507 - FINAL PLUMBING
508 - FINAL MECHANICAL
509 - FINAL GRADE
510 - NA P NG
Issued �y14 - N RKS Date v
Re -roofs
Type of Roof ....... _. ......
All roofs_ shall lie inspected poor to, any roofing material being,installed.
If a roof is installed without first obtaining an inspection; I'agree'to remove
all new materials for inspection. Applicant understands and will comply with
all `non -point source regulations:.. „ , `
Signature of Applicant Date
All roof coverings to be _ Class t^B" or better
OFFICE
All roofs_ shall lie inspected poor to, any roofing material being,installed.
If a roof is installed without first obtaining an inspection; I'agree'to remove
all new materials for inspection. Applicant understands and will comply with
all `non -point source regulations:.. „ , `
Signature of Applicant Date
All roof coverings to be _ Class t^B" or better
OFFICE
i F 03
✓70 0 &J�?&
2 �2�103