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CIBUILDING
DIIVIISIONN�
PERMIT
CONTRACTOR INFORMATION:
B`IB,plp'n3DK�q1EVENS CREEK BLVD
ALLEN SIGNS INC
PERMIT No. 02050117
'11�bL4" AASSOCIATES INC.
1982 STONE AVE�%�Tnff2
PIIONF:
(408)280-6500
SANITARY NO. CONTROL NO.
ARCHITECUENGINFER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB , MECH
3 LJ
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am laaanscd under provisions of Chapter 9(commencing
SIGN(INDIVIDUALfo0°LETTER)
witIt Sc tion7")trf Division3ofthe_yLi<usincss.a and Pmfessiom Cole, and myli<en>e
tura ata a
FINALE®
clna> J7 SD 5
C
Dfir
ARCHITECTll he. DF KATION
1 understand my plana shall he used vYpuhllc rcenrd>
MAY L
3 0 2002
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby am. that 1 am exempt from the Cmussmr's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
BUILDING$2000
BUILDING
which requires a permit to construct, alter, improve, demolish, or repair any structure
poor tits-asionace, also acquires the ,ticnut for such peamnm Bleu signedsmmmcnt
m5t he slttn?ea pars ptxt the pro sons of the Cnmmcmrs License law (Chapmr9
(comm c'ng wish Sea ]UUII) fDisaon3of the Business and Professions Code),
31�21Ft.0I8&rA&a k-
t 0-,:
Valuation
or that he is exempt therefrom art! the basis for the alleged elem'ptirrm Any violation
t_ ;1' a •.. _ `.Y . ':\.•s s .�
-
of Section ]031:5 by any applicant for a permit subjects the applicant to a civil penalty -
of not room than five hundred dollars 650u).
10IAFIN IIv7@IMDATION
.,. " •, Occupancy Type
Gl, sowner of pnspmy,in, my employee,, ith ....... heir vole compensation,
103 — UFER
will 'do'the workfand Bae structure is not intended or offered for sale (Sec. 70W,-
BusinFn'aia! Professions Code: The Commnor's License law does nm apply to as
iU4 _ -
Required InspecllODS'(``. .161 i!
owner of popeny who hands or improves thereon, and who dao such work him.elf
105 - ANCHOR BOLTS
tont such vemem mems arc not intended or
or through his own employees. Building
-algreeroriale:ICWwever, the Wuamgi,nmProvememaaanlawitnidnhe"re::ar
304- ROUGH-ELECTRICA-L—,-:-:-:',-:---._.__..._..----`----__..._
completion, the owner Wilder will have the burden ofpmving that he did not build or
505 - FINAL ELECTRICAL
improve for Pm,m of sale).
.°1„as-rofjec
514 ---- F-INA'L- PUBLIC -WORKS------ — ...
p(Seeny0am exclusively with licensed
., „... .. ,.
comtrucl the e Contractor's
(Sec. Business and Professions CWe:) The Contractor's
Jas nut apply to an owner of property who Wilds or improves Hereon,
due, ro to a
”
and h ca
.and who commasfor proje<tn with.a.<ommctor(s) licensed pursuam m the.
orLaw.
Contran's LicenL
u law..
0 l am exempt under See.' - ,a .B&PCmi'misn,ax 0.
`
Ow .' r Date „
Ter
WORKER'S COMPENSATION DECLARATION
' ' i hereby affirm under penalty of perjury one of the following declamtionn:
❑ 1 have a„it 'will'ar.mmin a Ccnificam of Consent in mlf-nsure for Worker's
Compensation, as provided for by Section 37M of the Labor Cost, for the
perfonnenee of the workfor which this permit is issued.
° I have sad will maintain Worker's Conn, anion Ineumnce,'as «quina by Section
37W of the Labor' Code, for the performance of the work for which this permit is
iii J MyWu1 r,C pe RIwo r rand Policy actolvir art
t>(e PdI •s3Z vexes 52
; J 4
CERTIFICATION OF F.KE ION FROM WORKERS
t e, ' 1!, s j ?. s y 3, rTi = . i. t . t
` COMPENSATION INSURANCE
” 00 or Fefiion meed nm Ne,nrnplemJ irthe perms Ia for one hundred dollars
a
I's
($ 1000 )
I f.
IL
•" Icrtfy that the Peai a bf th kA., which lh:'pe t isi>sucJ l
- hall of empl Y a YM t Y eon r so no berothe h) m to th< Work<rs
n Lowshfnma Date.-
Comicant -�
'Applicant .,•t ' ' .,.., 0 �
- '
. NOTICE TO APPLICANT:theWo,If, after making this Certificate of Exemption, you should.
`• -
bccmite'aebjen to the Woikelx Compensation pmvisinns of the Labor Code, you must'
forthwith comply with inch provisions .,,his permit shell be, deemed re .kad.
..
.. _.... _...._ ___... _ .... _
.._ .. - _ __ _ _ ...... . .. ..
CONSTRUCTION LENDINGAGENCY''tl''
__ ... _ ... 7;_
"I herbby affirm triad Baer, is a conswcami leading agency for the performance
sof the work for which this permit is issued fSa1lU3]. Civ. C ) . 1. 1.
Lender's Nnme-t "-...v r ,.�....:.... a. _: ..�. r... _n.
r
Lender's Address'^ '
I certify that l have read this tpplicmion'and sale bar he above information is
correct. l agree no comply with ell city and county ordinances end state laws relating
no building construction; and hereby authorize mpreunmtives of this city to enter upon
the able -mentioned ,open, for irr,a im parpases.,•
( We) ogre, io save; indemnify and keep hmndcss the City of Cupcnim against
liabilities, judgments, costs and expenses which may in any way accrue against said
City in consequence or the granting of this permit. - ' ' '
1
N��DaF� $TA SAND WILL COMPLY WITH ALL NO'- Y
f/v
5PPEICA.
'cl "' •t •
Issued by: Date
rlilger =': o?
y%YI
- " '+
Signora of`ApP1i,, Co rector '. t to "'•'
- t%ZARDOUS
Re -roofs
MATERIALS, DISCLOSURE.'
Will the appfiLda or farm building ocropical mrina6thandle fi�rnrdoux material
_. Type of Ro
fs
as d ! ed by hCMunicipal CoeChapte912. ahHh d Safety
• r ;.o' . ,. • . t
Code Sat 25532x
°yet,
- '
t
All roofs shall be Inspected poor tu,any-roofing material being installed
,
WII the irco m scot r builds m useequipment or which
accupby
If a roof is installed without first obtaining an'inspectiori; l agree to remove
Mae.L
ent, h anus air comate nano ai defined by the Bay Arca Air Quality Manngemem'
d
or, mo? ' '
all new materials for inspection. Applicant understands and will comply with _
all non -point source regulations,
•
I have read the huardo s.mmerial. rtgmr<rrcntsyna' Chapter 6.95 of the
a
Cal fdmnu Health & S _ fciy,Cbde Secuom 25505 25533 end 25534 1 understand that
if the building does not currently have a tenant. that it is my responsibiliy m nmify he--
dcrup,at of the fcgairememi which anusrb, ma pnor to issuance of. CmiOcate of
.. .....a
,-. ,, ,
Occupan Y
Signature of Applicant Date
"" of better
All roof coverings to be ClassB
OFFICE