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01120089
OF NO - CIBUILDINGmSDIVISION PERMIT INFORMATION: c h BUILDINGADDRESS: PERMrr NO. 20100 STEVENS CREEK BLVD NORTHWEST SIGNS 01120089 OWNER'S NAME: APPLICATION SUB DATE DEERFIELD REALTY 325 WASHINGTON ST 12/21/2001 PHONE: SANITARY NO. CONTROL NO. (831) 469-8208 BUILDING PERMIT INFO O O ARCHITECDENGINEER: D ECT PLUMB MECH <Z" Z Z 8 N= LICENSED CONTRACTOR'S DECLARATION Job Description O Z gOW I hereby offion that I am licensed underprovisions of Chapter 9(commencing wish Seetion7000).f DivisionJof theBminess end Rofessi.nx Code,and my license * NO CONDITIONS is in full farce and effe t. zz Licenu C�lgqss <'yG Lie.is I. Dam 1!t/sa/or CmmucIm AAX. W 'f 3r6.v3 3 a`y ARCHITECT'S DECLARATION L LI 0 g I understand my plans shall he used as public recitals Sa�' a iC O Licensed Professional 6!2 OWNER-BUILDERDECLARATION 1 hereby affirm than 1 1. exempt from the C Professions on License Law for @e F 2 following mason.(Section]OILS. t.anter. and Professions Cade:Any city su county I 35 .c G which requires a permit to construct.olmr,improve,demolish,or repair any swemrebrib G$_prior to its issuance,obit requires she applicant for Con permi s Lice o Law asuumem 3- (comaincing i pupttammthe of of the the License law(Chapter9 O'.�se a;./ - _ Va tion (commencing with Section 7000)of Division J of the Business and Professions Code) 1 ' , j 3 r V k'V! e .f. . or shat he is exempt therefrom and the basis for she alleged exemption.Any violation .* of Section 7031.5 by arty appliconj fora permit subjects the applicant too civil penalty —, Occupancy e .of not more than Ove hundred dollors($500). 10 A ION p yTyp Ol,ex owner of the Property,or my employees with wages as their sole compensation. -will-do she work.and the'stmaurc is not intended or offered'...sale(Sec.0094,' Business ad Profession,Code:The Contractor's Licenu Low does not apply to an 104 — REBAR Required Inspections' ' owner of property Who builda or improves thereon,end who does such work himself or rhmugh his own employees.provided that such improvements are not immmdW or _ 105_ - ANCHOR__BOLT_S.. ,offered for kale:If.however,the building or improvement bs sold within one year of ---- -�" completion,the owner-builder will have the burden ofpmvingthashedid nmbuildor 304 - ROUGH ELECTRICAL Improve for purpose of sale.). 505 - FINAL ELECTRICAL - -- - — - ..,__-- -. _ ._ — -_ . ... construct pmpe.7 oro exclusivelycomrofessi with c Connorsjo -- S14 - FINAL PUBLIC WORKS - _ License the prosect(Sec. to a Business end Professions Code:)The improves the on. License Low does not apply man owner with property who builds or improves Hereon, _and who es License L such prolan with a commemgs)Iicenxd.PursunnLm.Ne._ ._. ___ _._ ... ._ ___.. _ _.._ _ _ —--------•-.-_-- ------- - - ____- .. .._.. ._ .___.. El I arr toh License Lew. - ❑lam exempt under Sec. � ,B&PC fonhis reason ' t�; O _ wren •, Data .. WORKER'S COMPENSATION DECLARATION -- ":. 1 hereby aRmh under penalty of perjury one Of the following declarations: lY I have and will maintaina Cwifhcam of Consent to self-made for Worker's Compensation, as provided for by Section 3000 of the Labor Code, for the Performance of the work for which this permit is issued. �I have and will maiauia Workers Compensation Insurance,as required by Section 5700 of the Labor Code,for the performance of the work for which this Perot is haeued.MY Worker's Compensation Insurance cani<r and Policy number are:' . I __f - -- ... .._. ._. �..�._.�_.._................_...,......_..-_.,. ........ .-.«,.,. - - r 'Cvnec—/97"L `VN'LIQ'?IblicY N..l J429-00' s71 - i' " • . CERTIFICATION OF EXEMPTION FROM WORKERS',' a;.' 1Jti COMPENSATION INSURANCE' (This section heed not be completed if the permit is for one hundred dollar " "" IS 100)or lcss.l h _ .. _t hio I ttnhfY thin'I'an m she performnnc f thework for which ti's pennu is issued.I shall not employ any person m any manner so m become object m the Worker' t ` Compensation Laws of Calibrations.Date g2(}/ NOTICE TO APPLICANT,IL after making an,,Cambrate of Exemption,you should ' became subject to the W'orker's Compensation provisions of she labor Code,you most Q O forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY ' E" I hereby offlrm that the a truer lending ag cy for the performance ,'mss fore work for which ibispermit isissued(Sic 301 Civ.CI a� Lender's Narde.,.... a........-._. .. ... _... .._ .. . . .. - _ - . _ ....._-- _.. .. ._ . . .... ._. . ... .._._ _- .. ..__.. ....---. .- _--- ... As Q Lender's Addresssn ' h T ,U Qt , 1'cenify that 1 have mad this application and state that the above information is ks� correct 1 eg.to comply wiih all city and county.alinances end sham laws mlating Q. to hildingc.natmction.and hereby atuhorin representatives of this city to enter upon ',,,.(� the abovamemiored psopenY.or inspection Purposes. F 6t (We)'agme to uvedndemnify and keep hortnless the City of Cupemhio'Sgainm i..i y liabilities,judgments,costs and expenses which may,in any way accrue against said V.Z City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POLYI Issued by: Date SOURCE IF w h5. �Mic of ApphcanUControctor, Data. Re-roofs ' HAZARDOUS MATERIALS DISCLOSURE 'I'ypC Of.ROOf. - Will theapplicant ,future building ono ant yore m handle hazaalous material _ ,-„ _.-_ _ _,„ „„ ,... ..,....,_....-__--„ as d fined by,the Capering. Municipal Code,Chapter 9.12,and the Health and Safety h, - ' - q Cod Seam,255320 I - "1 ... ❑Yei ` 4 i� All roofs shall be iriap:ciedprior to.any-roof ng material 4eing.installed.__, Will the applicant or future buildng mcupunt use equipment or devices whim' If a roof is installed without first obtaining an inspection,,Fdgree toremove m et ha rd us erre ntaminams as dein y the Bay A A Quality Management Dh met all new materials for inspection. Applicant understands and will comply with 0YONon, all non-point source regulations.. . - .. .. . ..Lyase, I have mad the haiardous material;requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505.25533 and 25539.1 undersand that - ifthe building does notcunemly have a report.that it isthe,OccuP ,my responsibility to notify t - - - - - y e requirements which..at be met prior to issmnce of a Cenificam of F' ane fth Signature of Applicant - Date woe...anmodad agent Date All roof coverings to be Class "B" or better .. . . . . . OFFICE - - - — - • X N vFNQ � = eco CD CO) vn a g OH Yr -m m3 D. D p D n 030 z o > > m (n O 3 3 T c w O z d"' m A m m K b c � § m D TNCD M c b c g M. 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