02060164 CI TY
OF
DIVISIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20279 STEVENS CREEK BLVD GIACALONE ELECTRICAL SERVICES 02060164
OWNER'S NAME: APPLICATION SUB DATE
CONGRESS MARK I AND LORETTA R 6300 MONTEREY RD. 06/25/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 842-9655
O O ARCHITECT/F-NGINEER: BUILDING PERMIT INFO
w^� BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
as
0 I thereby IGrm that I am licensed under provisions of , 9 m nein Job Description
Z�+ y a Peovi, P 8
° withScnion] p)ofDivision3oftheBusincsatd < i ,c a mylian. ELECTRIC DISTRIBUTION BOX CHANGEOUT
m , in full farce and rife t.
ce e se Class ` Lic.st
w 3 v6. spam AQ— Commaor
11ll Wue DELL
(.-u O g I understand my pl...hall h used as public recoNx
so
Licensed Professional
es OWNER-BUILDER DECLARATION
so 1 hereby affirm that I am exempt tram the Contractor's License law for the
F following mason (Section 7031.5,Business and Professions Cade:Any city or county [•1
I O which requires a permit m construct,alter,improve,demolish.or repair any structure. Y
ud1 3 w..prior to i¢issuance.also requires the applicant lot such permit to file a signed statement. _
,but he is licensed Pamuion in the previsions of the Contractor s License Law(Chapter 9 �y g((��g1pOr Qp��ea Ji,e CC b Valuation
(cdmmencingwuh5cnwn.]000)af Division 3 of the Business and Prefximew Code) ( {mss'.�'r 3,11, L9U'f,Lt.s(I U,JI,{}- p,X Ito-r
m that Ke is axempi therefrom and the basis for the allegN eedmpsian.Any violation
—of Section 7031-.5 by any applicant tar a permit subpar.the applicant to a civil penahy
,of no,more than five hundred did bar'($500). 304APN ELECTRICAL" Occupancy Type
01,as owner of the propedy,or my employees with wages as their sole compensation.
r
-will do the-wmkl'and the'nroctme'11 ma intended'or offered for sale(Sec.)BW'," - -_--- _ - —
IBasiness and-Professions Code The Conbnctors License Law does au apply a an 505 - FINAL EL WIi� PNetions" '
owner of property Who builds or improves thereon,and who does such work himself
orr through his own employees.provided n Nat such improvements are not intended or
-".blTndd for-sile.IL howb'veCthe Wilding improvement is sold within one_._f ____—__.__.__ ...____ __. —_...____.._. __ .._._...._..._. ._...1..
Byear o s „
completion,for
the owner-builder will have the burden of proving that he and not buil)or
improve
f ,
purpose L I .p I
°1 of the i petty seely t i g th I d t t m
onw,the p 1 t(Se.7044B ., e and Prof e.. nsCm:)The
Cot tr's p
License Law discs not apply, r ofproperY who bolds orimy e. there n -
-and ho o tracts forsuch projects with. mracter(0 ficcusual.pronanot.to the.
ot mrs License Law. q L
0 I am exempt under
CSec. :8&P C for this masonDate
Owner WORKER'S COMPENSATION DECLARATION
I hereby alRfm under penalty nfperjuO one of.the following declarations
!'.•O 1 have and will inaiamin'a Cenlficam of Consent m self-insure for Worker's {J
7 Compensmion, as provided for by Section 3]00 of the Latin, Code• for the
performance of the work for which this permit is issued.
01 have and will maintain\Workers Compensation Insurance.as rryuired by Section
J700'o! he La f to pert rte f th work fur which the perm t
¢s ed M 1 c anJ Pol cy bcr are
i .. 0 �....
Pal' y No.. .
r{'�I GRTIFICATION OF E%EMPI'ION FROM WORKERS
CO TI INSUR N '
(TMi senior ncul no be ca n fm one hundreJ Julian - 1
IS 100)or Icss.)
._ 1 aenplui any
person
n in
ne rn the work for
co e'this permit e Wane) I t ,i ,
Citi mpent employ person m any Hunner so vs m'hecnme cattiest to the Worked
Compensation,' Laws trCal'f m'd Date
,
.
NOTICE
OTApplicant :..
,becameETO APPLICANT,WorkrsCormakmgthsonamrotcol LaW,iods.you
�I -
baaoinesuomplythe such prskions or this
provision.of thetabor Cock you man
Q O fonhwi,b comply with such pmvisiond or thix permit shall M Jttmed invoked.
V� CONSTRUCTION LENDING AGENCY - -
a ' I thereby ffm that there n.t t leading agency for theperformance Z. 0:
�r ofthe wn,k for which thispe, .t 'sided(Set.309],Cis Cd
Lenders Name. .. - -..-_. . .
1.d A .....:.1.... _... ... __.. . . .... ..... ........ .. .. . .. . .. .. .._
7-Z Lender's Address •
U Q 1 unify that I have mail this.,licodan and cute ino,the above information is
Iz'f correct.1 agree to comply with all,aityunit county ordinances and state law s,elating
Q V to Wilding construction.and hereby authorize representatives of this city to enter upon
the nbwe-mentioned property for inspection purposes. „ ,
[y 0.
(We lagreem dimity and kepi I.-xtheDty fCp -in agind
;14 liabilities lab lit 1 Ib ,e t, t J perm which 'v n any y against sand
V ►I CtY ncc, Ith i gafN pe 't " r.
P� 1C P8l COMPLY WITH I \ON POINI Issued by: 1 Date
�' 2 -az
t rnpPlir nt/C t ter - .Date.. Re-roofs
H\ZARDOUS MATERIALS DISCLOSURE V1 s� ✓ G�
Wil the pplicam or future building occupant store or handle hazardous trial Type of Roof..
in di dbrN ca,pr al a.le Chapter 91x. dm HItn ds mrY - _
Cod s t 2sa�2( 1 - q. e ., ,. . .k' ,.lir;
" ' f All roofs shall be inspected prior-to any.roofing.materlal being installed. -
wiume�ppiiaantar to-bu,i goccdpant paaya,pment or de ¢ca wmcn If a roof is installed without first obtaining an inspection,Tagree to remove
p,n hundWs airevacramnat' ned by the Bay AteaAir Quality Management
I vzt trmr - _ all new materials for inspection. Applicant understands and will comply with
°Y No all tion-point Source regulations: '
I h see read the hazardous materials regdof rements t tdc,�Chapmr 6.95 the
Califdrnia Health&Safety Code,Sco a,25505:25.5.33 and 15534.1 undersord,hm
ifihe buildin us not cancan ha , amen.that it is anyoupid,rinloy to notify the --
cerapa - t ,,yareamcn which nail ed met pnm as issuance of a Cenificale of
-- _ /_ Qy Signature of Applicant . Date
owner,ar authorized agent [v Date All roof coverings to be Class "B"or better