02080136 CIBUOF
NG PETNO
DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20450 STEVENS CREEK BLVD SASCO ELECTRIC 020Yy80136
� B DATE
MMHUS 1600 MEMOREX DR APPLICA08/23/2002
PHONE: SA ARY NO. CONTROL N0.
(408) 970-8300
O O ARCHITECT/ENGINEER: g BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
—1 L-]
�yy
Z LICENSED CON'nRACnderp DECLARATION Job Description
Zt5 hcrthyaR. Mi,i.3.fffieBunderprovisionsofchapter sCode commencing INSTALL UPS POWER SUPP .L A)
wish Section]000 fDivisionJof Ne Business end Pafcssi sCode,and' liceae
y f
L,.-n'
, full force end�tftt. ' aC"
Liccnu Class y+-[]_ Liu.pr tUJ '
Be u U in _ Contractor t f
so Ci R ITEC DECLA I
1 undcrstmW my plans shall be used a pub- recams s '
�vm a n 0 Licensed Professional
OWNER.BUILDER DECLARATION
I hereby eRitm that 1 un exempt Toro the Contractor's Liceae law for the, L _ Di
C?< following reason,(Section 7031.5.Business and Professions Cade:My city or county $2000
O which requires a permit to construct, he,.improve,demolish,or repair any swcturt
oua.3°9 Prior'its isswree.else require.Neapplicant form
ch Permit 4.r&.4grudauwrcm
- - - - - --- ----- "-- -
Nat;he is liceo4e ptvaWu to die rimsoioa of the Contactors License law(chapter 9 X13.C.,v.,Fn.3:i�{rpr�,a 55 4,7.3 ^^..` Valuation
(commencing with Section 70001 of Division3of Ne 0usiru{4eoa Professimm Code) C0'1\" y..00.e^J�_11V„
or that he is exempt Nercfiom arta the basis for the alleied exerdp loh.Any violation
of Session 7031,5 by any applicant fm a permit subjects Ne applications a civil rely g,t„,,,{,�
of not more than five hundred dollars($5W). 101A-N Y'TINDATION - Occupancy Type
❑1,as owner of the property.or my employees with wages n their sale compensation, 102 P I ERS
--willdome work,and the structure isnot intended or offered far sale(S..-7044. 1 O 3 - UFER Required Ins ec[ioi4s'' `
Busineks and Professions Cale:The ComossaWs License law does not apply to an q p •"
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his awn employees,provided that such improvements art not intended or ,..._.
-.-__. - ._. __..
--oRdma for sale.If,however,the building a urdeov<mem is sold within not Wild of', " 105- ANCHOR BOLTS
completion,purpose
owner-builder will have the burden of proving Not he did not Wild or
improve rot purpose.(,ala.). 106 - SEWER & WATER
- .._. -._.... ._., ... 202....___.UNDERFLOOR--PLUMBING-
El
1.as owner of to property,am exclusively contracting with licensed contractors to
construct the project(Sec.7D44,Business and Professions Code:)The Consonant's 203 - UNDERFLOOR MECHANICAL '- '
License Law does not apply m an owner of Progeny who builds
• r. - . improves Nertn,
:: _ dad-who contracts f . ro1ess with a eomtnemt(s)licensed --.204----rsuenm.N
. .UNDERFLOOR-F-RAMS....__._.___
-------
Contractors License Law.
❑Iamexempt under Sce:, .-_.._ ........ .. ..........__.... . . -..
,B&PCfar this meson 205 - UNDERFLOOR`'INSUli78TION
wair Data 301 - ROUGH PLUMBING
- -
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby affirm under Penalty ofKUuryone othe following aecmmtions: 303 - ROUGH MECHANICAL
❑ I have and will'malntain'a'Cenificam of Consent to self-insure for Workers 3 04 - ROUGH ELECTRICAL
Compensation as provided for by Section 3700 of she Labor Cade, for the
'pedmormce of the work far which this pemdt is i...ed,. 3 05 - FRAME
❑1 have and will maintain Workar'.s Compensation Insurance,a mquirt4 by Section 3 06 - HOLDOWNS
3700 of the labor Code,for the performance of the work for which'this permit is 3 0 7 - INSULATION
'
issued.My Workers Compensation Insurance carrier and Pol cy numher arc:
30,8 tSHEETROCK -'- - M"-
�C PolicyN �� 1 4. 130'950 'aEXTERIOR��LATH�' � t
<, -C ERTIFICATION OF EXEMPTION FROMWORKERS',
. _ COMPENSATION INSURANCE' __._.._____.__ ___-..._ ._ __..__..-_._-..._..
--310:-,-`-'INTDRIOR-LATH-
t"' '(This section need not he completed if the permit is for one hundred dollen _ -, ''%,1:" s`.I f
(61001 ar legal 311 � SCRATCH COAT
n as
manner m as to hecome sub«t 313 -' -'ROOF -NAIL- .• _ .,, .:. _
1 cenify that in the perfommnue of the work for which Nis permit is taus;I
Finanvaemvlurmvp n mineworker 501 - FINAL EliECTATC71li"ENERGY
Compmumion Laws of Cahmmla.Dine . .5.02._- FINAL--PLUMBING.-ENERGY- -.
._Applicant
NOTICE TO APPLICANT-.If.after making this
Cmificate of Exemption,you should 503 - FINAL MECHANICAL 'ENEAGY
become subject the Warkers Compensation provisions of the Labor Cale.you must
O 'foahwimcomplywithsuchprovisionsorNHPermitsliankattmercvoke. _ _ 50.4_ - FINAL_ BUILDING -ENERGY.. -_-__-._-
_. ._.. .
.F" .amu '" 7.
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
' 1 hereby afrm thin Nem is a coatruction lending agency for the perfor mantt 506 - GAS TEST "
of Ne word for whichNis permit is issued(sec.Jtw7,Co,C.)
_
a _ permit - - 507 FINAL-PLUMBING
,U.Z �eert Address .. - ..
e Q 1 cenify that 1 have mad this application and them that she above information is S O FINAL MECHAN KCAL'•
k7+'Fw correct.1 ague to comply with all city and cautny oNinanca and unit laws relating 5 9 - INAL G E
Iin Wilding conswction,and hereby authorile representatives ofthis city to enter upon S O - INAL NG
Ne above-mentioned property for inspection purposes. , -,
{,a 0. (We)agrcetosave.indemnifyandkeeph.rMcsstheCityo Cupeninoagainn 51 - INAL RKS
r (A liabiliaia,'sed menxs,corse and expenses which may in any we cmc againn acid
V Cityi s enceafthe ting of Nis 6O2 F IL
A NDE NDSAJOWIL _99# POINT issued& _ Date
t.GUL m . . --
q PliwnUContrac Data Re-ro&04 - 00 IN-PROGRESS
HAZA ATERI DISC SURE
11'Ne eppliconso rcWilding occupant st a handle haumus mammal Type Of Roof, -. - -
as defined by the Cupemno Municipal Code Chapter 12,and the Health and Safety r^y_ - n
Cade Sttt on 25532(.) P t- ori(.s s-. aT. . %'m`ss f
❑Y°°'-, o No. 'm _ All.roofs:shall be inspected prior to any+roofing..matenal.being installed. . . . .
Will the applicant or Jim re huilding occupant use equipment or devices which If a roof is insfalled without first obtaining an inspection;-[agree to remove
emit hazardous air conhemiwnis as define by the Bay Art.Air Quality Management
District? all new materials for inspection. Applicant understands and will•comply with
?Yea [3 No all non-point sodice regulations.._:
-,1 have mud the"o"nums'materims rcyviremems under per 6.95 of the
California Health&Safety Cnde,Sections 25505,25537 and 255 lundemmnJ that -
-
iftheWildingdoesnotcurtemlyhow a ability to notify the
oceup o e;require s wH' xt he met prior m as a of.CeniRcate of
c�SignamreofApplicant, --- ._ ._...._ _. . Date. _ .
.F ':,I' r orixed age Data All roof coverings to be Class"B"or better.
s':�: .. .,._ ... .. .... . .. ... OFFICE .