00070162ct
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUnJANG ADDRESS:
PERIMP NO.
(lWN1iR'S NAME:
APPLICATION SUB DA'rE
20823 STEVENS CREEK BLVD
00070152
TONli:
SANITARY NO CONTROL No.
NTT AMERICA
07/25/2000
]. ARCH I'I'ECT/ENGINIiER:
-
BUILDING PERMIT NFO
O
C
BLUG IeLEG7' PLUMB MSCI{
U
w
I—.'I IJ IJ 1=1
a
hICIiNSiiDCI1NTRAC'IT)R'S DIiCLAItAfION
lob DOSCrlptlOn '
1 hembY aRm, that I an, lieemed under m vi:ions or Chapter 9 (commenting
w with Section 7(X0) of Division 3 tithe Busincssand Cale. and my license
%Professions
Lorin lull lirtm xtW.rllc�O
.
Lic.p—/ /Zo
V Liccnsc C ll_ layv � r I%lo
Fin ARCHITECT'S DECLARNIO
5 1 ame.,taal ror Nan, .h:dl be tore ;.s pa.l,ua rentrds
ELECTRICAL
.
�p Licemed Prom,,crol
LL OWNIfR-BUILDER DECLARATION
1 hawhy aRnn that 1 un, exempt Irian the Contmaor's License Law far the
a following reason. (Section 70M.5. Bminess and pmressions Ctde: Ally city muranty
.
O which requires a Iwmlil to ronslmeL alter, improve, demolish, or repair any sWcture
,
prior to iw is,uancc. ubo re,mm, lhch,dh u If nuuh "amino fdc a signal ^mmtncnt
— that hettoren,dpumaamcome pownt snfdo, Cultura LicenseLaw (Chapter 9
Sy. Ft. Floor Area
Valuation
ktmmencia, with Senion 7(0X0 of Division 3 of the Business and Prnfes.itns Cade)
err rant he is axe ;era thurefnun and 'lot basis Ibr the ulicgcd rxcmPtitnAny violation
of Acro 7031.5 by any applicant for a permit .hect, theapplicant It, a ckil pnmlty
APN Number
Occupancy
,if nmmtrethanfive handmJdollars 65(10),
$Tylpe
Ed ],;is oltire prupray0lilly en,ployce with wages ;;s thcir.ule�cnngmnwtio 1.
Required Inspections
will do the work, and me structure is an Imendcd or offered Ibr sale ISuc. 7OW.
Law does
Bmiross and Pmfc,mom Cade: The Cometh or v Liceme not apply to an
r of property Who build, to r impmvcs twocon, sad who doe, Inch work himself
owner
32532053. 00
his own mnpltyees. P ovidcd plat such improvemcho ser, orn lnm;med'or
afibml ro, sale. If. h..c,v, the building or immo,croem is .to within one year of
completion, the ow ncrhuilder will have the burden of proving that he did not build or
ROUGH ELECTRICAL
improve Fam,low, tf.:de).
304 —
0 1. ., owner of the property am exclusively contracting w ith licensed contractors to
501 — FINAL ELECTRICAL ENERGY
amstna, the Inject (See 7(". Bminexs and Pmressimis Cale:) The Contracmi s
improve, mrreen.
505. — FINAL ELECTRICAL
Lienee Law does not apply it, amwnn nor prci,d, whit naso it
and who contracts for such project, with n ctnlccm,lsl licensed pennant to the
Ciammdors License Law.
❑ Iran exempt and. Sec. . 11 & P C ror this all
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby alfinm under penalty of perjmv one of the fallowing dcclandolu a:
I Ihave and will a aintuin a Cen.Ocate it Cunwnt tt self-in^u¢ for Workar.
'
..,...Bann, as provided for by Section AW tl' the Labor CWc,.for the
performance of the work for which this permit i, issued.
❑ 1 hove and will tannin W..kc, ', Compematin i Imwmoer, m mquired by Senion
3710 of the Labor Cade. for the performance of the work for which this permit is
sued. My Worker'^ Conalmation Imwranec carrier and n�mnher
APnlie�y
arrier. ln-CAn , fn, Pull, No.:,p{,7_LLl
'
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSAI7ON INSURANCE '
roti$ Senion need not he completed if me p .it is for one hundred dollars
($K(b err less.)
1 cenily that in the perfomaance nl the wairk for which this permit is Issued, I
shall not employ any Person in any manner so as to Broome subject to the Workers'
'
Compemntinn haws of Califomia. Ilam
Applicant
NOTICE, TO APPLICANT: If, alter making this Ccnificule of Exemption, you should
T become subject tothe \Yorkds Compensation provisions of the Latin Cadc, you must
-
., linthwim ou..lu, with such prnv..intoor this permit shall be created revoked.
n CONSTRUCTION LENDING AGENCY
1 hereby anion that there Ix a cnn.amnion lending agency for the lerformance
of the work for wblclb this tenni.. Is issued (Sec. 3097. Civ. Cr
_
Q lender', Name
T Lender's Address
1 certify that l have read this application and ^ane that the above information is
orrect. I agree to comply with all city and county ordinances and state laws reining
in building concWnin l. told humby authorize myresom unwi%m mix city ,, enter a,,.
the abnWr),tnnd eu'tlun �,at Poor..
:L1 indemnify e
d M'c)agme msmx. ande,croesk
hihannlmstan wayaconot uinoagaimt
liabilities, jnd and which n,uy in any way acerae ugaimt suit
��
ing of lex
arric,.Inst
Z City In cm.xeyuerec of the gruming nfmis permit.
APPLICANT AiRSTAND$ D WILL COMPLY WITH ALLNON-POINT
SOURCER T 1���/!���
Issued by: Date
Re-roofs
Sl"come of plbou7 Comm of „•"°
HAZARDOUS MXI'ERIALS DISCLOS RC
xwn the applicant or future budding occupant some or ham➢e hwardom minimal
Type of Roo
to panned by me Cnpenmt Municipal cable. Chnpmr 9.12, and tine Ilenithand Safety
Cala, Section 25532(a)P
ores 0N
All roofs shall be inspected.prior to any roofing material being installed.
1 Will line npplica.,Im Bnmebundipgnrrtp.nt a,caymnnant trd.... -which
If a roof is installed without first obtaining an inspection, I agree to remove
mit torturous air eonwmiwms as dulba d by the Bay Ama Air Quality Management
all new materials for inspection. Applicant understands and will comply with
r>,rin^
El Yes [3 No
all non-point Source regulations.
1 have mad the hazardous materials requmarch s under Chapter 6J5 of the
Calib mia health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that
If oho building dor. not .....ndy haven nand. I'll a In .try rcxP^^^Told' to ....lily dm
cupant of the mquimmems which must h pmt prior to iss anco of a Certificate of
Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B"or better
owner or authorized men, Date
L111MI N4