02080160. l ,,. _._ ....... ._- OFFICE.. -
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CITY
DRoNO
CONTRACTOR INFORMATION:
IVIIS[rPERMIT
BUILDING ADDRESS:
PERMIT NO.
21251 STEVENS CREEK BLVD
02080160
O[_.f'L "8F CUPTERTINO
APPLICATION
PHONE:
SANITARY N0, CONTROL NO.
I eco Zp
ARCHITELT/F.NGINEER:
BUILDING PERMIT INFO
<
BLDG ELECT PLUMB MECH
N i
LICENSED CONTRACTOR'S DECLARATION
Job Description
't.
I hereby of i m mat l am licensed under provisions MChapter 9 (commencing
with Section ]000)of Division 3 of the Businasaw Pach,"ians Calc aw my license
ADD GAS LINE
ef5
c c 6
in fall
License Cores Lic. a
Y_
(NO FEES-FO� Yw12R ERTY)
O
Date " Contractor
O t;
- ARCHITECT'S DECLARATION
be
3 5
;l
1 understand my plans shall used as public accords
AUG 3 0 2002
S p O Licensed Professional
es OWNER-BUILDER DECLARATION
5 !dI hereby affirm that 1 am exempt from the Contractor's License law for the
-�� following reason. (Section ]031.5, Business and ProfnsionsCwc: Any city or county
realn Pro Anyr county
—�
BUILDING
permit m conswct, alter, land
which requires demolish. or m any
_
--'"-" - -
i3$..por to its issuance, alsorequires
prior oliehavisiocantfmx Contractors License Lowdnapter9
` - mbrheislicensedpur9.ml?theptonsvision me Contractors
Prl�wme, Cor9;
bcingwith a CodU,
Business Pih.
,.�,,-,,r; ,5`Lj.-Ft.,71'IOOr: Area,., ;;t
Valuation
it
SccuarTWti othe bails An 1
and the basis for the alleged
., thiel Ilme leg
or Nat hlis exempt tarry a plicanion. Any
t ,. .', 4 p., ,v- dqo 7:'tf Vi.\::.:
the l memos
orSection103 n by anyydred all for x500). bjmsthe epplicam too civil Penalty
applicant
i onnot mare than nvrhuwred m,nar.. (ss(gn.
APN Number
rr;ot. r Occupancy Type
01. as owner of Me properY, or my empinyces with wages as their sale compensation.
101 -EQIMDATTnN
102- PIERS Re uired Inspections
9 P
-will do the wod:: xnd-the srmcuire is no, intended or offered for sale (sec. 7 4 :
=Busineiiand Professions Gide: The Contractor's License Law does not apply to an
owner of propcny who Wilds or improves thereon, and who does such work himself
103 - UFER
or through his own empt,.,, provided dia such impaso me us am not intended or
";plTcred for sale If; hiiwcve{ the buildin - -' cm<m is so1J within orf ear of
- -' - - - -_ ...._ .._._ _
104 - REBAR '•t,irta >- eu>' ^l ',••
'<ampletlon. Neowner-builderwiB havethe WNcnofprovingthat hedid notbuild or
105 ANCHOR BOLTS
improve fm purposcof'.1c).
-
t :lFl,l .----
of he I rvcly-conn-ti^g with I csed conmato
T06_ SEWER - ; — -
namia ire project (sec]a4, Business and Proreaaiana ewe.) me contractor.
202 - UNDERFLOOR PLUMBING ''f -` 1'
i = License Law does not apply to oa owner of popery who Wilds or improves Merton,
zC. _and who,cuntmasfocsuch.pmjectr.ith.a..,rmwtms)uc<need&purmant.ta the..
_.....___.20-3--'---UNDERFLOOR'-MECHAN-ICA.L....------.__._.._..._._._.
Commcror L
OI ie dc�Sc "' &P f thism son
wt� 2
-
204 - UNDERFLOORI'F'RAMEc�`t
205 - UNDERFLOOR INSULATION
1 `woalceRscon+i+"s hONUI:cLARATI�L
t.
301 - ROUGH PLUMBING
.-Iherchyafrm;amllrtp<naRyarp�r;ary�bneynne.rminwi^gaecm,atm^a:
302 - TUB & OR SHOWER
o i'hs6e'uw wilrmainnin a C:riReate'dr'Consenrto self-imurc for workers
303 - ROUGH MECHANICAL
Compcinatior as provided for by Section 37W of the WW, Cwa, for the
304 - ROUGH ELECTRICAL
_penfonnanceofthe %orktowhichthispmain sissued.,
-
305 - FRAME
' ❑ I have and w llmei i W rker. C6nipcTis;ition I waince a quimd by Section
'37W or the Labor Code, r theperfari l rn ',work rwhich this parno'k
306 - HOLDOWNS
issued.My Workers,C p- ton lel n andY Policy be
,
_-,,.._ __ _
307-(- - . — - _ '
c eo1<yry .
-CERTIFICATION
jINSULATION
h` f`V t3'OIB + `+,SHEETROGK� @J k:
I OFC%EMPTIONFROM WORKERS
COMPENSATION INSURANCEa
a. _.-
---- — EXTERIOR--LATH _. _ _ .-. _ _ ._�.....
3.O 9,_s14`__
r
(Thnseciior%i ncednot be dompleicJ if the permtis for one hu rdrcJ Jullara
310 - INT$RIOR LATH- p"` ` UI <..e n !`: p+•
311--... .., _
_-. 'SCRATCH-;COAT,'- -
"- Icemfyth imth perform9�ce'of th� Lvrkf'whichth perms sns eJ 1,
w
_ IIr..0""''f."io4t '•
313 ROOF NAI li`
'n61i r t < pm n ma�p.Jpan�6' �5,,,,,. k
--o".c g'd°"+�
C,pa�pmSJtjmau Det®
�c
501 ELECTRICAL ENERGY.
a t
ted y hod
Lhe
... __... ..-._F.INAL
502 - FINAL PLUMBING ENERGY
o�fgtFid
aeETOAPI
�^ sy Ya v
6 J ,,. ons trine uW cw<
WNkelf C mmanrmth o permit c r revoked.
O � 'felon Im<mMr 'tn rep � t' t" sen^
503 FINAL MECHANICAL.,_ENERGY.-_...... ._
s^'C^r10NLENDINGAGENCY
CONSTRU
'•
SO4 FINAL BUILDING ENERGY -.. \
tgee
fh b 'ffimthtth-' t cti nl dingagencyr he perfrmpn
ofJ kfr'nclth pc 'i '. d(S 3tro]C CI
505 - FINAL ELECTRICAL"'"' r M.
W s.,
q Len"e Nam
_
506 T-GAS 'TEST - .
' 4�p!,t.
Lenl Addrc,, -
U C ll rrrtn�iln dm ppri<t t nd tt thtm W tion is
50 FINAL PLUMBING nQ
5 8 - I NAL M CHAN I CAL
W (:. ;comet 1 agree tu,coi �p1y wish all my a d t sty, pro nano ora stun bows relating
U
O,V tri buildingconnrvmion,andherebyauihoriceieprcxnutivcsohhiicitymcnterupo6
5 9 - INAL DE
j, �, )tieaWe f prep p,rl pppt pm.. ,.
a W) grte m d mo fy anJ k ep ham] ss the Cny of C p nano against
5 - INAL
rn liab I t Ids pts. t d p nx Nch .Y n anY Y «fere Bairn said
V,Z Gty9 enceifth p t guf th p t -
WITH: LQ\�(1.n•-�P/Gla-r'
L�/y
514 RKS 0
('OP�NCA ERS�7AVD5"AVD WILL COMPLY
Issued by; Date
-
Re roofs
ig (Apple nUC t eta - 'D t
HALkRDOUS SfATE1tIAIS DISCLOSURE l'.
" WIIth'appTcnt rft b Idng0.upant m al nt
.Type.of.Roof.
unplCw Ch pt 913.and the Health aaddSof Safe ty
dbye Cupen Md
as def th
Cwc 9cetn3553dait U s „H'i b, f !
aYe' k i ! ,
.�,! ', icrr a, s.t..: 'll tl.
- it t - i r y 'i t; '•. ,: '.
roofs shall be_mspected prior.to.any roofing material being mstalled._......._..-
n
,- I1 the Pplic ni fu W lel ng oc«piumum opti,onlin a, device, which
-All.
If n roof is installed wi[tiou[ first obtaining an in'specnon', I-agree [o.fetnove
emo hjabas it crimicarlicinmrs, d fn d by the U, Area Air Quvl ty Management
,filmct, ,
all new materials for inspection. Applicant understands and will,comply•with
_
DY i, .-. I, ",. . ,
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all non-pore[ source regulations...tI-.,
31
I ha:< reaad hssarl us,materiah requirements under Chapter 6.95 of the
,&iifamia HnhN'& Safety Code. Sections 35505, 35533 and 35534. f understand that
- - - - - -
ifihe Wildin d t, tly have a tenant, Thar it is my. respeasibiply to rarity the
8 gpsna a
joce p t f the requi m5 t hich'mu t be reel pour to issuance of a Certificate of
-'
..
'
oc< c ','� g�
Date
.Signature of Applicant - _ - -_ - .. ..
All roof coverings to be Class "B" o[ better' 1
.,, ', ,Data.'
K o Iloonwd agent , r
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