02070178 OF
C BUI
BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: I PERMIT NO,
21265 STEVENS CREEK BLVD TCT TITAN CONSTRACTING TEAM 02070178
OWNER'S NAME: APPLICATION SUB DATE
STONESON DEVELOPMENT CORP THE 12684 HOOVER ST. 07/29/2002
PHONE: SANITARY NO. CONTROL NO.
(714) 890-6655
O O ARCHITECDENGINEER: BUILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
Z 5y 2 LICENSED CONTRACTOR'S DECLARATION Job Description
OZ-O IhcrcbyafBrm Nmlam licensed under provisions of Chapter 9(commencing REVISION--IN HOUSE USE ONLY
F= 000
t with Section 1 )of Division 3 of The Business and Professions Calc,and my license
MLs in full force and enact.
ieemeclasa u°.n ORIGINAL #02050106
asO e.U Date Conn«ter
'n n.a fin ARCHITECT'S DECLARATION
(_'=O S 1 I ndcntanal my plans shall be used as public records
r
O O Licensed Prnksaioml
or Oat I am exempt
from
DECLARATION \ '
oi I hereby affirm o that 1 1. exemq from Ne Contrns Ca Liccnu Law for the
(:Z fallowing reason.(Benton 703 1.5.Business am Proftemoli Codc:Any city s county
F O which I.toils in permit m construct.alar,impmve,demolish, fie a Ti any structure
3$,.that mIlcensed e,alsorc to the Ne applicant for archpetors LElmasigned summat
thaheisli«nud pursmmtpyhe ofDfvinsof the Commuters Liccnu Law(Chapter Cartel
- vs Sq.FL Eloor�Area„ x r-i,” "a nation
.clothe is comp,a}ionx9000ndtebasisoof tNe Businessand Professions Codd j,�Il,�' � gl.�a d„ ?r 1_i t', N."I'. ,/.7a:+'at
«Hai He is exempt Nerefrom end the basis for the alleged e�rription.Any violation I
-of Section 70315 by any applicun for o pnmiuubi Nc applicant to a civil pemlry
,of not mote than five hundred doll.($500). umber n•c- Occupancy Type
❑I,as owner or The properly.or my employees with wages as theirsole compcn.mtio., 1 nj _
aL
will da Ne words.and sions Code:
The sem Intendeor's Acer offered for sale lSa )o an --
sBusineof abd popery,
W old Cme The Contractor'.Licensed w Law d«.a net apply on an 102 - PIERS Required Inspections', '•t f
owner of properly em builds or improves Nc such
improvements and who does such work himself
or dvoagh hid own employ«.,pmvidin Nr lace tissolam sonintended or 103 - UFER
-or(ered'Nrale.u:nowe�er:'Ne'ewleib8 o;imProtzmztlt is sold wamaane year or _-------_.__...____._. _.._._.____._.___.________.___ii—_.._.___._. _,._____.__-._._.___
'completion the owner-builder will have the burden of proving that he did rot build or 104 - REBAR , ., ..__ ..r
improve for Pmpnaaof 111 105 - ANCHOR BOLTS
al:esownpoofth am '¢actin Nlicenudcontr«mrsto
P(See r aeon gwi 1'06-=- SEWER--&-WATER 11 11:..'r:•.�'
Linemenawdoeic sno(sae to
owner ofBusiness andertywhobscmc:)Thecontmnora 202 - UNDERFLOOR PLUMBING fl°f' ,'..:` '.•.r"
-
License Law does not apply m an owner of properly who Wilds or improver Hereon,
i S _end who,contracts for,such.projects with.0 contracmrn _ 203
rts).licsed pursuant to the. . ... -erre_ _ _ _ L__..,___erre_._.._.._...._..._.—__._._.-
- Contractor.u«gseLaw,,.l ff \I,l,. - -UNDERFLOOR_MECHANICA
❑1 a „pteers ,..8&Pcrrtm.aaaon 204 - UNDERFLOOR'I'FRAME,”
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION _ 301 - ROUGH PLUMBING
Ihereby afirmunder Penult yof,rjurymTc.f h followingdeclaemimm: 302 - TUB & OR SHOWER
❑ I naoi crid wiR'inaihtI a1Cdrtirea6W Consent to self-insure for Workers 303 - ROUGH MECHANICAL
_ Compensation, as,provided t« by Senior 37till Nc Labor Code. rt
fohe
performan«ofdew«k fmLalhch this parm,is issued. 304 - ROUGH ELECTRICAL
❑1 h d will ma t Worker i Co pens s o Insmann real by Section
305 - FRAME
3700 f N LT bm'C& f at theperfmm m f iM1<work f hien rtes Permit is 306 - HOEDOWNS
toed My Workers
Compensation- insurance rand Policy numrcber a -
uuw la .._ t s• .-- `
307---,INSUL-ATION`"._..__.
Rel ref Vr Al.r'd PolcYNTi 's ' - r�r -, .d: " ,. ♦.LI3 r, IPO
�-tw T, ednoW mSAc ON INSURANCOM E I one hunated as k iL .a.i 308 2"SISI-IEETROCK•?:. . .
COMPENSATION INSURANCE . ,. ,--„ ,,,.•,,,,
-'• _- 3'0'9':,:;�, EXTERIOR-'LATH-._..._'--;;-j'
� dollars 310 - INTERIOR LATH ;
-------
IeerlJ,tniinm rrm.iaeerme 'rkrd:wnnN-a Ci'umed'I --'- - 31'1'.-_.-SCRATCH
a a� ,,ill . _l .ye... •' r„ r
Applrcun become subject to the W ken
Cni.tan° dsyofC n hi fmitUme ` T `°I° ' ---_- 313 - ROOF NAIL' '
r
dAt]TICETO APPLICANT If,aver Coinmak g"is Cenificam (Exemption;you - 501__-_,F-INAL--ELECTRICAL„ENERGY-. .--. - --- - -
should 502 - FINAL PLUMBING ENERGY'
nr ICE T _n m I A k' after ton prov 'a or N Lobo ion,Cony u s n
Q O torah Mc comply w,Nsuch provisions o m Permit hall be Lamed rokm. _„503 _--..FINAL.-MECHANICAL..ENERGY_ _
�,> coNsrRucnoN LENDING ncErlcr --. ' 504 - FINAL BUILDING ENERGY-` ”
' 1 xi
alum Nat Nerc d co.t t d'ng erg racy f rah perfoincrI t r L IB I
W . of eTI'or
Nxpe r. .neals« 309]cv.cl 505_ - FINAL ELECTRICAL_ .
- _._.
Z d No
err 'Ad me
--506 GAS TEST
U'C ,., i eri ry iAm i time Tena mi,dept intron ana.tme mm me«nave inroonaron is 507 - FINAL PLUMBING
Tire
egac to comply,with all pity dna county,ordinance and sate laws mlatin8 508 - FINAL MECHANICAL
�;rJ po building conarvnion,and hereby aurM1drra represenativex of Nis cisyweme,upon
a IN Wen. tramp pn,r npaonPryo : 509 - FINAL GRADE
h.0: (W) gree m e d - fy and kc p num]..tC IY f C pcnido a8'nat
ti] li h Int 1 dg ems t od pen. h<h m y n any y c again.t said 55510 - FINAL L I ^ /
U Z cry q ee nne8rant garN perms - - Issuedbl4 - F A WORKS D ` v
'!! i11 LfCAVT❑VUERST\NDYAVD WIII[.OMPLY W'ITH'ALL NON�PGIST'
SOURCE REGLI:n71VN5„ Y
.SiBnaiure:of APPlicanr/C mmcmq•.'.�y^r.r' ,. 'Dol:•.,1. Re-roofs
r 'os derrrm b g1C HAZARDOUS'MATERIALS DISCLOSURE
Will rhe ppli<rat Murc b Idi g ac p rat tore n handl h d s a'I Type.of Roof.
y CupertinoMn ;palCodCM1aPt 912 dN H -IN mSafry _.. _..erre __.....v. ..-'..`\^ 9t .,......„••'• .~ m..
Cine S al 255120 ri f s t
Tt s
d” r All roofs shall be_i5ispected-prior to_any roofingmateria]being installed.---•
x�ft
cTorromfulture holdirlimeripsont racerfaipmentb devices which. If a roof is installed''without first obtaining an mspecuon 'I'agree to remove
emnh d ac m na t tl fi dbyN B,Are A Q airy Mamg t
District? all new materials for inspection Applicant understands and will comply with
all on poiIt source regulations -
.:U s, ter,, :R•s ,
C )41 have•rmtl;4he hassrdouz]materials requirements under Chapter 6.95 of the
Califomin Health&Safety Code.Sections 25505.25533 and 25534.1 understand that
if the buildingdges not currently have a tenanq Utas it is my respseadoloy m notify the _ .. .. _. _. .- __ -.. _. .__.__..-._._ _..__ 1. '_ ... _.. .-...
. . - .ywhich ,. Rcate of -
Oec ane ”
ac pat f IAc requ to must W ion prior m ace of Ceni
ci Signature of Applicant _ Date
y
'o trio ,Ih u g t .,,, oarre. All roof coverings to be Class"B"obetter '
OFFICE
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