02030007 CI TY WPEION
ISPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21271 STEVENS CREEK BLVD HORIZON RETAIL CONSTRUCTION 02030007
Adkk�WN'F.R'S NAME. APPLICATION SUB DATE
"OAKS SHOPPING CENTER 1458 HORIZON BLVD 03/01/2002
PHONE: SANITARY NO. CONTROL NO.
(262) 638-6000
µl 0 0 U
ARCHITECENGINEER: BUILDING PERMIT INFO
H m— BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
I herebyaffimtakar Ism liccoseda deraa 1nornsof Chep¢r9lcommencing Job Description
'.„ed wanseneon]BBol0Divismn3onneeusmnyn�P%ro o9epryanamyfiagse TENANT IMPROVEMENT. (1587 SQ �
in tont iva ' N(�o (o t6o
i z 0.< License CI
•0.i0 V D of Contraau
iO ARCHITECI"S UECLA '1
g I undersmn0 my plans shall be used as public records fI"M$� p Q2
} F0��02 �uN o J 20
i
Li
p censee Pofasional
E: { Y
'X o Oe,I..R ea,ungEfr DECLARATION U U
m•=,., I hereby affirm aha 1 1. exempt from the Conant,Co License Law for the �' '�,1(�
Y?a following reason.(Smits]onstr Basin.,and ve de o demolish,
Code:Any city or county G 81AD0MU
CED which requires o peonia to canxlme6 slot,improve,demalii,rorrepairc—i,any swain 1
a3pri
Oat
to liceuanceasnt to the thuappnsofthe Contractors icense aw(Cbmmem 7 al
hommussnffn4d pursuant mth)ofDvonsof thethe Business and Professions
Cde)ttr9 r. ryr v Valuation
(commcncis crew StherehoOlp)oche baiisor theaBusineaand Professions Code) t Ia.w q (3.Ltl LrJ.'
or that be 7 exempt thdrefiom and the basis for the,bi the exemption.Any violation
of Section]!1715 6Y cry apPlieam for a perms mbjmes the applicant to a civil penalty
ofnut m.n a ban rve hundred eouan ls5W1. 101APN�"DATION Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation, J 02 - PIERS
win do the work;and the swenn is not intendedor ofered for sale(ree.711
Business sad Profession Case:The Cannot.,i License Law does not apply m an 103 - UFER Required Inspections'-
` caner of pmpeny Who builds or improves thereon,and who does such work himself
0
or through his own employeesprovided that such_i neent is soli are not intended yew of 104 - REBAR
;bRcrW for ole.If,however,the building or improv<mcm is sold within one year of
impletion.theownerbuilder will have the burden of proving that he did not build or 105 - ANCHOR BOLTS
`mprovemrpumoseofwlc.)' 106_ -,-.SEWER & WATER
13 1,as ovnu or to p:openy:ame:eSusively eenGaetimg with licensed o tors to 202 - UNDERFLOOR PLUMBING _
- onsuuct the project lSce.7614,Business and Professions Cadc:7 The Comnaor's
License Law eines nm apply to an owner of propcny who builds or improves thereon, 2 03 - UNDERFLOOR MECHANI CAL ' •.
_ .and who contractsfor.such prni with a eananclans)licensed.pursuing to the
Contractor:License Low. 204 - UNDERFLOOR'FRAME'__. ___._._.- .. ..
G l am exempt under Seo. .,B&Pe for this reason205 - UNDERFLOOR' INSULATION
_ - owner. Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
1 hereby arum anger penalty or perjury one of following aeelanemnx'.
303 - ROUGH MECHANICAL
❑ 1 have and will maintain a Certificate of consent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
erfor
Compensetln
n , as plded nryfor by Section 37W of the Labor Code, lar the
pmance of the work for which this general is issued. 3 05 - FRAME
❑1have d willmafminWorker's C'-mp'nsr 'lsunn« required byser 306 - HOLDOWNS
37 of the Labor'Code.for the performance of the work far which this Permit is
aMgw krt goal nI un �e �s alpory 307 - INSULATION
rPnunrgM ( C/�ZSZZ 308 '- ,SHEETROCK
CERTIFICATION OFF.%F,MP71ONFROMWORKERSr f""4 ° @3O"9 r i•.'."'XrPrERIOR'cLATH -
.:'., COM1IPENSATION INSURANCE _
. 'anisseaiunneed�no,hecompendifife pcroof isfor onebumdnd kilars 3T0__,-,,INTERIOR- LATH
ISItwl or le5s.1 311 - SCRATCH COAT
. .:Icn'ryto-�lnin fir ee .rtn rkr whimtn.pe ais xsaed.l - -313 ' _ -ROOF NAIL _ .yI ._..-. .... .-_ . -
sh511 not emplyany Person ya .o as to become subject tothe Workers' 501 - FINAL ELECTRICAL- ENERGY
Compensation Laws of California. ate '-
Applicant -- 502' '- -FINAL --PLUMBING' ENERGY
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should,
Z beeomesubjkuotheWorkersCompensationprovisionsoftheLaborCode.youmost 503 - FINAL MECHANICAL ENERGY
O forthwith comply with such provisimns or Nis permit shall be deemed nsnkce.
-504 I
(•' "" ' '''' ""
'CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL ,
"1 hereby aHlrm that there is a construction lending agency for the performance
onn0 work far which his p= .e, issued(See 3097,Civ.Cd_a 506 - GAS TEST
.
yp LendNme '- 507 - FINAL PLUMBING;
ULend Add..OI agree that I have read this city
and co and same anc me above information oche is 508 - FINAL MECHANICAL l
i100 U eoae8.I agree to comply with en sty and anumr ordinances and sloe laws rel.11 509 - FINAL GRADE
V he above-mentioned
rcbyaection uposeotatives orchis city ao rn¢r upon
0. mearovemenreetosappndemfor inyandlacphannal;. 510 - FINAL PLANNING
L (WO)agme m.costs and C parses k hi h may in the way erm,aCapengainst
st said
fin City in co sequences,roses pro
expenses whim may m any war arcme against Baia 514 - FINAL PUB IC WORKS
U.i City in consequence of the gm g O WILL
permit. 'T
AI`PLI NT UNDERS IN AND WILLCOMPLY WITH ALL NON-POINT I
ro R LA m '• 2� Issued by: Date
or A'pilfilii✓It 6n MeIur Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuture blding occupant store orhandle haz dous ingenal Type of Roof..
asdefined byth Cupenmo Muni plCod<Ch pec 913 adth H Ith and Sar syr •jr) •1�" s - ' ,
Code
od Section 255321a) - - t
❑Yes: q, .: r, •o, , t !1.' t f '. - '.
„_.All roofs shall be inspected prior to any roofing_matenal being installed.
Will he ppl^ca t, f e build) a«cup t use equipment or devices which If a roof is installed without first obtaining an inspection; I,agree to remove
doth ofd nam tat. def db eh By Arca Air Quality Management
District? a. ., all new materials for inspection. Applicant understands and will comply with
l nye }_' n - - all non-point source regulations..' -
R.i' 1 have read.the hazardous materials requirements'under Chapter'6.95 of the
C.hfiomia Health&Safety Code Se am,25505,25533and 25534.1 undentandthat
if the bu g does sol currently a tient,thin itis my responsibility to unify she -
occup t f she reyvireme is ¢vmuv be met pr m issuance of a Certificate of -
a Signature of Applicant Date
ow r auymnpeangema Do. All roof coverings to be Class"B” or better
.-- _.. ..
OFFIC
E