01080144CITYN
I BDNDIERONO
CONTRACTOR INFORMATION:
BUILDING PERMIT
BUILDING ADDRESS:
19333 VALLCO PY # CAC -01
XL CONSTRUCTION
PERMIT N0.
01080144
"CMTs: COMPUTERS COR.
1500 BERGER DR
ccP�
OS/30�2001
PHONE:
(408)271-2425
SANITARY NO. CONTROL NO.
ARCHITECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF -CH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby uffim that 1 am licensed under provisions of Croupier 9 (commencing
T I
with Section ](W I of Division 3 of the Business and Professions Code, and my license
is nfall force ..it
B
,
INSTALL 7 AC UJNITS IN COMPUTER LAB.
Liccnua.Lic.p
Dare ve Convamor
ARCHITECT'S DECLARPkTION
I understand my plans shall h used as public records
Liccmed Profcuiorul
OWNER-BUILDER
rom the RATION
1 hereby affirm 1 exempts the Contractor's Law for he
Any
c
Business and Professions Code: Any city st county
following massa on 1. an :
]onstr
j
which requires a pcmria to connate, alms improve, demolish, or repair any stannum
permit t t,
that hp is liaised pitisuanl t°thcVtio�ts °f rhe Convicts/s Lianu Law (CM1ager9
Code)
J•,. 5,,., _as .. F''t loor-Area-,- r fry's .- Valuation
Sq.
Icommchum, with Section 7")of Division 3°fthe Business pAndPrpfessions
or that he is exempt mcrertom and the basis for the allksEd ailo atma. Any .iolaried
<_iJ y t'-..1 a(�x, s.,tt- J1%11 <:Yl i�i•.
'316 2 0 0 7 7 . 0 0
of Section 7031.5 by any applicant fur a permit subjects the applicant te is civil penalty
of nal ms. than five handled dollars (s500).
APN Number
Occupancy Type
0 I( as owner of the norm employees with wares as mph sale compensation,
pd r remP r e canna
101 — FOUNDATION
102 - PIERS ^ '
Required Inspections'`"
:will mi me work, and ter odeTstructure C nti massed erecoffixondLaw for sale (sec. nwa,
h
and
Code The Coe, and Law dyes not apply to an
deem .
owner of y who improves thereon. and who does men work meteor
owner of n, Who
103 - UFE R
l.ymsor
or through his own employees. provided mar such mripven o t is &ol are not intended or
h his o
-.compllT« the If. It{wr i„old-wimm one year or'
eburden
_ , -__ _.__ _-.._ . _._ ._)._ .,
- ' 104 - REBAR L o.':n r. ' r ... a.
lder w llhaebuilding
of
ne°wner.noimer atm have me burden or proving mer he did not balm or
opolve
105 - ANCHOR BOLTS f
fir
improve for purpose of sakJ.
M_.....
— ' the peep.. em exclusively with lice) contractors aro
h owner
106 ---SEWER -& -WATER---—
f
d Professions T e C tncmrt
tr tape ansa, owners= and Prry who s codon The
mnewn me pr
2 0 2 - UNDERFLOOR PLUMBING -t7 . v.: •r a :
aw Des no improves
such Proj.... with pursuem.ro.the
that%hcense commet.foratlymanownwuher of pmomaciansi d�npm.rat.b.-th.
.fib win p°nwense
._.._._..2.03---_ UNDERFLOOR -MECHANICAL- - '--
L
01romt°rsuanderSm.
❑ I vn eumpr under Sm. � � ��• ' ''� � B k P C for this mason
�'�'
204 - UNDERFLOOR .F.RAMEi,rn
205 - UNDERFLOOR INSULATION
Rr eau
- WORKER'S COMPENSATION DECLARATION
301 — ROUGH PLUMBING
Ihereby affirm under penally ofPerjury and ofone following declarations:
302 — TUB & OR SHOWER
❑ 1 have it wiB maintain . Comficam'uf Co..., to self -esus far Wmkrr'a
3 03 — ROUGH MECHANICAL
Cmd,mathim, as provided for by Section nos of me labor Code, for the
304 - ROUGH ELECTRICAL
performance of the work for which this permit is issued. „
- FRAME
I have and it[ maintain Worker's CodpemaRon his ... net, ai.qui.d by Smdon 4305
W of rhe Labor'Code, for the performance of the work for which this permit is
306 — HOLDOWNS
�Ylyyo prnc p; t e:dr aeamerandP^hrynwmx,a ..
307 ",— I,NSULATION-�
cane AM6Rt �eoupyNaWC�g7892y0�a��
i 308.` l=r'SHEETROCK'� ":b,. tel .I:
1 iCENTIFICATION OF EXEMPTION FROM WORK S
” RANCE[
COMPrN5AT10NINSU
r
_ - -.-3.09-- -EX-T-ERIOR----LATH
iThrs isho° tired not tK amplamd tine permit is far one hundred dollars
310 I- INTERIOR LATH - . r•.' . '•. I• ! "C
rsioo)ormxs.)
311 - -- SCRATCH . COAT_._ .
. , i certify that in the ae'aaronpe of the walk far which ;hsx pkrmii a iom«f: I :
-'manner
313 - ROOF NAIL .l"' T,
shall not employ any, person in any sb is to become subject to the W«kers'
Compensation laws of California. pate '
501 - FINAL ELECTRICAL ENERGY
-.Applicant
NOnCETO APPLICANT: IL after making this Certificate of Exemption. you should
502 — FINAL PLUMBING ENERGY'
t,momv'abbject to the Wrolams Compensation provisions of she labor Code, you must
fonnwimcomply with such 'pmvixmnaarmisp.is snd)Wthemwre.oked.
503 — FINAL MECHANICAL ENERGY
CONST . RUCTION I.ENDING AGENCY- � � • " "
504 - FINAL BUILDING ENERGY'
I neraby from that there is a 5onswetion leading agency for the performance
505 - FINAL ELECTRICAL: • •
oftneworkmrwhich this immitisissued Sm..3u9],Civ. C.) r';;.:;;.. :'-
Fender's Name'.` - -
_ _ -
506 - GAS TEST
d"aA°°r"'
507 - FINAL PLUMBING
1 reify than I have lead Nis application and state that the above information is
508 — FINAL MECHANICAL -
corrtn, 1 .gree to romply with all city end coumFordinanccs and sem laws relating
to building corswunion)and hereby amhorf=e'mp smtadves ohm. city to enter upon
509 - FINAL GRADE
rhe b a Decd prop ny f o purposes._
(w)'g dtosee ndemnfyeadkeep M1 1 'aheC'ty fCuNrhinoagmnsr
510 — FINAL PLAN ING
expenses
liabilities,judgments, t d panicswhichmpy;neny y_ against "aid
''
514 F A WORKS
City m, ice of the gram g of th pe t
'AP ICAM UNDER ANDS A DWLLL__COMPSyY WITH ALL NON-PoINT
Issuedb Date
y
P3 Lfa:Sl��l4Ca�bC /0- A-01
Re -roofs
Signe yin of IkanUCom n r. . ` Data.
HAZARD S MATERIALS DISCLOSURE ,
ding part, sov or hMl aloc ndous mue„al
vin iia applicant or ram. bud«a
Type of Roof -_ •. ..�.•
ed by the CupMunicipal Cade Chaps 9.12 d the Health and Safety
xxsvi:�,enms
., ,.0
., �.
....-. r`.r,l L'.,, a'0:fi11
Code, Secuo^ 255321a)T:IS.,r:^L.', .. =� '.i ! .,
„- ❑Ya
_ Sa`laL..
•. i s 1
All roofs shall.be.inspected priseto.any_roofingmaterial.being installed.._.
„!'
'Will she applicant orfuture •building soccupant .use wwipmentordevices which
If a roof is installed• without first obtaining an inspection, Ilagree`to remove
emir Wonder, nid°it, mnmmmanu as defined by the Bay A. Air Q..Iity Management
all new materials for inspection. Applicant and will comply with
District.
-understands
all non -point source regulations. -
R' j I haverend the'huurd.ne, mat'als requirements under Chapter 6.65 of the
Cul(fnmia Health &Safety Coda, Sections 25505, 25533 and 25536., 1 understand that
i f m: dui Icing does ..I thmently hove a¢root, thin it is my ox,mr ibiIhytonotify he
�v I
occ p r of tic icquirem r which must be m r p ten° iss r of Certificate of
-
-
0 `y r D
Signature of Applicant Date
._
All roof coverings to be Class "B" or better „
- Dam
Owner or a t art=ea ag t' ',
OFFICE .. -. ..