02120081 CII'V OF CUPEWfINO .^-
BUILDING DIVISION PERMIT CQNTRACTQR�INFORMATIQN "1
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nuI LDINO ADDR Fs3: SYL-MAR CONSTRUCTION # PRRMITNO.
10150 N WOLFE RD 02120081
RAN NAME: 1310 TULLY RD. # 114 APPLICATION SUR DATE
J C PENNEY PROPERTIES INC O 12/19/2002
k PHONE: 408 293-7969 SANITARY NO. CONTROL NO,
ARCH)MCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MF.CH
5.00 LICENSED CONTRACTOR'S DECLARATION
. p 1 Mrchy affirm that I am licensed under provisions of Chapter Y(commencing Job Description
with Section 7000)of Division 3 of the Business and Pr fesiors Code, y and mlicense is
> in fullfnn'candelleet. TENANT IMPROVEMENT (777 SQ. FT. )
Z85— "cc
nse Cla Lie.M
Z'o Dam j Comesctur
HI'IT;Lr UEC R O
ra K I understand my plans shall he used as public ords ■ L tl�/
ap6V ,tl
we- Llmna,d NoLssional
OWNER-BUILDER DECLARATION
1 herchy affirm that I on exempt from the Contractor's License law for the FES 2 A 200J
6 p 0 following reason.(Sector 7031.5,Business and Professions Code:Any city or county
$ which requires a Permit to cons0um,alcor,improve,demolish,rr repair any structure
prior to its issuance,also requires the applicant for such Permit r file a signed statement
fC that he is licensed pursuant the provisions ohbc Contractor's License Law
(Chaptcr9 Sq. Fl. Floor AIOU DIN $57VSuffitlon
a; (cnmmcncing wltb Swtimt]tk10)ofllivisinn3 of NC ltusincss onA Prnfasvinns Cndc)or
1!5$ Net he is exempt therefrom and the Innis for Im alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of Occupancy T
not more NanY
P Type
an five hundred dollars(M).
01,as owner f the property,or my employees with wagm es their axle compensation,
will do lesions ands: o Contractors
License Law
dos not apply
owner
of —
and Professions obu builds
The ns Boman.License Law docs not apply if an owner of 102 - PIERS egmred Inspections
own enywho builds orimprovesthereon,endwho aversuch work himuRod(or side.
however.thea.ping or I provmet such nt is sold wilsamne intended or offered for saltIf, 103 — UFER
however.the buildingorimprovementis oat within one year of completion,the owner-
builder
of
will have the burden of Proving Nat he did not build or improve for purpose of 104 - REBAR
) 105 - ANCHOR BOLTS
1.es owner of the property,am exclusively confessions with licensed conversiontor', m 10 6 - SEWER & WATER
wm the pmjen(Sea]044,Business and Professions Code)The Contractor',Li-
censeLawdoesnmapplyto.novae,of property who Wilds or improve,Kenton,and 202 - UNDERFLOOR PLUMBING
t37M.f
cnse Lew�fnr such pryiccu with ecmtracmr(alliccnscd pursuant to the Contractor's 203 - UNDERFLOOR MECHANICAL
am er[xe�mpt under Sec. .B&P C far Nis reason 204 - UNDERFLOOR FRAME
er Yl� Dam 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DM? RATION 301 - ROUGH PLUMBING
I hereby alTum under Penalty of Perjury one of the following dmlcrations: 302 — TUB & OR SHOWER
have and will maintain a Certificate ofConsent to sel6imure for Worker)Com"n.n,v Provided for by Section 370(1 of the Lahr Code,for the Pertomism.ofthe 303 - ROUGH MECHANICAL
for which this Familia issued. 304 - ROUGH ELECTRICAL
have and will maintain Workers Compensation Insurance,a rtquircd by Section3 OS - FRAME
the labor Code.fm dm Performance rif Ne work for wh�'l tisadmid.
My Worker'sCfynpcBsatinn lsnnsumncewnicrand Pnlicypu r -7J 306 - HOLDOWNS
Carrier. p�'L PaEcyNa,. 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
obisscchim needrmlecompined ifere Permit estuarine handmddallars(Sloe-) 309 - EXTERIOR LATH
rrr less.) 310 - INTERIOR LATH
1 verify that in the performance of the work for which this permit is issued.I sholl nm 311 - SCRATCH COAT
employ any person in any manner an az subject to become subjeco the Workers'Compensation
Laws of California.Dam 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.If,after making this Cenificam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation provisions of the Labor Code,you must 502 - FINAL PLUMBING ENERGY
O O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
.y. IherebyaffirmNotthem isaconstruction[ending agency for the Performanceof 504 - FINAL BUILDING ENERGY
C > the work for which fair N.it isissued(Si 309].Civ.C.) 505 - FINAL ELECTRICAL
D] Q Lendcr'a Name
5 z LenderaAddress 506 - GAS TEST
U O 1 cenify Nat 1 have read his application and sum Nat the above information is 507 - FINAL PLUMBING
ry ,r^y correct.1 agree R,comply with all city and county ordinances and state laws relating to
o V
building mnswctinn,and hereby ouNorircreprescnmtivcsnfNiscity mcnmrupmtha 5 FINAL MECHANICAL
U above-mentioned property for inspection purposes. O9 FIN
fy (We)agree to save,indemnify and keep harmless she City of Cape far,against
rV) liabilities,judgments,costs end expenses which may in any way accrue against said City 5 N G
U zr".
ence of the gran'ngof I spennit.
N NDER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 WORKS Date
TIO �3 a� Re-roofsof ApplicantsCommicmr Dam
1{AZARDOUS MATERIALS DISCLOSURE Type of Roof
ill Ne applicant or future building occupant store or handle miardous material
by the Cupenino Municipal Cure,Chapmr 9.12,and the Health and Safety
arn z553z(el'IAll roofs shall be ins ected Aorto an roofin material bein Installed.
Yes gNn P P Y g gill the applicant or future building..pan,um ripii cm ar devices whits If a roof is installed without first obtaining an inspection, I agree to remove
fdous air conmminents as defined by Ne Bay Arca Air Quality Management all new materials for inspection.
C]Yet Q�Nr
1 have mad the hvardous momrials requirements under Chapter fi 95 of the Cali for-
niaHcJuddl=,%
S ' s 25505,25533 and 25534.1 understand Nv ifthc building
does ndam itis myrespamibility m notifthetcepamof Ne
requircprirrm issuinevofa Ccnifinold Ottcup ey Signature of Applicant Dale
AMMO-A.. All roof coverings to be Class "B" or better
Min e r nuNnrized agent Date