02010115 (2) CI But
BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10465 S DE ANZA BLVD CODY BROCK 02010115
OWNER'S NAME: APPLICATION S B DATE
•FAR EAST NATIONAL BANK 912 WASHINGTON ST 01/2972002
PHONE: SANITARY NO. CONTROL NO.
_.. (650) 591-0757
O c z ARCHITECUENGINEER:
u 0 0 BUILDW G PERMIT INFO
u BLDG ELECT PLUMB MF.CH
I-__I
y Z LICENSED CONTRACTOR'S DECLARATION Job Descri f10n
5 z_E I hereby aRrin Thal 1 am licensed under provisions of Chapter 9(commencing P
yt:� whns«amn7noB)mroivis;un3mrmeBusmea naPmfs"mnacmde.anamyR«nye TENANT IMPROVEMENT.
Cm z�j is in r me and.frfect. -
reopu Li=so. INTERIOR PARTITIONS .
S a v ° - cnmmcl�f
III: INTERIOR ARC ITECT'S DECLSIRATION
g 1 understand my plans shall be used as public records
a.re-v O O L¢cnud Profnsional p a�
OWNER-BUILDER DECLARATION •1V/
1 hereby affirm Mol I an exempt from the Contractor's License law for the ®
? following reason.(Scotian 703 L5,Business and Pmfesvime,Code:Any city or comm,
6x0 which requiresapermit t construct, hr. p demolish, p ytincture
a. .
/4
po , u 1
had IwitiuMmilld
�
pu sea a (he f,h<C , t r Lc La (Chapter 9 _ ._.
(cm nes g with Section 7oap -fDivisioni3 nn BurnesgdPgres:' sea) ( \'l-p Sq:Ft:,Floor Area:,% - e gluation
.1 than hes a PI fl refmm and theb for the allegW rico ren Any relation ' L L 1 i 9 u
of Seeman 703 C5 by any applicant for a perm t subjects the applicant to a civil Penalty APN Number
:ornammethanfvehandleddullm,SSBB). ','I.<.,. Af)ccupancyType
❑1,asowner mnn<nmP=my,«myemployees with w.ga:auncirsole cnmpensammn, _ i �����ii
'wilt do,he work.and the swc,urc-is not intended or offeredfar'sale(Sec.'7few,
'Busmess-and Proux"Mrs Cww:The C.N.Irm's License Law does no,apply to an 102 - PIERS Required Inspections
owner of proPeny Who builds or improves thereon.and who does such work hims"f
11M.
or eyed Fib his own anPlmyces. budded that such vement mens arc net on ye tl or -- 3 - UFER
offered for sale w er the building . sold wohm One f icer or --- - " - —`--- -—-- — '
8 improvement
mmplcLimn.me owncrn;IJen,ill have the burden of proving that liedid no,buil)or 104 - REBAR ._ ,r,'-- ,,, ,
improve for purpose of sale.). 105 - ANCHOR BOLTS
_. _ ::rev,mer mih:... _.... . _ _.. ... ..... .._ .... ..-.--
nawcontumacious'. 1'06.._- ',SEWER._.E—WATER .. .. .._ _.-._.. _.. __._
O1: pSec.7 am Business
v Ir t t g with I' "consumer Lathew
tiePonder,(Sec 7lo a ounces. and Professions Code)The improves
"
- oil
conalwsmnapurtmanmwnatha.cntrwnnnnitrensedPrwns neon. 202 - UNDERFLOOR PLUMBING
_and who.mmr«m.fLa such pmje=u with a.<ommemKs).licensed.pmreuantto,lrc_ _._. ..__. _.203' ----UNDERFLOOR--MECHANICAL-'---- ---Contractor
License Law.
❑lame.lmptunder Se<: a&PC Immix wave. 204 - UNDERFLOORI''FRAME;!1
ownsnate-^ 205 - UNDERFLOOR INSULATION
s'
WORKER'SCOMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby afGnu under pepal,y,or perjury mde.othe following declarations: 302 - TUB & OR SHOWER
1_ 0
❑ 1 have;nd win maintain a Ce:,;Bcae mi Consent t0,elf-Insure for Workers 3 03 - ROUGH MECHANICAL
as provided for by Section 37W of the Lanor Cade, for ,heream eemnhewmrkrorwnicbmixp mi,isi um. 304 - ROUGH ELECTRICAL
1 have a wdi manta Worker's Cum'
peroration Insurance,as required by Section 305 - FRAME
370D of the Labor Core,poir h perfo^r...c itf,he work for which this permit is
issued.M/yWorker,c ce<ys,, Insurance c 'd Pm eys mea 306 - HOLDOWNS
WWF mr<rN WG . '27 .__.. 30.7 _INSULATION'-- - - - - - . _ . . -...-
F
CERTIFICATIONOFEXEMPT' NFROM,WORKERS' rl.ya i -308 f P#SHEETROCI<°-y.Q.!°�• r` l` `
- COMPENSATION IUSURANCE' -t- ` ''
--- 309'-=:,EXTERfiOR-liATH ___
'I M I sect n neetl not b<Icomplcied if penn;l is for one hundred dollars
uloo)mrl=as) 310 - INTBRIOR LATH
t
.,' i ^rym:2,nmcerrmn ''i,n ` kfar- mcnmsp< .Isea:1 ...:...:3'11-- --="SCRATCH -COAT --. .
:man , mPlay any Person,n any mann- m
Loo as to becoe sub3=a m,he Workers' 313 - ROOF NA I L`i l'P t
Compensation Laws or Callflomis.Dale
NOT - - -- - 501 _-_..FINAL-..ELECTRICAL_ENERGY...
..... ,h Cnf 1 fE
NOTICE TO Walker,
Brpekg p,o you..,
Z neemsubjectmmew E 'entCompensationper it hamB, ab cod,you mus, 502 - FINAL PLUMBING ENERGY
z p toren ince ply - cn- permit ana- ___ aworked._ 503 .--.FINAL..MECHANICAL_.ENERGY__
m
-
T?:I t .CONSTRUCTION LENon len AGENCY " SO4 - FINAL BUILDING ENERGY. '
a > 1 n rear Tyre,maim s q< ,ren lending g agency ro m perr i;nanae
WI•. man,: kr whichthispemY ssued(sce309rac.c) _ - 505 - FINAL ELECTRICAL"`
-
(� monde Na ...__ - -- -
506 - GAS TEST -
U_'O l eon fy mal i nave read his application and slate that above information is 507 - FINAL PLUMBING
�.F smoM.I agree to empty with all city and county ordinances and state laws whining 5 0 8 - FINAL MECHANICAL
: rJ to building constitution.and huMb authorizerepres=malves mftu,ody to calor upon
W the at«e.menhepedproperty for inspection purposes.
. - 509 - FINAL GRADE
L' (We)ugree,o'save.m ^n
derumfy and keep halees th,'City'of Cape n"mrs, TNG
_ V] uabditic,.juagmems.cats aad=.p=oses which may w any way were,agofml said 510 - F I NAL P
U.Z City inconuqucniM of the graming of this Permit. ' "" - -'s - \
%PLI -4N0 WRL'COMPLY WITMALLIIJ N.POINT" Issued 6514 N WORKS Y Ov
E )_ y: Dale
72 0
_ wmw.f A,pIiwwMCmrwaaor'•^'° '.:..'• .. ,".Dae • ,
HAZARDOUS MATERIALS DISCLOSURE - Re-rOOf$
W,11 the.,,loam or fortune buildvocafram aware mi haddle hanoto a ordemid
. Type of Roof_.
as definr4 due Cupen o Mun p
yC9atl Chapter9.12.and me Health and Safety
Code 5 1 n 2553 O^ -
GYN
' , /1 L ,a J
mtna�ra s c'nta I:as aerf do m Ba nr A -All roofs shall be�mspegted poor to any_roofing material being Installed.
❑Y= n t (.T;
wn meapplicants r, re Wild'
Ice c p ,use
q tp ennm devices which If a roof is installed without first obtaining an inspection;I agree t0 remove
District, Y Y rQ IryM gmem _
LiY s all new materials for inspection. Applicant understands and will comply.with
{�y all non-oint'source regulations:`• y
1 h e read he bit and . mewrials r=quimmens,rode Ch pre ti 95 of the I
Calif m:a Hcallh&Safeny Code Section 25505.25533 and 25534.1 understand that
ifinebrild gd«s not currently have.tenant Itis it I,my- ponibl,y no reify the
«cuP air. s winch nun he 1 - m is-ane of C«Gane of
P
,u Signature of Applicant
�3 2z 2
i`r Dae. All roof coverings to be Class "B" or better
'. a... :r:. '.•__'. i' OFFICE