02050058 (6) OF
CI n
BUILDING o ERo No PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20610 STEVENS CREEK BLVD NORTHWEST SIGNS 02050058
I AAM�ROPERTIES, L. P. 325 WASHINGTON ST lg
APa15fr,ff .(f62
PHONE: (831) 469-8208 SANIITTARYNO. L CONTROL NO.
a re0 o ARCHITECUENOINEER: BUILDING PERMIT INFO
u- BLDG ELECT PLUMB MECH
GL
S m Z LICENSED CONTRACTOR'S DECLARATION
I hicanyafimather lamlicensed under provisions of Chapicr9(<ommencing SIGN lob Description
�wF with Secti.s.700)uf Divisimild be Busin<s dProfeseions Cute.and my license
is in full an
(fee
ae x 6 Lite C(5 Lo.
O a O IJeu//_S/d( Comm
—L RCHITECT'S DECL ATIO
u.O,g I understand my plans shall be used as public records
ass
i Y
1 ce p O Licensed Prald,i
ei2 OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Con recom s License Law for the
C i $1600
¢ following reason,(Section]031.5,Business Code:Any and Professions CoAny city or ceouty
8 t G which requires a permit to consuun,alma improve.demolish.or repair any structure
asciipriorm its issuance,also requires the applicant for such Permit o file a signed statement22 - ---- - --- -- - - - -
that heislicensed puesoanuothe provisions of the Connections License Law(Chapter 9r ,3.'SQ•ff��3Dn 0n,);•, 1 �•i,' ,�, Valuation
(commencing mcing with Section 7000)of Division 3 of the Business and Profession,Code)
or that he ii exempt thertfrom'und the basis for the alleged elcmptiod.Any violation i "s.".
of Section
of him fivv any applicant for v Icnnit subjects the epplicvm to a civil penvlty
nnt more
man e hundred dollars($Son). 10]APPI 1'$101Re3DATION C'., Occupancy Type
D 1,as owact si pmpcnr.or on,employees with wages as their sole cempenmtinn, 103 — UFER
will do the work.and the xm:cture isnot intended oroffered for sale(Sec.]oda. - 104 — REBAR Re wired Inspections
Bai nes,and Professions Code:The Contractor's License law does not iii a on q
owner ofproperty Who builds orimPmvevtoereon,andwho does sumwork Himself 105 — ANCHOR BOLTS
or through his own employees,provided that such improvemcars art not intended or _.__-
-offered for sale.v,however, he hooding 6r imyre.amcm is sola within-one yearofof - - --- 30,11 ROUGH --ELECTRI CAli � - . ......_. -
completion.the owner.buimer will have the burden of proving that he did not build or .505 - FINAL ELECTRICAL
improve for purpose of xi
- - 51-4 --FINAL -PUBLIC -
WORKS- " ,
Elliars control tre proper,am exclusively contracJ�soim lieennea enntraemrs to ,,
. . ._ .
construct the prejen(Sec.76fa,Business and Professions Code)The Contractor a
License Law d«s not apply to an owner of property who builds or improves thereon,
.: and.whtcontrects for sum.projecu with a.conmeror(s)licensed pursuant to he .. _... ._ -..
Conlmee License Law.
- ❑lam exempt under Sec. � �" �.B&PCfor his rtason
Date.
WORKER'S COMPENSATION DECLARATION
w crI hereby affirm under Penalty of pri one of the following declarations. If—B E W li
, 01 hove and is ill maintain a'Cerillcate of Consent to self-imam for Worker's SEP 0 5 2002
•
Compensation, as provided for by Section 37M of the Labor Code, for the
perfnrmance of the work for which alis permit ix issueJ.
' ❑1 have and will maintain Worker's Compensation qt y Section
nemif t Insurance,az rt
„ b
vi Mn Workers Compensation Inssutilance c.imcr and folwork io hetethis e perms a BUILDING
e Lisbon Code.for the per ici rd
wrar
ili
t CERTIFICATION OF E%EM ION FROM WORKERS', '� i\. L 1. is tv•`.t 6 I ,S r'
-. .._. __. ... COMPENSATION INSURANCE. '
(Oris'section tired not be corm if the permit in for one hundred dollars i
(SI W I or Icss.)
It employ
matin the performance,nn the work for whim this ct to t e orker I - l l -,t.,t:,; ,.
eh mpent employ any person in any mannerist,as m become subject m the Workers '
Compensation laws of California'Date
Applicant
.NOTICE TO APPLICANT:IL ufler nicking alis Cenifcnte of Exemption;you should _ " � - - _. .. _ _ _ __. . __
Become subject to the Worker's Compensation pars,isnow or the labor Code,you must
r..BO ' ' " t"' CONSTRUCTION LENDING AGENCY"
ronhwith comp
ly witi such provisions or this permit shall Be deemed revol
z 12
y a g agency pe ormalace. ' .• t''
of the work for which thisPe• t sued(S 3097Civ.C) - -
On (� tender's Name f5nn Jut the ...onatmn• , f the rf -. " ,_ ..
z Leni Address
U 0
tW. „+ I certify that 1 have mud this application ural state that the above information is
0 t-t 1.Wilding
il.I agree to comply with all city and authorizecounty nepossismadnces and state to en relating
:0 W the aboientenswed profaJhertbyectonurposenmtivea of this city to enter upon
-,rte the above-mentioned profanity for sty and ke,,harmless
h o; eWjudSmemsave.indnnnify and keep lu:mayinthe way
Cupertino against � )
W liabilities,judgments,costs and expenses which may in any way accrve against said (l v
U Of in consc uence of the mung ofthispermit. '
SPL�^f NDE SOT .PJR• .COMPLY WITHALL'N N-PCIM 6 Issued by: r Date
Signature of Applandnrm
Comeor - Dat•,1' Re-roofs /
HAZARDOUSMATERIALS DISCLOSURE
Will the applicant or rutfunno,Wilding cups t store or handle harandsous nomenal Type of Roof , .. ,.. . .,..-.. .
- m defined by the Cuperfirm Sow Ytn m 25p5p1l2(x7 t MtCod Chapter 9 2 t and the .t a d Safety
Code,
1 All roofs shI a•l'l be liinf p'ect ted1.p{rio.r[ot any roofng ma[enal be`,i.n
g ms[alled.
r p d' g p t
...
uncequiparmant ordinices which If a roof is installed without first obtaining an inspection, I agree to remove
urt haticiddrim,.1"Carturvarrounts as defined by ithe Bay Are;,Air Quality Management
Dist t all new materials for inspection. Applicant understands and will comply with
t( ov , ._ all non-point Source regulations. -
f4 r.
1 have read the h rm oils mater ala nequ rcmcros and r Chapter 6.95 of the
Califomia Heilth&Safcy Code.Scamons 25505:25533 and 25534.1 undennindthat
if the building ders not currently have atenant,that it is my responsibility to notify the - - - '-
-occupam of the requirements which and be don,Fromm instance of u Celli ca¢of
Oe, Y.
_ Signature of Applicant Date
c wnern,aamxar<d ages ”' . oat . All roof coverings to be Class "B"or better
OFFICE ... _ .. _. . _ .