01110039 (2) CITY OF
DIIV��ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21269 STEVENS CREEK BLVD 01110039
-NER'S NAME: APPLIC TION SUB DATE
:UPERTINO DAY SPA 11/06/2001
pI PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF-CH
�Z O LL L1
ts-- LICENSED CONTRACTOR'S DECLARATION
O m 1 hereb .f irm Na,l am licensed under of Chapter 9(commencing Job Description
;N_° prav;amn. v g TENANT IMPROVEMENT.
BCW with sediorce"I of Division 3 of the Business and Professions Code.and my license
77 is in full force and efiec,.
s 6 License Class Lic.g
°a O Dae Contrac,w
1 G,
ARCHITECT'S DECLARATION
1 understand my plans shall be used as puhlic rtcords FIN
Y
1 O O Licensed Professional
den I woBUILI
.'anp, DEthe An IO
1 hereby aRrm that 11. .B.,A from the Conroe, License (m $45000
C b G following reason(Section]031.5,Business end Professions i r cou
f F° which requires a permit,o conawn,altar,improve,demolish,or repmr any swnom
e 'rotoisissaua:c.aiw urea,xapplicw,fw swh uo BI...s - - -- --
3m ..pn _ ..regI ., pp pvmi gnedahaptert
Nm hdTGhcensed pSoclu ,oche pif Diown rixinm mein And!P,faw(Chep,w9 .., ,1 [[ 'S C' yy r�s . 1 — Valuation
(Co.mencipBwithe i1mf rrimofobasisoofeA116 11a6rnd Professions Coda) -I1;\ g�y!yam •t;l'/�j�•\®V{;N•�`I".},�1Q�j\•
er that he is 31.5 bytherefrom and Ne basis for he cur eB adman to Any violation
'-aI Sernvn]031:5 by Any applicant for a permiuubjectame Applicant do a civil penahy-
ofmarawethanfivehanawdolle.(s5fa)._-, _ _ _ 10 1APN VUd?MATI ON Occupancy Type
Ell,"owner ofthe Property,UT my employees with wages u Neiraolecompensaum, 102 - PIERS
-'Bullae,the work:adios ode:tiro nli,emended or cense Lied ors ism
not ap ly in an 10 3 - UFER Required lnSpeCtiOhS'i'`e''B.'a 1-
`owner as and property
is b Cade:The roves them's.and w taw does no,apply to w
1-
owner offh his ow Who builds or improves t thereon,end who does such work intended
or 10 4_ - REBAR _
or through his own employees.provide)Ne,such impmvcmems arc no,imenJed or
(gf(eredfor sdeowneri If, weer thellhue the
nden of Waving
ss old within one yam of 105 - ANCHOR--BOL`I`.5' •� �•,iL •. ,t,.<a.t,'.f,
completion, m owner-Wilder Ider will have the xNcn of proving,ha he did no,Wild or
imprave rer P=To===(cal=,). 106 - SEWER & WATER '
1 owneroRhe property am exclusively conwcting with licensed contractors to ZOZ= UNDERFLOOR -PLUMBING--i.('ISJ -
a.c,me pmjeet(See,lou.Business and Professions Code:)The Contractor' 203 - UNDERFLOOR.-MECHANI CAL`h t r
-_- ittnse law does nes,apply,o an owner of propeny who builds or impravea All
_and.who.cantmcta.for,such m'ecu wuh.a.contrsu,
p j otls)licensed Wrtwm An the, .—____
—204-----'UNDER'FLOOR-FRAME------------ ------- -
'% Commnor'e License Lew..
❑lame:empaneer ee: "' a&PCforthis,mawn 205 - UNDERFLOORLNSULiATION
301 - ROUGH PLUMBING
caner' ORKER'S COMP NSATION DECLARATION - ,302 - TUB Fc OR SHOWER
themby affirmunder mnalty perjury one o(Ihe following declem,ions: 303 - ROUGH MECHANICAL
❑ 1 have anl'avi0 maintain a Cenifiame of Consent,o selGinmm Ins Wwkcrs 304 - ROUGH ELECTRICAL
., Can, awiom.,.provided for by Section'3]00 of the Lobar Code, for the
'Indti mace of the we*for which,his permit is issued. 305 - FRAME
❑1 have and will maintain H'prkdr's Compcnaa,0 1 mnnn ai regmied bj Sec„ a 306 - HOLDOWNS
3](10 of,he Labor Code f r Ne performance of the ick for which Ink pe ",is 3 0 7 — INSULATION
_ _iuwd.MYWohela Compewuon.Iwumvicevbrile dPolaY oumbe a _....�._. -•
t..,.. -- ---308 -. 'SHE TROCK .... ---- . ---'------ - - - -
Carper Pol icy ... 2 p l
t ICERTfFlCATIONOFE%EMPI'IONFROMWORKERS!' 1✓;"� 309 i-IIEXTEfzfiOR•`L�P:TH<<
r COMPENSATION.INSURAt10E
�'•�. frW stct�od'tied notxcom rated if the permit is far one hunerce donors �3�:'0-�;;�'IN`I'ERIOR—'I�A`I`Hi_•_V„, --'-;,_c,I '1:. '1..), -
fs100)oneas.) v 311 -:'SCRATCH COAT
'IT __..__ --_.ROOF-,. 1 __�__ _ __ _.. _.• _ ._
I earn ythat'.,he rfdmttan.of the ark for which @, -'"3 13' 'NAI L'•--- -
pe peon is`issued 1an"
shall not employ any person'm any minn rens a , become subject to the Workers. 5 O 1 - FINAL ELECTRI CAL•IENERGY
Compensation Lows of Callforala.Dam,
-Applicant __502 ._-. FINAL PLUMBING ENERGY__
O TonPPucANr.rsCmn After makingmneen...6thEaemptmn.Yoasnemd 503 — FINAL MECHANICAL' ENERGY
z z NOl]CEuM1jecuothe Worke/kCompensation prnviiioni o(Ihe l:ubor Code,yeu'mun
O forthwith damply with each preAsiem or suis prmit shall x deemed revoked. 504 _ - -FINAL BUILDING ENERGY.
occame s
s.w I herb aPo' -
CONSTRUCIiONLENDINCAcENcv 505 — FINAL ELECTRICAL
F oLende I herebe h,�°at N can war^lending age cy fo Ne pert ce -
A hthis permit, , ued(See 309]Civ C)_ _. L. e 506 — GAS TEST _ .. _._.. -. .. --
j:z Under&Addrat- _ 507 -
U O FINAI PLUMBING ._
Application¢et on a d amle,het the x information is 508 — FINAL MECHANICAL
I cemfy that I have this
— —
"t.' correct,Iagree to complywah an city and coun,y,ordlnanceaad ,t .low,reading - 509 - -F-INAL -GRADE ---'--- -
O.V ,oxddingcontrusaidn;andherebyimhonaeWpresenmtiveaoftiscitymcnterupon 510 - FINAL PLANNING _
W ,he above-mentioned,property,for inspection purposes.
J° (WA)Agree to serve,indemnify And keep Wholesith'd City of fupAriW dg=inn 514 FINAL PUB WORKS
N' liabilities,judgmnps,costs aM a=panus which may in any way accrue against said
U ,z City in ca^seque^te of the Shining of dd,permit. -
"=^-'} APpt. ANT' O - ' NDS A .ILL COMPLY W YTH ALL NtONiPO1NT - _. . -
ol s R t5u Issued by: Date
^ rAPPlldanl/Cmawtor f �a,e,i Re"COOTS .... ..
' - HAZAitDOUS ATERIALS DISCLOSURE l.s
• 11the Applicant ortuvue budding occupant dom or handle WaarEas material .Typeof.Roof .., _ _ _
.ns dcfned by the Cupemno Man¢pal Code Chaptec9 11.and the Health and Safety
x- '-- "
.. .
Code,
ode Section 25S3$a` I 'i:+,SSf�,� Y„ .t ', . ''s''g_ 'r�,iA,tit% ”" . .,_. 1, 1✓ ,. .
❑re:, -, ❑N y, l •:.-.j; .,?
...-All roofs shall be.inspected.prior-to..any.roofing material being.installed.-"--__-.__
Wd1,he applium mfuwrc xilding occupant uta equipment or devices which If a roof is itist�lled'without first obtainin an firs ectidn Iia iee`to ierrtove
ern hvallons tar conmminanta u defined by the Bay'Aiu Air Quality'Management g P �i
Drama] all new materials for inspection. Applicant.understands and will comply with
❑r r , .V ❑yo' .. .�' 'r " all'non-point source regulations::. l. .t; '.) .
�s1 I heve'rted'the haiudow m5mnds aquircmMte under Cxptar fi 0 of the s
C'ehtomie Health&Safety Cddc;Send...25505,25533 and 25534:1 undersand that
if the boilding rias not normallywl have uenmt.that it is my rtsponaibiliiy to notify the
oddapam the rcqui me Is wMch must x met prior to iuuance of a Cenifcate of
Oce alley. .
- ' Signature of Applicant _ Date
caner o .allorized agent o.rc. All roof coverings to be Class"B"or better
OFFICE-. ._
t ,