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02080031 (2) OF CUPERTINO C[BUILDING DIIVIISSIONPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 22771 STEVENS CREEK BLVD SARATOGA CONSTRUCTION 02080031 wLfg NA1 0 UZI 12201 SARATOGA-SUNNYVALE R APPLICATION 08/0772002 HONE:!-1 SANITARY NO. CONTROL NO. ( (408) 996-1711 El BUILDING PERMIT INFO !,-Z❑ ARCHITECDENGINEER: BLDG ELECT PLUMB MECH �U LJ LUI L_J I__t �a Z S v=mi Z LICENSED CONTRACTOR'S DECLARATION Job Description O Z—C I hereby affirm Mat I oro licensed under provisions of Chapter 9(commencing DEMO F=I_aq with Set�op 7")of Division 3 of the Businessan Professions Code.and my license Q Y�J is i fulff���rca and a et. n�`(� K�6 Li tunas I' Lie.N 77/76'9 7 9 KO D Contractor C �� w 3 a rfi ARCHITECTS DEC ION 1- O 1 understand my plans shall be uaea as pub scoots �s ip O License)Professional \ `as` T OWNER-BUILDER DECLARATION v 1 hereby.(firm that 1 a.1. exempt from the Cession; is License Law,(orate following acres (Section 7031.5.Business and Professions Code:Any city mcounty $15000 E�o which requires a permit to cnnatmn,ober,improve,demolish,or repair any swdurc a 3m priors.its ifalwsta.ds Ou t.join, fine inn Contra for ioicense awochapter 9. thatbelicensedwith s70 pfDivisiontheCone tornu«nremaxii ode) ,,34S��F2tOF��or,L$Ta-, gA., ,• Valuation (commencingwith Sttsignoman ofDivisionbasis Sof the tartnessand Professions Code) i,f.):\, { ,_ t , y1� v ;3,L s'r. or that he n 31.5 bt ta,ip i and the nasi.for the allege),Bear fts a civil violation "" ' -of Section]031.3by airydred amforaprmdimbjtttxtheepplicammecivilpeiuhy- iannatmoremanRvenanareadauarr(sStro). NO A1§t$'MLVb INSPECT ONS" Occupancy Type ❑1.as owner.fibs progeny,or my employees with wages m Meir sale compensmion, will do th 'work' dthe saucwm rr'is nintended or offered for sale(Ser:701 Bu4n. s ai,a Professions code The Contractor's License Law does not apply to an Required Inspectionst ` d., o r of property Who builds or imves thert proon,and who does such work himself orr through his own - - - res.Provided han wen _ arc not intended or _._. . _. _ ._. -:ERdrcd'f l 'If'howevelh bIdedB improvement is gold h_one.yearof \.R.4.v .v completion,he owner bulder will have the buoten f proving that h did not buil)or improve .. for Pawose ar..meJ. i to 1,as owner of the m n Imivd rano th licensed contractors to _._..,._ ... P m. yam sac and Pr gwi 9C4:J`. - = construct the Profen(Sec.7t3JJ,Busiowner of pos er�,who Codes The Contractor .. ..i CT rl tY - - License Law does -f apply. i owner of p.emon who builds or improves thereon, _ _end who es Licca fLawch.projttts Niro a comrazmrts).licensed pursuant m.thc ' 01 am exempt pt uAde Law. _ ❑lam exempt ubd<rSm:' '� "s� •' '.BA'PCfor this sawn 1'•Ih :-I•:>. •I!lti)1' OwnerDate' " WORKER'S COMPENSATION DECLARATION I hereby M.undegperally of perjurylonc of tnc following Jeelamtions: 1 have and. will'maintain o,Co.Bwar of Consem to self-Imuse for Worker's Compensation, as provided for by Smiion-37W of-Ma Labor Cale-far the 'performancc of the work for which this pentyl is issued.. ❑1 have and will mainion Worker's Compiansation Insumnce,as hundred by S&tion 3700'of the Labor Code,for the perfonnaoce'of me work for which this Permit is y C n.. ' � !!pp jOZl •-:'�: 1�' ,11,E ���l.iS`k( atl r^ ,.'.r, V, (�Jf//f,' }I C RTIFICATION'01 EXEM�FROM'WORKERS ', < ! �xf •(ThislsNsino need not be completed Rthe Permit is for one hundred dollars " " �' - •' �,"'' 3 1:- ] o ($I oft)or less.) s.... I mf that ih the rf Finance of the rk for which this permit is issued,I ,hall not employ any Person in any manner la us m become whim,m the Workers' ' Q z ComF naso lowsofCalifornia Date -Aani. - " of 'eNOTCETO APPLIyANT if,after making this Certificate Pt you Should beebecorme subIno tnc Worker's Compvenx;lpnoviii6as of the Labor Code,.you must forthwith comply with inch provisions orthis Permit shall he dammed revoked. F y �F'•i •t'°CONSTRUCnON LENDING AGENCY ' ' ""• ` .I i 1 . -aa I hertby afRrm Jot them is is consmuc ion lending agency for the Perfoimance 911• 11"I F th work for which this pe i .. d(Sec 3097 C C) of rZ Lend A I emir,ee that I h mail al city ant d et t thates bo laws re ti . �+ cord l green comely with II iry.gnJ mymd'ince f d utelawsmlruing :>x to budam ommume ionoodhe.,isuthoon idirp .ienmiives of shitcity mentorupon ,,, ty the abo(We)xgloned pmprny for inspersion p harmless ;Wel g e w,c e'i d n fy andpensee hamay in rainCity or c pengainst against Vi Ctliabilities.judgment,costs and expenses which y in any y ......1 / Q Z City uq ceoST g i g (Hsps c' (511 ICAVT UNf AT TAN A\DNILE COMPLY'WTfHALL 15N Porn"1"' Issued by: f Dale S L iREGU1�1TIQh F . ''\:M1 ignourenf Applicen atmnor ;,'. �..;' '"".'. •;Date',: Re-roofs reser d11Mea pl,`r10 Marc, Plol w Chapter`erclor z,"„ash na=nrew renal --.-.Type of Roof. ..._..— .-- ,.;HAZARDOUS MATER ALS DISCLOSURE e Health .. .. . _.._.__ .« _..... Safety 'Code Senicn 3532o)", Nu.. �' '1} l sr'1 ` r ." . ' 4ai. u0it 1. 1,h4 I � �( t t 1 1 t All roofs shall be inspected prior,[. any roofing-material being installed, -, Will n ppb t t - i g- p m q p t deqa n n If a roof Is installed Without first obtaining an inspection-'Pagree to remove cot havrdoma coma at J ed by the BayA Am ' rySI Q g t District? _ all new materials for inspection AppiTcant understands and wall comply with -oY - Na„ i-.,:• -.:� all-non point soutc8 regulations Calf IhHlivwlth J the h do is maser; 1s re 550S.remrnu`under 4,pmr 6.95 di 0(the s S rely end.Section 25505 t it aid responsibility 1 ity to"aid Jai -if the buildingdoc.a oat currently haveamnam;that it is my responsibiliryonotifytoe ` occupy t f the esquiremin hich must be mit prior to issuance Ara Certificate of Signature of Applicant_ Date wit rarest oreeeag„t"• Dme,. All roof coverings to be Class "B"of better,` ,.a 5, •^ '' '.'..'.",'.' ;... .'.. I: ...,. .._ ,r_.:._,. - -_... . -OFFICE