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
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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,`
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5, •^ '' '.'..'.",'.' ;... .'.. I: ...,. .._ ,r_.:._,. - -_... . -OFFICE