02080003-DCITY OF
•
CONTRACTOR MO RM ON:
BUILDING DIVISION pE
BUILDING ADDRESS:
PERMIT NO.
20803 ALVES DR
BLACH CONSTRUCTION COMPANY
02080003
OWNER'S NAME:
YMCA OF SANTA CLARA VALLEY
1650 LAFAYETTE ST
APPLICATION SUB DATE
08/01/2002
PHONE:
SANITARY NO. CONTROL NO.
,(408)244-7100
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
U
LICENSED CONTRACTOR'S DECLARATION
,lob Description
1 hereby affirm that 1 am licensed undyr provisions of Chapter 9 (commencing
with secpon 009) of Division 3 of the BuyQE;s and Professions Code, and my license
RELOCATE 2 EXHAUST FANS
is in full (b and ecu .3 �po�{ 1 d
l �C D
License ass Lmc. p
Date � 81 [or C
ARCHITECT'S ON
understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5• Business and Professions Code: Any city or county
$10000
which requires a permit to construct, alter, improve, demolish, or repair any structure
_,prior.to.its issuance, also requires the applicant for.such permit to file a signed.statement
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'
Valuation
`
that Q%Ig jicensed ounstiAh4tddte provisions ofthe Contractors License Law (Chapter 9
(comunspclQg, mw`,m�m,Sec4iatr �UO,of Division 3 of the B ipes{ and Professions Code)
or that he ms exempt tlierefrbim aha the basis for the allt 4'l. gripgoa. Any violation
-of Section -7031.5 by any applicant fora permit subjects -the applicanttoa civil penalty-
i9f not more thamflve,hundred dollars (x500).
-
l O 1AEN �AT I ON
e'"' "' "' Occupancy Type
❑ 1, as owner of the property, or my employees with wages as their sole compensation,Q2
PTRES
Sec:�044.-.
`-wt ' •'tt[Cwot14- 'the3tructmure'Is not-interided-or'oRered'forsme (Sec:-7044.--
7B.01
'Basineas Arid Professions Code: The Contractor's License law does not apply to an
.. .. - •
103 - UFER Required Inspeetlons1- �''Lt i • : F
owner of property Who builds or improves thereon, and who does such work himself
10 4 - REBAR '
or through his own employees. provided that such improvements are not intended or
-- -._. fi.....
.offered'Fo� sale. -if; Aowever� if[EFuiTding or -improvement is sold within one year of
'completion, the owner -builder will have the burden of proving that he did not build or
"` '•-___._104
`-- -•' -
improve for purpose of sale.).
106 - SEWER & WATER
- tj t: >a; mvira o[ihe property, am exclusively is n racting witb li«nsed contractors w
2 0 2 • �
UNDERFLOOR --PLUMB ING" --'- �t .Ln�":� 'r �'.�.:I t::f•C:
construct the project (Sec. 7044, Business and Professions Code:) The Contractors
License Law does not apply to an owner of property who builds or improves thereon,
203 - UNDERFLOOR MECHAN'I CAL' _F:"
:. and. Who itnuacts.•for_such.projects with. a contractor(s).liceased. pursuant. to. the_.._.
_...._ __.. _ ___.._.....___.r...�._.._._ _....____ ._...... .
204- -- UNDERFLOOR- RAN1E _..__
ContractoesLittnsetaw..
❑ I am exempt under Set: "-' ' •:'�Y•&'P C for this reason
205 - UNDERFLOOR'`'I-NSULI TION
301 - ROUGH PLUMBING
' ' WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
1 hereby efl,rm under penalty;of pe ij .' ont of,the following declarations: '-
303 - ROUGH MECHANICAL
❑ 1 hil i'ana viifl°'A fi n WCertificim of Comm ii{ self -insure for Workers
304 - ROUGH ELECTRICAL '
Compensation; as-provided-for•by•Section 3700 of the Labor Code, for the
petfdrmince ofume work fps w¢icbjhis prnnit:is issued.
oil
305 - FRAME
❑ I have�arid will timaintam Wtitker. dampcnsaiipnIlnsunince, as rixiaired by Setdon
306 - HOLDOWNS
3700'of'ihe-Labor Codi; for'the perforance.of the w6rk foi'which this permit is
isi Ted.' My Wdrkers Compensation Infs!urince carrier • d Polity number are:'
e WILD S` r[C�i45_l�pohry
We"'
307 - INSULATION
Nbiy%OZ�'..�:4:)
_;:CERTIFICATIONOF.EXEMPI'IONFR'.. WO�
,:.
'.: ; 3'x;9 t-`:EXTERIOR`:11A.'
c• .g
' COMPENSATION INSURANCE'' ` ' '`•'• t'_ -
.3-1`0 ••�N'i'E IOR -I�,TH �( -;-„,;..
�`
not be eoinpleted if the permit is for one hundred dollars
O0>or.less,)
•'' ,..,,;• ,-
• ' }� `I' -. : +
311 - SCRATCH COAT
($y•''('itiis°iection•tleed
•, • ,
,
.,.•.. ..•...� : _..
..'.I certy that�m the performance bf the work for wtueh this pcmut is issued, 1
SAill `not employ a)jy"person in maonerso'as. Workers
- - 31.3 -= ROOF•- AIL.__._..._. •,..-_::-:::- ..:.-_:--: - -
- - - c&
FINAL CAS;'` ENERGY
any' to-biaome sutiject to the
coen5igonLaworcatrfomra.Datw " =
501 - ELECTRI
50.2 .. _ _F-INAL PLUMBING -ENERGY--_- ....------ _---. • -
N�[[L`ETOAPPLICANT:If,'kfier'makingthisCe[iiFcattofExe[rip6oii,you•shoutd
bet'ome subject fo thi7*brkees Compensation provisions of the'EZ Code, you'mus[
503 - FINAL MECHANICAL ENERGY ”
fdrihwith comply with skh provisions or this permit shall be deemed revoked.
504 - FINAL. NAL BLT I LD I NG ENERGY
._.._..-- - - -_ ......_.
""" CONSTRUCTION LENDING AGENCY'
- - -- --
505 - FINAL ELECTRICAL., "
I herlbj% ii(frm` tlm�t duere'is•a`e6iistrirction lending agency for the performance..
6fthe-virork for which th)i pertriil_is isfuea'(see: 3097, civ. C.
: . - . '. �'•
506 - GAS TEST
.
nder's Address •,
'•_
507 - -FINAL PLUMB,I•NG.,-•;
;. ;• , .. ..,.. ; • .. .. '..,•
- I certify.that I have read this application and state that the above information is
,
508 - FINAL MECHANICAL: m
i c6trect.4 agree.to,comply.�with, all�city..artd county.ordinances and, state laws relating
509 - FINAL GRADE
1: to building construtiior: and Rim6i auth6fte r4resentitiJes of this city ro enter upon
thy,above-mentionedproprr fn'rinspection.purpme.,.
510 - FINAL PLANNING
,_ (We) agree to save, tndernirify and`keep hiumless the Ciiy of Cupeitino against
1' liabilities, judgments, costs and expenses which. may in any way accrue against said
514 - FINAL UB C WORKS
Ci in con se4uenee a granting of this permit. ` -
AP' VT UND. -S .,NDS b.Nb %TLL COMPLYAk*H ALL NON OiNT
�•. /r'n )
! (i
sa C REGU''.4 S'.. , '' �h
",
Issued by: Date l///
Re -roofs
fApponttactor :. �" •-•.. ,•••-. ....':.Date _ ' , `
„ RD(3US, MA7•QI2IALS 0ISCI'.QSURE -
the_apphcant.or fGtmir@�t Tilting ocivpani store or turidk haia'rAous.mateuja!
pe. Of ROOF •
'sdefinedb y the Gupertuuio Municipal,�ode, Chapter 9.12. and the Health and Safety
;.ii;,' "
�
i
%❑ Yection
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es , (.: N6`1 , i '
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All roofs shall be insgected.prior_ko.-aily_roofulg zilaterial b jclgJ staI d.__.._
:Will the appf � °�; tune ''' ;^ °caps°� nse equipment or device woven
emit harardods' doetamihadis defined liy due'Bay Area Aii Quality MatiSgement
.._.•__.,
If a roof is installed •without first obtaining an inspection; -I' agtee'to'remove
MOCL4 :.
a e . A llcan n p
new materials for ins ction-_ t u d y
p pp ' understands and will com 1 with
0" es- _ ❑ N -
:
_
all non -point source regulations.
' �L have mad the h ousi