02060095CITY But-DI
CONTRACTOR INFORMATION:
-DING PERMIT
BUILDINGA OR S:
1- & STEVENS CREEK BLVD
CRW INDUSTRIES
PERMIT NO
02050095
INIE'9"ROURETAS
1157 DELL AVE.
A99c%`o97YM_2
PHONE:
(408)378 -2477
SANITARY NO. CONTROL NO.
ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed u11rrrrdpppler provisions of Chapter 9(rommencing
J DDEESSK� qq
FIRE REPAIR (NO' HAN�I/%IATCH EXISTING)
wnlm Section nxn)nrWfllwli s na rrofasinn. � a<. ana n, Iensinr If e R�A� L c ps
tl e®
to Con r
BAT(
Sect+
T'S Ul M
1 understand my plans shall No used as public records
AUG O 2002
Licensed Professional
OWNER- BUILDER DECLARATION
1 hereby affirm Nat 1 in exempt from the Conwcmr's License law ror the
following 7031.5, Business Prfestions Code: Any city county
BUILDING $ 10 O O O O
reason. (Section and or
which requires a permit to consumet. alter. Improve, demolish, or repair any slmemm
pnocteLL issurrea.irk.requirealheapplicam for such perutm Gleasigoed statement
( (� •s. s - 3B�j.G't.Q'4eCoS'.®d8a "t `', � i ;
• Valuation
dust he is licenudpurunint teflu"rovis ions ofine Counittim, license Law (chapter 9
with Section ]00)) Division 3 the B.,ines Professions Code)
(commencing of of and .
or that To Is exempt therefrom and the basis for the alleged coned ion. Any violation
(.a4 .' , .
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
,of but me than five hundred imils. PISM),
101APN hP UNDATION
•' Occupancy Type
❑Las owner oftheProPcny.0 my employee¢with wageaasthebsnlecompenmtrm.
102 — PIERS
1 - R Required Inspections
will do the work: and the structure is nor intended or offered for sale (Sec. GOW,
` Business' and Professions Cod, The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
104 - REBAR
or through his own employees. provided that such improvements am not intended or
- Reredforrole.If.howeventhebnndin- i ._ ridsoldwiihin one._ of_.
incompletion, burden of build
.- _ _
__ .... 105 = _ANCHOR — BOLTS__.____.__.___._.. ._.___ ._.._. -_.
• s .
the owr¢rbullder will have the pmmving that he aid not or
106 - SEWER & WATER
unpruve n,r pnrPnae nr sale.j.
-202- -- UNDERFLOOR- PLUMBING -- - - - - -- ---__ _. .. ...
O l; ni owneyof the Prnpcoy.amen<lusivoly contmctingw-uh licensed contractors to
-- =---
sill
construct me project (see. 7014, Business and Profession. Cede.) The Contractor's
203 - UNDERFLOOR MECHANI CAL i Pl . 1:
License Law does not apply man owner of a counywho b.1wersed purarn . .nerd-
..and who such projccb. wish u conoacmr(s),Ilccnscd p
__._.__...204. - .UNDERFLOOR.FRAME_
... _.._
ctors License Law.
❑late eaempl under gee I'- (;B'&PCfonhis reason
01rmemrsLicendl,Srm
205 - UNDERFLOOR.INSULATION
°. - �^ ' �' 'Dote ' � . •' '
301 — ROUGH PLUMBING
owns,'
•' WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby of na under penalty of pe,j., a of fellow in, d<elammns:
303 - ROUGH MECHANICAL
❑ 1 n'o,2and »ill'aurnmin'iis Cenircate of Consent to self -maitre for Worker,,
304 - ROUGH ELECTRICAL
compensation, as provided for by Section 3100 of the Labor Cock, for the
305 - FRAME
performance of the ework fur which this permit is issued.
-I
306 HOLDOWNS
0 1lo and llmit "W k Cunp t 9 dbySection
37W of he Labor Code f pilfforouninten of the work foe which die, 1 1s
307 INSULATION
is d W k C crnper9. un r ol y u1nite 1
A4e: t
s% d Polity
o�J
3 0 8 .: SHEETROC.K._ ;_
�7,
f "
PTON
;309 :'= ,„EXTERIOR.,LATH .
%
CERTIF CATION OF FROM WORKERS
ENI ON INSURANCE ' t -
_ ._..._._310- ,.=- INTERJOR -- LATH(. - - - - - - -
rlhrauatonkeanmberomnlaed nn<p< .it iamrnnewnareaannars
311 "- SCRATCH COAT �.
3.13 .- .ROOF =:NAIL
`!kP,nryenunmelne mnn nnhe wartb for comesu,pttothes.nedl
501 - FINAL ELECTRICAL''IENERGY
C...not employ any person in any manner so as m become subject to the Workers'
conPens.t anrcdirma.Date '
502 - FINAL PLUMBING ENERGY
''
t NOTICE TO APPLICANT- If,+ fter making this Cerorndte of Exemption, you should
503 - FINAL MECHANICAL 'ENERGY
becom subject e subjeco the Workers Compensation Provisions of the tabor Coda you most
long, kh'camplyw id, such maskmm,ar this p.I, hall beaeemedrevnked.
504 - FINAL BUILDING ENERG�
- _ .... .
'•:: ^ " "' <' ••�'PCONSTRUCIION LENDING AGENCY ` "'
SOS - FINAL ELECTRICAL '.. .• t
' 1 hereby affirm that NercisYronivuNon lending agencytonneIi crfurmanc`
T
506 - GAS TEST
of the work for whichsdr, Permit. is hi,, ,....,.y.... ., ..
Lender's Name" , , is issued (Sec. 309): Cis. C:) -,_a . _ t.<
- .. _.- . -507 -..GAS FINAL PLUMBING -- - -
Lender'sAddrtss' '
508 - FINAL MECHANICAL'''
1 cagey that 1 is
Nis application and acme Nasshe above inoss
509 - FINAL GRADE
neliu
Fiirtccl: 1 agree to comply with all city and county ordinances and cline laws relining
ply with
"
to bold' g immunuctim,rund h 'by Gmho i p t dive fth city to nter upon
510 - FINAL PLANNING
Nc 1n e o em u ed pmMnY for inspect on rpo
+gre tos a naemltyaneee taro 1 mecty fCPh I, anSl
liab ill ms, o f d xpc m y any y c 8 +!nst avid
id
514 - FINAL PUB IC WORKS
/a
Ciyra q ceof me' m'go th
(CAP U ER$TA, SAN II C MPLYWITHIA IN POINT
_ IR ItEO TIO _
Issued b r Date /
y'
m
Re -LOOTS
HAZARDOUS Mdingre ome SURE
'uW11NEa Leant tiro future building accuuD
Pp. g p t1 or handlcherallous material
Typo Of ROOf
pe 'pa p anJ Safety
as defined by the Called.. Municipal Code, Chapter 9.12, acrd Ne Health
1
Code SOe YOn'255J2(1 f * � No
..... ,
' r
e
All be being
W Iltheanplic a, f t
roofs shall inspected prior. - any roofing.material installed
If a roof is installed' without first obtaining an'inspection; I agree, to remove
cm t ham ilmo l r contammadrs en defined b) the Bay Ama Art Quality Management
Dead,(' `' I
all new wterials for inspection. Applicant understands and will comply with
❑yea,` a ono.
n -p '[ source regulations:
I hr read N harudou 'matenaH rcqu «me i a &, Chapter 695 of the
Calf m Heefth & Safety Code, Serious 25505,25P33 and 25534. 1 andeonrulmlit
Id rtes not <urtendj h t 1 t' s my mipo s ul y to notify the
a2 p f t qui i hi must be t pros r 1 issuance of a C fi r of
Signature Applicant Date
of
OL
_ _
l All roof coverings to be Class "B" or better
riaeda nt " Date .
OFFICE' ---
_..