01080005 CI BUILDING DIIV�'ISSINOIONPERMIT CONTRACTOR INFORMATION:
BIIrL[}INCs(rrt1DRF,$S: DE ANZA BLVD ## C2 PERMIT NO. 01080005
°1kL5R#LO hL�ENTER ASSOCIATES APaVTbolsy�DST] 1
PHONE: SANITARY NO.// U CONTROL NO.
G O Q ARCHITECGENGINEER: BUILDING PERMIT INFO
u❑ BLDG LER P UMB MECH
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§Sy i LICENSED CONTRACTOR DECLARATION �n]��
_o h<rebyaffnnthailamlicensmundcrpravisiunsofC pmr9(commenci"g TENANT IM PROVEI1VZesc�rpti n
In F-m wnh Se �n]IIOU)of Division t of the Raciness and Professions Code,and my licenx
=xf forreand 33(oG7ti F-�_
.Eacei0 L U ns[Tose Class Lic.a
ern; Conwcmr T
ARCHITECT'S DECLARATION I•jni O 8002
xo, 1 unJersune my plans shall M used as public mmrds J s L
i S p o Licemed Professional
OWNER-BUILDER DECLARATION BUILDING�' I hereby all dui 1 am exempt from the Contractor's License Law f«the
m
t 3 a following reason.(Section 7031.5.Business and Professions Cad «
Cade:Any city county $245076
Z m O which remotes a pernit to consumer.alcor,improve,demolish,or repair any sbunum
ca 3 ce .poo tou
issuance.alrequires.thapplicantfor such permitt File .sum
signed
is.
Iii
sed
(comalt withSeuamtptheryo Divisiay on die Basin a law( ,Cody) 3($ .0.(RCRI[.01(9a.•.r a ,'- Valuation
aim,9
(commencing„,msecu„]a00)drD Tao 3 ernelciede. aPanroayn.cme) J ' fti• i f.. . .�,.. , . : � ..u_I !t Pe`�;'
or that he n exempt rory.p li and the basis for the ar,dbe uemnot to Any l Pennon '
of Section ma S iv any ap d doll for u permit subjec¢me applicant w a civil pcnulty,
Drool more than rive wmma dollars f55oo). 10]AP-N il ION Occupancy Type
01.mowneror the prapeny,mmyemployees with wage,as thdrsnlc cmra,me6on. 102 - PIERS '
sod]do The'wmk.-end the stream is no,intended or offered for sale(See:]fu4.' 103 - UFER
Buiimas and professions Code:The Cannot.,,,License Ino docs nm apply man Required Inspections
owner of wwmr was bailaa«impmvea[Hereon.am sono ears cath work nitmelr
104 - REBAR
or through his own employees.provided that such imprommems arc not intended or
Mferad r«ale.If,however:the buil)ng o p einem Id ton one yecr err '-- -- 10 5 -- ANCHOR BOLTS
completion,the owner builder will have the burden of proving thin he did not build or
improve for purpme of sale.). 106 - SEWER & WATER
oilaown art,rth _ t”:nm excmavel Nadi:; _ .e” ._..._ . .202 - UNDERFLOOR PLUMBING- ...
prapery yd gum Co de)The Coacmrsro•
Doane[the does r (Star ]loan Business o am my whom ethers The cenranorY 203 - UNDERFLOOR MECHANICAL
. - . cand who
law dors nm apply to an owner or property sono Wilds se im'rovrs thereon. .
Coss who eoma«a for such projects with a eemanm aj licensed pursuant to the 204 UNDERFLOOR- FRAME-
conga«ors Licensecoda Law.
' ❑lam exemuundept r Sa. ,B&PCTo,this rtamn 205 - UNDERFLOOR' INSULATION
owmer' 'Date' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
;ba,by
st mraander'npltyOfperjuryoneenncrolmwingdeclarations: 303 - ROUGH MECHANICAL
o I have and will maintain a Cenifcae df Comeat to se6lns«e for Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the 305 - FRAME
_ performance of the wail,bar which this permit is issued.
01 have and will mainum Workers Compensation Insurance,a's rcquirtd by Section 306 - HOLDOWNS
3'( of the LOW,Cade,for the performance of the work for which his per is 307 - INSULATION
/ Iss M Work 's C penmlion Imurarncc tamer aM Pol cy number err
�whG� IwD2 va i �i 308 SHEETROCK ' _.._
am - .•, -•.,Pal cy Na
?, ';'I CERTIFlCATION OF E%EMPTION FROM WORKERS' - -.+�' 1 ,3 09 i ,' EXTERIOR`LATH I
..__ . COMPENSATION.INSURANCE, ..';« ..." 3-10--- INTERIOR---LATH:. ._.___._... ___.... ----.__._,_"...------....--------
"' (mi4'u2trab area oat He edmpl2lee Tone pem,it is e,rane nanarea as"'rs 311 - SCRATCH COAT
(51003 or IczsJ
313 - ROOF NAIL
1 certify matin tae Pcrf«tia. ... .. ,.... ." _. . .." ...
,nallnot eml naarmewo1.hasrk 5w me .bccihis toteWorm,l 501 - FINAL ELECTRICALeENERGY :
p oy any'coon in any manner so a m become subject m the Workers;
Compensation laws of California.Dare
NOTICE
- _ - - " ,.. _ 5.02 ._ FINAL PLUMBING ENERGY -,___„•
NOTICE TO APPLICANT:If.ofmr making this Cenifca¢of Exemption.you should 503 - FINAL MECHANICAL ENERGY
become aanjem come worker'a compcnmuan pravisioma Dobe taborcme.yore muv _ _ - _
Q forthwith comply with such provisions or this permit shall be deemed revoked. 504 FINAL BUILDING ENERGY
t i. 1"CONSTRUCIONLENDING AGENCY 505 FINAL ELECTRICAL -
IY , I hereby amen m t Them is.constructionding age c3 fo the jicffmmana 506 - GAS TEST
r of to work forwhich thispermit - <slued(S IN Civ.C) -
Leader a� ANde - 507 FINAL PLUMBING
.UC 'leenrythatlnverenathsa'pocatonanastamtnatthe bo mrmsiionia 508 - FINAL MECHANICAL' '
ccarx&.l agree m romply.wim AI Troy lad countyordinances and state law:rtlsting 509 - FINAL GRADE
'O U
to WAding construction,and hmalby varthorma repersentronow of This city to enter upon 510 - FINAL PLANNING
.fin W the above-memioned property for,inspection purposes.
.y, fwc)agnmuo.Dae.indemnify and keep Harmless the chy.fcapeniao against 514 - FINAL PUB C WOR
cO liabiatiea judgments.coons and expenses which may in any way accae against said
U.rZa City in consequence of thdgaming of this pcmut. - - r
APPLICANT UN�ERSTANOS' NDW ( LYWRHALLNON+POINT v
souac.REG IONS. Issued by: L%'rG/
O
'gnam cbA a co v 'Date, Re-roofs
r MATERIALS DISCLOSURE ';,
Will the appl'eu t t Wilding nesupant store or handle hicandous material .Type of Roof
or der m by In Cupr M t P Code Ch pt 9 12 a d the Health and Safetr . . ..._ _ ..e,... .-_
code SOY .ssslL,a1 ..t t o Ir• r s . , a i _ I. _
All roofs shall,be inspected prior to any.roofing material being Installed. _
Will th applicant«rot e WildingOccupant eqp p t devices hien If a roof is installed without first obtaining an inspection,,I'agree to'remove
cm t M1mare air connotations as-defined by On,Bay Area Air Quality Management
(
District? /. _ all new materials for inspection. Applicant understands and will comply with
1� 4atoY �9ao ' '- r - all noii-point source regulations. . l - - -' -
�1
have dad the havrdous marine 5 requirements under Chapter 6.95-of tae -
alifmnie Health&Safety Code.Sections 25505,25533 and 25534.1 understand that
nhebuildingdcesnot currently have a tenant.that it is my responsibility to notify the
cupant of the requ11 mens which must D prior m issuance of,.Ccnifcam of
cupancy. .. Signature of Applicant Date
ant Date, All roof coverings to be Class "B"or better
' OFFICE'