02080073 NO
CITYILDING DIVIiSIONPERMIT CONTRACTOR INFORMATION:
810690 RNs DE ANZA BLVD TERRA NOVA INDUSTRIES PERMIT NO.
0 YI(M60 PIZZA & BREWERY (BJ) 1607 TICE VALLEY BLV APPLICAB(g Tr72002
\, PHONE: SANITARY NO. CONTROL NO.
(925) 934-6133
O O ARCHITECtIENGINEER: / BUILDING PERMIT INFO
%U E BLDG ELECT PLUMB MECH
G w6 LJ L i =1 I=-
8 h 2 LICENSED CONTRACTOR'S DECLARATION
pi- 1 hereby affirm that I ann fivensard under provisions of Chapter 9(commencingTRUSS CALCS CHKJob rse 98VAE USE ONLY
_C: r wiNSection 70W))of Diviamn3ofine Business and Professions Code,and my license
�J isi« ;llfarm ad affect. g ORIGINAL #02050055/TEMP PERMIT #02070017
n 0 a U Date
Contractor
to ARCHITECTS DECLARATION
I understand my plans shall be used as public records
at
w se p 0 Licensed Proal
fession
OWNER-BUILDER DECLARATION
w'-"m 1 hereby affirm Nat I am exempt from the Convector's License Law for the
C?Q following teusom,(Section 7031.5.Business and Professions Code:Any city or county
which requires a permit to conswct.alter,improve,demolish,or¢pair any structure
�3� _pn t t - nee.also
a'me
ppl can such pernat to tilt a ergno"s®ement - - _-- 1800 Q.____..
Mat ly ll:r<uu pars vol tom pr tn..If ri Conuacmr_'cc Pr law(Chager9 a Sq.FC F1oorArea Valuation
(commrne ng wW Sato ]1100) f D' is nn]of me Business and Pro
n Code) kv ;a 1, i l , a f 'p. s„ l� 1p t t`k,•
or m t be
t e<mpt N re( and me burs for the a112gcd exemption Any mamrnn 316 0 2 I 0 4 0 0 '
-af Satron]036.5 by any applicant for a permit milers me appLcanuo a ctva penalty
Ino, nemanr.enandaldollarsPi", APN Number Occupancy Type
❑1,axownerOfthe propeny.army employees with wages to their sole compensation, 101 - FOUNDATION
will do the work.and the slrucmr,isnot;mmmded'Or oRercd'for sale(Sm.-law; 10 2 — PIERS -
Business and Professions Code:The Contractor's License Law does not apply to an Required Inspections '
owner of property Who builds or improves thereon,and who docs such work himself 103 - UFER
or through his Own employemployms pro-fled that such improvements we not intended or .... ._ ... 104— .REBAR - ._ . ._-_. ._. .. _- . ..._... .. _ .
..
offered for inn If.howevcr,the bulaing - p i1 'le -thin one yearor ...-,.. ._ _ .._...
completion,me owner builder will have the WMcn of proving that he did not build or
improve for pnrpnsc nrsale.). 105 — ANCHOR BOLTS '
—
elicensed — 1'06...—_. SEWER &—WATER1 a p f ma pnpeny.am exduslyontract g with c tract i
ont m p j m(Sm taw Business a
Prot ss nm Ceee')The Comm t 2 Q 2 — UNDERFLOOR PLUMBING
License law does not apply m an owner of property who builds or Improves Merton, '
_and_wrim,mntreacrs fw.sech.Pmjats.wim a.connactm(s)licensed pmaaant.a.dye. .. ._ . _. 2.03..- ..._UNDERFLOOR-MECHANICAL.... . .... ...
_
Contractor's License law,.
0 am am exesemq under Scc: P C,forthis rcason 204 - UNDERFLOOR- 'FRAME
_ owner" " Unit' 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
_ -
IhercbyalBrmunderpaahtyofperjury,oneofinefollowingdmamtiona: 302 — TUB & OR SHOWER
y' ° 1 hide and will maintain h Certificate of Consent to elf-;,.are for Workers 303 — ROUGH MECHANICAL
Cnfommnci of,ha provided
whichthispermit
Section 3t00 of the Labor dole, for me 304 — ROUGH ELECTRICAL
Performance pc t'.t.. o. .,
°l mr,o and will mumoin Worker's Compo tin Insurance.as regniaA by sedlon 305 — FRAME
37ao f m Labgr Cale f theperform a of to work forwhich this imam i, 306 - HOLDOWNS
issued.My Worker,Comp,,O'jltm Insureand Po I y be are:
_. 307 — --INSULATION-
Policy No
cdrr S sv .a i ! F'. I'h( . - �. .. .. , - ... .
( jCERTIFlCATIONOFE%EMPfIONFROMWORKERg _7I' t3.0:8. P ?1SHEETROGK.1. ti<{�?+tl;
COMPENSATION IN- RAN: ---- _._._309;- "-EXTERIOR- LATH .....
srGonnaenothcompletedif,hcpermitisfor one hundred dollars 310 ' — ' INTERIOR LATH I -'
SI00 aR, 1 ori r1 mai i�m rfermanee nr mn'work far worn this t is umea'( ..COAT `
-. ..
Coni not pb'r'any P< y .m become subject to me Workers 313 - ROOF NAIL-, --
compo n L ICAG1l Ore502 FINAL PLUMBINGAENENERGY
APPI cant ._ ._
NOTICE TO APPLICANT,.If,after ,lion Csions fE rpt rnashouldumust - ERGY'
become sb) t t it Workers C pc t provisions of theLabor CW you must O mon m<comply such taints xm txnauxe mea km 503 — FINAL MECHANICAL ENERGY_
O _
E'7 - '_ CONSTRUrnONLENDtNGAGENCr ' 504 FINAL BUILDING' ENERGY ' . : -
--
C,> the by.drtothtthrc onstructionlendingagency for the perform 505 - FINAL ELECTRICAL "
ofN work forh'cnm. .it sissued(Sm:309]Tv C)
E 9; -'Lendersbl .. 1 _� -:
— 506 GAS TEST — --
�.z Iknder Adore.. '
U.O I rtify that I have mad this application end some that'heb„te information is 507 — FINAL PLUMBING'
Isr?E, scoricet.I agree m comply with all city and county ordinances and state laws miming 5 8 — I NAL MECHANICAL
O U rebuilding Instruction:Ind hereby aar izc repres<mmives of this city to enter upon
the above-mrnnoted pmperty for inspection purposes., 5 9 - INAL DE
- ` 0.- 1W'Oagree1..,a:indemnify and keep hannl<ssthe City ofCapeninoagainst 5 - INAL
-h liabilities,judgments,costs and expenses which may in any way uceme against said
U:.Z C6ymciamequacedfflegmnlingonhi.rermit. 514 NA RKS
.. _. APPLICA\T UNDERSTANDS'AND WILL COM PLY WITH'ALL NON-POI"T
SOURCE REGULATIONS:. ' . Issued - Date
.Signs l'Appllcant/Con t Dine' Re-too
":.HAZARDOUS MATERIALS DISCLOSURE 514A
- R IN-PROGRESS
W 11 Mc pplica t r future W tldiug acupant Mort or handle naaardous material _ Type o Roof _
. and the Health and Safer c .. .. .._... ,r -. _. ,, .... ....
as defned by the Cupm Municipal Code Chapter 9 12 -
Codc Sation 29A O .1 I ••...'•s',s t.o. 3 ,.' r i 1
°Y. i- y rlt °N s `
All roofs shall.be inspected prior-to any roofing material.being_installed, _
wu theapplicanton future Wilding oc p a wean p I device,mmom If a roof is installed'without first obtaining an-inspection;'I'agree to remove
emir h b x contaminants a defined by Nc Bay Area Air Quality oly Management
District? _ _ .all.new materialsfor inspection. Applicant understands and will comply with
°Y °” all non-poini sou.rce regulations.,
have mad the h d materials requ menu under Chapter 6.95 of tat
he
'Colora H Ire&Saf ry-CM,Sections 25505 25533 and 3553G I understand m
"ifNe n Wilding does not currently have a tenant that it is my responsibility Cb notify me
me6upam of the nopimmemx which meal rte met priocm ixmnee df.a Cenificme of
-� .. <
.q�qupamr. _Signature of Applicant
;,. ._ Date _
Owner or aurnoriaedagam;: - Data All roof coverings to be Class `B" or better
.._. OFFICE ..