01090077a
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BUILD NG DIIVISSIIONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20330 STEVENS CREEK BLVD
DPR CONSTRUCTION INC
01090077
OWNER'S NAME.:
SARES-REGIS GROUP N. CAL.
1450 VETERANS BLV
APPLICATION SUB DATE
09/19/2001
PHONE:
(650)474-1450
SANITARY NO. CONTROL NO.
ARCHITECTJENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONIBACFOR'S DECLARATION
Job Description
1 hereby a0irm that 1 am licensed under provisions of Chapter 9 (commencing
with Section ]000)of Division 3 ofthe Business and Professions Code. and my license
ADD 3 TRELLISES.
is in fall force and [Reel^ [' i•
Littnx Cless f( ` J!%�'i r0
Date U?? -fes SDECLoi 1fN7i l:+,. 1,e, r7
ARCHRE DECLARATION
a �D
be
1 undrnmn0 my plans shall M used as public records
NOV G 8 2001
Licaned professional
OWNER -BUILDER DECLARATION
1 hereby ,(Ban that I amt. exempt from Ne Contractor's law for the
e: Any c
following mason. (Sedan Nnstr Business and rtes Code: Any city or county
$96491
improve, de
which require n permit sa tontine when improve, dcmuch arrit t or repair any swaum
file a Lae(hapter
prior tsc ence.alsantt theapplicantContractors
sLicnseo 9
that he u I'censbd punuadu the provuioru of the Crtnuanoh License Law (Chapter 9
Section ]000) of Division 3 of the Business and Prvfeutotss Cade)
a^, :, s �wr Valuation
3, l7^J, Ujl�l'1'L V �1 e 1 i ; �•
lcomtne c g with
or that he ,s exempt therefrom and the basis for the alleged e.emptimn Any violation
a tl ,) t
of
eflu more Nanfivahu`MtNduIt.far($55(Ml),itsobjects Neapplicant toacivilpenalty
101APVtL�tOb�ftATION
l Occupancy Type
01. ua owner of the property. or my employees with wages as their sole comp=nsotion.
102 - PIERS
103 - UFER Required Inspections P
will do she work. and the structure is not intended or offered for sale (Sec. 7854,
Business and Professions Code: The Contractor's License Law does net apply to an
w er of property Who builds or improve thereon, and who does such work himself
104 — REBAR
or through his own employees. provided that such improvements are not intended or
ofrtmdfarsale.o Wwova,theWadingoatimenofplatnsolawithinreteyearter
_
105 - ANCHOR BOLTS
the owner! will have the W rden u! proving that he did not build or
nprove for satle.)�
mpmv puryoscn
106 — SEWER & WATER �
❑ I. al owner of the partially, am eaclasively emu- acting with Blamed contractors to
- 202 — UNDERFLOOR"PLUMBING
aortae the project (See. voila. Business and Pref e..ides Coda) The Contractor',
License law docs not apply to an owner of property who Wilds or improves thereon,
2 0 3 — UNDERFLOOR MECHANICAL'
and who contained; far such projects with a contmcmrfs) licensed pursuant to dre
204 "- UNDERFLOOR FRAME -
Connacto's License Law. ,
O l mieocmpt under Sm. .B&P C for this reason
205 — UNDERFLOOR' INSULATION
own=r Data
301 - ROUGH PLUMBING
. WORKER'S COMPENSATION DECLARATION
302 - TUB t4 OR SHOWER
I hereby amrm under o<thYof plajuty atm of the following declarations:
303 — ROUGH MECHANICAL
0 I hand and will maintain . Cmircma of Coastal to seB-insure far Walllws
304 — ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the IaWr Code, for the
parfmm rte. of the work ler whim, this permit is valued...,
305 — FRAME
❑ 1 have and will maintain Worker's Comp<nmtion Insurance, as occurred by. Section
3 06 — HOLDOWNS
37M of the Labor Cade, for the perfour am.< df the work for which this perms is
3 0 7 — INSULATION
issued. My Worker, Compersom n Insu me, carrier and P_olicY number ere:
— ._. � �
_ .._......_ __ _.. __
Carol, G�Lns c.etf;r.IicyNa.. 5G'A1,22Z9yo0
te 308. S EETROCK v.:.. ;..
tf E .
t:.°' CERTIFICATION OF, EXEMPTION FROMIWORKERS'I'
l.k
t' t 309 '-'EXTERPOR -LATH
COMPENSATION INSURANCE
...
. 3 T0'�- ', "INTERIOR LATH
(This'ac'erian riled m"Acca,olalcd iftW pc.it is for me, handled dollars
311 — SCRATCH COAT
151001 or kz) t _y,
—31.3 ROOF NAIL
I sadly 4t in the permorm nee of the work rot which this permit is issued, 1
shall act employ any, person in any manner so as tri become subject to the Workers'
501 — FINAL EtECTR I CAf ENERGY
Compensation nlawsnrexldami..Date
Apprean
502 — FINAL PLUMBING ENERGY
NOTICE TO APPLICANT. If, alter making this Certificate of Exemption. you should
503 — FINAL MECHANICAL ENERGY
beeorrc subject m the Workers Compcnssprovisions rovisions of the labor Code. you must
forthwith comply with such provisions or this permitthat be deemad revoked .
504 — FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL
1 hereby "(neat that that is a construction lending agency forthe perrormando
team=work forwldrn this peanitn issued(Sar 38.97, Civ. C.)
506 - GAS TEST ,
_
Leader s Address
_
507 — FINAL PLUMBING..hare.
508 — FINAL MECHANI CAL
I unify the I have seal this application wand&into Nat the above information i,
ct. I agrm m comply with all city and county ordinances and state laws ralsing
509 — FINAL GRADE
m building coultruellim. and hereby amnonze reprtxnmr,as aides city to rarer upon
Ne.WWaagieeto propertyfar in,ptaila purposes,
510 — FINAL PLANNING
(We) agree to save, indemnify mrd hamdes the City of t
514 — FINAL PUBWORKS
which ,.atinrt ,, seri
liabilities, judgments, case and expenses which may in any way .ecmq.gainat uta
WC
Cay, in con enceof the gmling of this permit.
r.
SAPPLICOUR iqE p N LLCONPLYWTFHALLNON-POINT
Issued by: Date
Signamrt of Afri icondCnntrxtor' ., Data
- - %. . HAZARDOUS MATERIALS DISCLOSURE
Re -roofs '
Wt)t applcat rt building omupam ,tort or handlehauN material
Type of Roof - .. _ .. .. ...--.. ._
es def.W by the Coper M gil Cada.Chapmr912.and tWN ilN and Safety
\ /
s .. ., r� ("t :i. A. i'v ��:• at. �.'.
Carl,.` .... l y
Me Section 255321.)''
r' .:
., ❑v rvo I. v 1
_ All roofs shall be inspected prior to any roofing. material being installed.... ..
Will Nc apphnm or fumrt ,Iding mcap.m ax al.imandoar davcpa whim
If a roof is installed without first obtaining an inspection; I agree tolremove
emit bamrdous sir cantamiranda e0ntd by Ne Bay Area An Quality Minagemem
Di,oia?
all new materials for inspection. Applicant understands and_will comply with
0Yes _ , . is
all non -point source regulations.
9'have read"the hnzsdoua materials rcquideri under Chapter 695 of the
California Health & Safely Cade. Sections 25505, 25533 and 25534. 1 understand that
if the building does not curtently have a tenant. that it is my responsibility to notify the
oc<upam of the requirements whit m s be ma prirtr to issuance of a Certificate of
Octtu /�/-•-^�//1 Z
9=i9-o�
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authooaed aged Dam
. .. ,.. .. ,.
i OFFICE
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