02090092CITY
CONTRACTOR INFORMATION:
DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
810 ALDERBROOK LA
02090092
2YMMAN ROBERT G AND FREDA
APPLICATION
�P1109%16/2002
PHONE:
SANITARY NO. CONTROL NO.
: ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG•. ELECT PLUMB MECH
:j LL:-,.l C -1
LICENSED CONTRACTOR'S DECLARATION
IOU Description
1 hereby ufOrm that I am licensed under provisions of Chapter 9 (commencing
SIDING
with Senian 7000) of Division 3 of the Business and Professions Code. and my license
in full fxm"e e t !
se Class eC . 301 Lin. a I ° T1 ?30
9 yR'I Ba"L �' w
F9 ts2X� /j,� g E�
ate rat
'
S DECLARATION
ARCHITECT'S DECLARATION
L understand my plans .[hall be used as public record[
S E P 1 9 200Z
i Licensed Professional
OWNER BUILDER DECLARATION
e I hereby aRrm that I am exempt from she Contractor's License taw for the
p y ${1A
' following reason. (Section J03 1.S. Business and Professions Code: Any city or county
B U' L ®� A Y "jam 7 O O O
i which requires a permit m west u t, alter, improve, demolish, or repair any structure
w
prim to its issuance, also requires the mmlicam fur such perm, 1. file a signed mmemem.
�'; f .136 §q'' 1t1 $JO trea -ti,+ a
A
Valuation
path -31 nasd,So m.7 0q) otfDivisiontheCeBusinrsandPrWwonsC r9
(co ro g id, Serf Jl%{0) of Division J of the Business few Proressmn. Code)
or that he ii dacmpt therefrom -and the basis for the alleged exemption. Any violation
s r.l %.jl A ,
I
of Section 703 LS by any applicant for a permit subjects the applicant to a civil penalty
I of not more than five hundred dollars ($500).
101 AP�ifJI�FlATION
>'�l <y :��' <� Occupancy Type
❑I, as owner of the progeny. or mY employce[with wages as their sole compensation,
102 - PIERS
'
-wt -oT ework0,psi the
sCWe:u Cnorimondwbnse Lavddbr sale
�Business'eM'Peofessions Cale: The Comrecror's Liana Lew das not apply m an
103 - UFER Required Inspections :,"i PVi /ic
or r or gropertr wen latadx or improves mereon. aria who does such work himself
104 - REBAR '
though
m through his own provided that such improd arc moomardedl or
'---
howevcax,
it toll
:that yio
one year or"
ILhowuilderw'huiavethe
-
1 -OS - ANCHOR - BOLTS--'-- ' ;T.+ :\ •'t, • ; >r : :• :. '.0
burden ofpmus
improerwforzale.
he did
ve for the owner - builder will have the burden of proving that he did not build or
improve for ptiRoseorsmol.
106 - SEWER & WATER �
-- - -- --..._..— - - - - --
p 1, as owner or the pmpeny am ex<IusivdY comraming wish licensed contractors to
PLUMBING------ F-:- ;:r
consauct the finite, sal. 7014, Business and Professions Cade:) Tee Conaacmr'x
License law does no apply m an owner of property who builds or improves thereon,
2 03 - UNDERFLOOR MECHAN'I CAL
_. and.whc.emnrai forsuch projects with.a. contracmrtsl- Iicamed pursuant m.the_
'
— —° 2 04- -- UNDERFLOOR -- FRAME " --
Vi.' t
oIt pt doe s B &PCr njsrca.nn
205 - UNDERFLOOR''iNSULPTION
.,
ow p;
301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hertb frtrm under ` '.'."
ya cpenabyo(perjyry o naprtberonowingd«Imaaonx :-
303 - ROUGH MECHANICAL
❑ I na.e`andwiignoirwirr r�'Cmrjcdle of Consent to self-insure, for worker's
3 04 - ROUGH ELECTRICAL
Compensation, a: provided -for by Section-37M of the Labor Code, for the
performance of the work fo,which ws permit is issued...
3 05 - FRAME
❑1h' -'wd lfmouta W k -iCo pe ronl urance, -a rtgmrtd by Section
306 - HOEDOWNS
3Jao of .n labor Nate f peifo anee of the work ter which this Permit is
3 07 - INSULATION
issuer. MyW keiCmp t Insurance canner , dPolicy b
"
_ ,. ._...- .... ..,.... .�... .._..
-:-- 308 - - SHEETROCK =-
J) CERTIFICArION OF EXEMPTION FROM WORKERS
v
i,rEATERII OR'iLATH 1�,
.. '." COMPENSATION INSURANCE^
Mint •rx
- 310 INTERIOR— LATH - ---•
- I.. d ibc cbmpltdf the permit is for one hundred dou
311 r3- =SCRATCH COAT `z\ - t�'�'I''! "` '�r•�
( ulool I '.f- ,
"s
r l n fl th i n the g t f ih w Ii'f 'b clash p m t eat l-
I
313.:.- >,..,ROOF- NAIL.-.:._ _
-
snn t mploy'vnypron nanymac mben a nJ tmme'wrkq['
501 - FINAL ELECTRICAL'`ENERGY' `
c icn,tna nrclr .Dan
- Apphcant .. . _
- - _ __502 =__. FINAL ...PLUMB.ING_ENERGY__-
'NOTICE TO APPLICANT If, after hooking th Certificate fEemption Yoahold
beemne sublectto the Norkrr s Compensation pnvi s of the Labor Code, you must
stun
______. _
503 - FINAL MECHANICAL ''ENERGY fq'' "
babwA cote pywimsaehg,nvi.[fons .,,his lKrmh snag be deemw revokes,
504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY r"` "
n by"ttnnthtm22: ant yrnthep durance
_ _.
SOS - FINAL ELECTRICAL, !. !,. '♦
ee309Anga
of the work for which hit Perini, '. tssu dlStt 3l19]'Civ.C) '� �
506 - GAS TEST "t
IandersAddrcis - ..,
---' - SOT- .= "FINAli- -PliUMB ING_._.__._.._
have read this above `
! .. l aniee
nnd stem races
508 FINAL MECHANICAli "`t°
W city aapplication d
correct: 1 agree t t on, a wish .11 by artand a rep esentornces and state laws relining
a uite law, ocla r,
until
to bull of ihic city to emcr upon
comavction. andhercby"uti
50 - NAL G DE
-i tiva mentativcx
Ina' \- mentione pony fortapectioopvryose[.
5 0 - NAL P N G
( jagree o ndemnify and keep harmleis`the City of Cupcnino againn
Iia line.% �ueg ix�c is and expenses whim may in any war ax ou against said
51 - NAL B RKS
Cir "a c.
7Ge rp �DS!A.4DNkILLeCONPLYWITH'ACNOr4- PoLNT
SP YRCE
I
Issued by; Date
t t Appl'wn C t r - -
.: ( HAZARDOUS. MATERIALS smar or DISCLOSURE!.', - `
1 It th t or building occupant t or namdoan mine a1
Re roofs
_Type Of Roof - - " - -"
a e Cups lvin
asdernW by th<Cupcnn A1uN (Code Ch pt 912 nth Health and Safety
and the
Cwe Sxcooh
yet., 55320 i lla h I t
-' -
O ,f. I
All r s shall be inspected prior to.any roofing.material being installed.--„__-
' Will th applicant future building occupant use equipment devices when
''cm t hazard r cam non¢ az dcOnw ny the Bay Area A Qu 1'Iy Management'
-
If a oo is installed hou[ first obtaining an ins ectron; Pa tee'[o remove
g P g '
° ' " _
all_ ew aterials, f i ectwn _ Applicant understands and will comply -with
r ' I ,
all on -p i sour re ulahons
h read the h d [ melee I qu cmems'u d Chapter 6.95'of the
Chfo mH nth &Safe Secuos_ 5505, 8533 and 25534, 1 understand that
!f the Id does not ly ve a mum that tis my pu .'bilityto -notify the'
'cr
-
-' .(- --
'• 'yz'�
I. require n th'mu the et ormis c fa CcniEcaro of
V" _1 w, t
,. .. .e
Signat of p Jc Date
All roof coverings to be Class "B" or better
° i nt Date
i
a