010701090W
CI Boobi DIVISSIiONNO
CONTRACTOR INFORMATION:
G
tP1;RMI'A'
BUILDING ADDRESS:
22342 BAHL ST
GRIDLEY
COMPANY
PERMIT NO.
01070109
E THOMAS J AND BIRUTA S
Alllkw
19 S 3RD
ST
APPLIC TION UB DATE
07%23/2001
BONE:
(408)374-0900
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
� -
BLDG ELECT PLUMB M[CH
a
1=1 GI 1.- L._I
LICENSED CONTRACTOR'S DECLARATION
I
Job Description
hereby affirm that l am lice
licensed under provisions of Chapter 9(commencing
ca with Section 7000) of Division 3 of the Business and Professions Code. and my l iterate
ADD 192
SQ. FT. REMODEL '
Lice�seC ;'"d° C
& BATH REMODEL.
n Date T&o
AR 1 T' 6 DttL1.AR N
�tt �KaCHEN
bs
1 understand n Ions h II a dWd" tic rtcards
,
P 1 p 2002
sil tried Profen_
u -OWNER-BUILDER DECLARATIONS
vi I hereby affirm that 1 am exempt from the Contractor's License law for Ree
following reason. (Section 7031.5. Business and Professions Code: Any city or county
D which requir°s a peim
rmit to construct, alter, prove, demolish, or repa,f any arunur
ce prior to In hsnunce, atm rcyuiret the applkant Ito such permit t° f le a signN smteme
_
'bat he is, licensed pursuant me pmvidionsofde, Contractors License Low (Chapter
$q. Ft.
FIOOI Area
Valuation
(commencing with Section 70001 of Division 3 °f the Business and Professions Coda
or hot he k eaempi therefrom and the basis (,,,,he alleged exemption. Any virlitam
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
•,ofnor.man rise hundred dollars (5500).
APN Number
..' Occupancy Type
El 1. as owner nrmt property, armyemployee, won wage, a, m<ir mle emapeaxawar.
101 -
FOUNDATION
will do the work, and he someone is not intended of offered for sale (Sec. 70cu,
R smcss and Professions Code: The Cmunicall License Law does an, apply to an
10 2 -
PIERS -
Required Inspections `
owner nrpmperty Who haims or Improves meneon. and who does such work him,elf
10 3 -
UFER
or through his own employees. provided Thal such int are not intended or
',dffertd
fbr s51e. If. however, the buiWiti'rovemcm is old whhin one
gar imp year
eat is of
_
- - -104 -
REBAR
the owner-bulld<r will have the MlNcn of proving that he did not build or
or
improve
unions, rnr patyilxe of"alt.). �
105 -
ANCHOR BOLTS
-
f31, u mvr¢r of the n , am eadusnal ,tonin
grope Y r con g with licensed mnmamors m
106 `-
SEWER--& WATER— '
-,inmate,the project (Sppl7U4.oBusiness
- License Law does not apply m an owner of property who Miilds or Improves m<re°n.
neroam,,,nobender)The (humat
202 -
UNDERFLOOR PLUMBING '
and 'nocomrapm.for such projars with a eommumntLreen,ed Portman to the
203 -
UNDERFLOOR 'MECHANICAL- - - ---
ois evernpI'mob,sit.B&PCrmmi.Mason
204 -
UNDERFLOOR'%FRAMEi'.'
oaKr D;te i205
-
UNDERFLOOR INSULATION
,. WORKER'S COMPENSATION DECLARATION
.301 -
ROUGH PLUMBING
1 hereby ubirm under penally ofperjury one of are. following declarations:
3 02 -
TUB & OR SHOWER
1 have and still maimain'h C<nifcam of Coastal to self -insure for Worker's
3 03 -
ROUGH MECHANICAL
mpcnsation, as provided for by Senion -i]BO of the Lams CWe, for me
Zaturteofthework. ro,.whichmitPermit isissued. ,
304 -
ROUGH ELECTRICAL
Phuve and will maintain Worker's Compensation Insurance, as retained by Senion
'
3 0 5 -
FRAME
W of the Letyr, Code. for the p,itormance of the work for which this permh is
issu d My Workers Con,coustion Insurance tamer and Prey number are
3 06 -
HOLDOWNS '
i,.
cease N�..Wf_ Q
� 307...,-,"
INSULATION _..... .
XEM —_W_RdKER
f ICA ION Ot EXEMPf10N FRO.N. ORKER ,
308' --
SHEETROCK
COMPENSATION INSURANCE
309 .-:
EXTERIOR -LATH-
(TF..ection ed not cn nplemd Ilhe permit's for ons hundad tlnllars
(sieo) I of
'•
310 -
'
INTERIOR LATH - - -
I {`�n
,r' 1..fymydtpp<'�r a e�m 'kBl;wn.nm Pe..�.is.a�d.1
'than
•311 -
SCRATCHCOAT- -F,.•. ....._. .. _
t pl y' a x ray y n tym b3eet I me workeri
c°top I°raLawt rl�
313 -
ROOF NAIL,... '. • .. ..
. Alan eat
_ ... . 501..-
-
FINAL.ELECTRICAL.. ENERGY ._......
FINAL PLUMBING ENERGY
llooIETOAPPLI AN1.Q)h ,/ king his CAfieate of Exemption you should502
Z . become subject to the Worked comp . ensation...ons of the Labor code. you mass.
mns or this la than be deemed revoked.
O rnimwlm comply with mm prov6pcm
503 -
FINAL MECHANICAL ENERGY_
AGENCY
504 -
FINAL BUILDING ENERGY -
.ill.,semis.ONLEw ea
(h by aline ill., s a roued (S vas leading agency for me perfommna
of me walk mnitit,aedrset.arn,cm.c.l
505 -
FINAL ELECTRICAL
LeriNrorwmtnmltp
zLinder, Name' .. :...• .: .. .,..•.. •. ..
Under', naarst �" �•
506-
GAS TEST-
'� IvicroiY mallnase neaa this apper:mmra and ale in., the ano.e hdmmal�nra it
507 —
FINAL PLUMBING ,
correct, l g eomply with ill ill, na loonly mbrimace, and state I bbi
508 -
FINAL MECHANICAL
j 1.Wld nr i co dh by m° p k tai s fm. IYt t upon
the p rty f pmtmn families,
509 -
FINAL GRADE
inst
lie ti d ' said
n liitt ue
iii to Ione pry c,, keepha yin a y way
pof'i hch ay'nany y c eogainstsad
510 -
FINAL PLANNIN
i
LNP "rnc�y� . f'"' L
NP R' t", C : 6 N. N'1LL COMPLI; N'rfH ALL 4 . -PO h'T
514 -
NA U C OR
L/;7O7/
I
Issued by:
mlmrt tA, .,a .1 or . - .. ..., -Da
HAZARDOUS
Re -roofs
1 "1I •
MATERIALS DISCLOSURE �,. f W II'Ih ppl cam f t bu Id' g rc panl to o h rile h a us mared:d
Type of Roof
yp
- -
as defione d by me C penlno M iclpul C Ch pt r 9 l and the He hh rad Safety
- " - - --'-' -" = - ..
Code socio 255J_la)
�Y:
-..
All roofs shall be inspected prior to any roofing material being. installed.
W11 he I "° r ` Ill
rpw I <q p o at ,wmm� nmm r J m B y A A Q l rat
If s ins Il�- 'without first obtaining an inspection, I'agree to'remove
Nthall
alls
or inspection. Applicant understands and will comply with
0 c s 1 Ira(. toll d Ch pl h.95 of the '. Ig " I Cm1e.Senion,25505.25533and 15534.1 make stmdmutirlpebl nq^I s t .nhhaveallnam, that it is my responsibility to notify theO capd of Y'q of a "I ch mut le ton prim o issuance of a Certificate of
p >J I f a - I? t
I .'•
tiof
cel gulatibns:.1
'
Signature of App roan[ Date
o °ally ; jd c
All roof coverings to be Class `B" or better
OFFICE