02080093I
CIBUILDING DPERTONNO
CONTRACTOR INFORMATION:
PERMIT
By�ly�tTV9p`R9 LUSTROL CT
CLEAR OAK DESIGNS
PERMIT 02080093
: ""JAMES W AND KAREN B
1723 B ROGERS AVE
APPLIcA8'9�'Tbn/2002
PHONE:
(408)436-5448
SANITARY NO, CONTROL NO.
z0 ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I_"U r I C7 I_1
i LICENSEDCONTRACTOR'S DECLARATION
Job Description
❑ Ihereby affirmchat lamlicensed under provisions ofChapter 9(commencing
KITCHEN REMODEL
m with Smtion7 )of Division3ofthe Business rid Professions Code, and my license
ULiccnu Lic. S
e
ARCHITECT'S
T TIO
H Con ror � �/-r�
����9g
LF-
I undem and my plans shall be used az p is rtcords
as Pi CA- _'J
OCT 2 3 2002
o Licensed Professional
u, OWNER -BUILDER DECLARATION
u,
1 hereby offirtn thin 1 am enempt from the Cm uanor's License Law for the
a following rtazon. (Section 7031.5. Business and Professions Code: Any city or county
$20000
❑ which requires a permit to constma altar, improve, demolish, or repair any structure
y.
--- ----- 'a
m priinoits issuance. also requires the applicant fw such permit to file a signed.smement.
- mat be slicensedp mtlpn,eprnwiPnanfinecnntraemr.L«neLawecnapter9
(commencing with Section Division the Busines PndPofess ons Coda
. ,,,.,,35]0130&1 't fka.
!'r')•sfi'.-,—t°./C. 1.'s
-
Valuation
or mat he is esprit, theefmm'and he basis for the alleged exemption. Any vi muni
--of Scetian ]036.5 by any applicant for a permit subjects the applicant to a civil pcwry
'of not mare man eve hundred dollars ($5001.
101APN NeMNDATI ON
Occupancy Type
❑1. as owner of the property, or my employees with wages as their sole compensation,
102 - PIERS
I
-will do the work:'and the mmon, i. hot importe! or oa'cred'fr, sale (see: 7DLf;Required
Business and Professions Codemrem
: The Cocr's License Law does not apply m an
Inspections ' -
owner of property Who milds or improves thereon, and who does such work himself
104 - RE BAR
it through his own em to ees.
8 P e _ Provided that such ire rovemenl art not intended or
-:offered-WiletheWddm - ___ p iissolawithinnod il--r
g w improvemen year o
'
__ -_- -.--, ..
- 1.05__ -.-ANCHOR' BOLTS-- __--
completion, theowocdoile'r will have the burden of proving that he did not builtl or
improve Wtpouo
106 - SEWER & WATER
❑I owner of theyperry - exclusively commerical, wthlicensed contractorst
—-UNDERFLOOR—PLUMBING'_._
construct the project (Sm. 7044, Business and Professions Code:) The Commerars
' License Law doe not apply to m owner property who builaa or therein,
203 - UNDERFLOOR MECHANICAL t•,
._Boa with seimproves
sa<n.pm;e< .with a.<omm<mas).E<en dpaaaant.m.the....._.._.__.-204....
__.UNDERFLOOR...ERAME.-..
Comment's License
Co1.. etc Licence Law.
_ ❑Iamcxemptorder sec. "" "'� ''(� "B'&PCforthisrcason
205 — UNDERFLOOR,'',INSULATION
IhKr "Date'' " - -
301 — ROUGH PLUMBING
- WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
- Ihereby affirm trnaetpenalty ofPejury,oneofthe following decimations: -
303 - ROUGH MECHANICAL
❑ I have and will maiouin a CeNecate of Consent to self -insure ror Workers
304 — ROUGH ELECTRICAL
Compensation, as provided for by Settion 37W of the Labor Code. for the
- performance of the work fir which this pennn n issued;..,
305 — FRAME
have and will notimorin Wwke o
'Cpe ti inamirce,ai requued by Sector
306 — HOEDOWNS
J]a of the Lelsof Code. fral thperformance or the weak for which this permit -s
'uee
307 - INSULATION
M ker`sCpjm,,n,!uimn 1 . urs c c nJ Policy oumber are
Cal
u Z1�iO
308 •— SHEETROCK -T
;CERTINo
FlCATIONOF.EKFI.1PIlON A, %Rs's
r i t a3Q9, t;; EXTERIOR_=LATH.lie, `•� "' "
' COMPENSATION OJ nNCE -`
..__. 310.--,.-INT-ERIOR--LATH -
.. '(rn s semtri �eea no. b<compluea f me permd is roe nue haidrea dollars
311.>,'- ° SCRATCH COAT
(5100) I 1
,: _
_.
Ic rtpth gJeperfection cc of the workfor which this Permit is iesuml.l
shall not employ any pe nya az to hmbrce bj t to the Workeri
..._ . ,_3.13.._7.-ROOF.._NAIL
501 — FINAL ELECTRICAL'ENERGY''
A °°
Cpm,pmps c t nLawsorclt '.Dm
.. ..'. - _ _ ... _
.. _ .... _502 — FINAL PLUMBING ENERGY
503 — FINAL MECHANICAL ENERGY
after Exemption. youu
APP LICANTor'sCmfers
Mcome
mind
subject
uj the such No Cimpc or tics previsionsll the erred Lishoi-Code you must
mnprevisions
vision ofth
become comply
j forthwitncomplywimstichpmvi,ionsormispermnsnaubea<em<arevokea._
504 — FINAL BUILDING ENERGY
_
CONSTRUCTION LENDING 'AGENCY ' -
505--- FINAli-ELECTRICAL 7 .
I heeby arfirm chat there is a construction lending m,6, for the performance
4. k f mi pc t s 309] which ISapal (S Civ. C )
506 — GAS TEST '
_.... ._... ...:...........
q Loader Address -
LeneasAd
__._._ ..507--=--FINAL--PLUMBING_. -.__. .....__... ... ..._ ...
"mu" "a" heteasthapplication a.retmatthboa informationis5
cont t Lag t omply lh 11 city and o tordinancesnil. state laws relating
p
508 — FINAL MECHANICAL "
- INAL GRADE
rob m gconstruction:.dhereby amho representatives fth'.city t enter upon
the hie therionedproperty fmoc,pecutin purposes,
5 0 - INAL ING
(Wgagreen. save. modemnify and keepbanalities me City of Cupenine, against
liabilities, judgments. costs and vepenses which may in any way seeme against said
- City in consequence oflhe'granting of this permit.',
5 — INAL B RKS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALL NO -
- _ ' ` }
SO :RCREGU TION ., a;^^
l
Issued bys Date
a' t IW
�'
slgnamre,or App;IcanvCommcmr. .� ., t' !Dae...
HAZARDOUS MATERIALS DISCLOSURE
Re -roofs
a ' Will theapplicant rmu building w pant tore handle 'hazallo vn'al
a
Type of Roof
az defined by th<C perm M nc pm Cale Ch pt 91S He Ire dSafety
Code S u n25532(7
1. ! of ;'� 4 i•kv s •'y - o-` I .-J- -'-, -' _ ,
fdth
El yes la k-;
! 1
All roofs shall be.mspected prior to any roofing material being
• Will meat t b lJ g p t se t a vep% wn n
emit hrudous n rone r mnummants az Jeeneo by the Bay Are. Air
r QualitySfanagemem
installed. _
If a roof is ins[a11ed' without first obtaining an'inspecti6ri; I agree: to remove
°Linc"
pY No - - - '" -
all new materials for inspection.. Applicant understands and will comply with
.PP - ..
all non-point'
i
source regulations ...
It read the h zardous materialrequirements- under Chapter 695 of the
'
Calif m a Health & Saf ty Code, Sections 2550p 25533 and 25574 I undersand that
Witte building does not currently have a tenant, that it is my responsibility to mmifythe
dcc ipare of the mquircmems which most be met prior m'c"muce of a ce 'ficin of
Occupy y. y S
al ill_--
Signature of_Applicant Date
All roof coverings to be Class. "13' or better
wnernrnuthodsadag<nt' ate
-71, ._.-,..._ I. - ... .-- -- - . . _ ..._.. -.. . . . ..