02030071 OF
CIBUI DNIC DIIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10849 BARRANCA DR 0203 71
OWNER'S NAME: APPLICATION SUB DATE
1ARGIE HATTERY 03/14/2002
/ ,HONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
as
Z Z N= LICENSEDCONTRACTOR'SDECLARATION Job Description
O Z_G I hereby affirm iNi 1 am licensed under provisions of Chapter. (commencing
p..,mow
with Section]00defDivisionJof,heBusinessaneProfessionsCode.andmylicense ADDITION MASTER BEDROOM/BATHROOM
p z 5 a cense Corse dna roost. �8�p
spa Date Class Contractor
ALE 93
3 a.y
Date SDECLA
ARCHITECT'S DECLARATION T� Q s]
as a 1 uneerzrarW my plans shall be used as public rtcoms APR 2 3 2003
i M o O Licensed Professional
OWNER-BUILDER DECLARATION
of to
H 1 hereby affirm Nat 1 am enemy,floor the Conuacmr's License Law for the
4 G following reason.armlitot JOJLS.Business andProfessionsverdeli Coat:Any city or county
which requires puree,re construct,alter,ght improve,demolish,or repay any tatuaure. alltL ANG
n3 •th t aissuance.rl q ,heapDfe ,f chpermitLic signed einem.
m„n'a,r«pseapnnutmthe pm . fm Contractors e h (cnapmry Sq,Ft_Floor.Area (._ r Valuation
uo n8 ',M1Secron]00p)ofD' 3 ❑n a int. pnaFrofe oncsde) rl; [' ,2.6U1'014':'0'0!gii� ”=ae3
or that he d caenip(m.refmm and me basis for me alleged ke rip tur.Any vinlanon
of S«,ion 703P.3 by any,applicant for a permit subjects the applicam,o a evil penahy `
rnot mo.than fivt bnadred drill..(S500) APN Number I,; .., _ Occupancy Type
101 - FOUNDATION
❑-will rlhe pr pony m s yes g.a.,ed f r pe sarion
Bsinothe' ok'and,M1 w, eCretintended offered apply. too - - - - -- -- - -- - --
owners ae ream coaTheCvevthe L Ii a ,work
103 - UFER Required Inspections'ow r property ow Who l ee nprov thereon mJ who encs such work himself
-.1throughels ownemploy«nhpmvieW that ii.,rsuch improvements arcnot naenear of -.1.04....--._REBAR. ..._._._..._.._._I__._._---
completion,
-_
IoRered for sale:If.-tidwever.Ino buileing'or improvemem is-sold wi,hiri one your or -'—com letion,,heowner-halik rwmhavetnebnNenM g 105 — ANCHOR BOLTS
in m,�ead o,nn ld or
,mpmveforwn parpoaeof. l .h p 106 — SEWER &..WATER
Ianowner ,ofthepopeny - 1 elyc , a g with licensed contractors,to 202 — UNDERFLOOR PLUMBING
construct the presto(see "Ito a B r . J progeny f. s il l :)Th vesC. dre mons
and,w<Lcwd«s n f apply man ownerth acmntwno)licesempuo.<.mt,the 203 - UNDERFLOOR MECHANICAL I
and.wha contracts for such.proj¢s wnh.a.conuauorL)r«nsed pursuant-m.rhe. _ .. _. -.. ,
eoIa.clu License Sev 204 — UNDERFLOOR;.FRAME
❑lam ene,np„neer setB&Feral nhis«anon 205 — UNDERFLOOR INSULATION
COMPE NDECLARATION 301 — ROUGH PLUMBING
Inerebr affirm under Penalty orpetiafr oqa or the eeslaratmnt: - 302 - TUB & OR SHOWER
- `� 303 — ROUGH MECHANICAL
FI ❑ I has and will rovidol f Certificate Section
of Courant ,o sell-insure for Worker's
compenaptipn, aa,proviaea for by stsaon Jnro aline Labor core. for the 304 - ROUGH ELECTRICAL
cerrom,anee ofine work for which mid permit IF iaaaea. 3 05 - FRAME
❑1 have ane will prommm Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
a:
37o0 of the Labor Code.for the performance of,hework for which this permit is
issued,My w k ra Compe.. , Insurance roomer and rorty number am:
3 0 7 - INSU_LAT ION
EXEMPTION FROM WORKERS
-l'
t RTIFry ICATION
F T_'01'"'308,
L.iPofyN : '� .1 .. 308 . zZHEETROCK •'
'�, CPO (' � 1 a` iiK al Ilit � '
COMPENSATIOVINSURANCE!_`. !''- ' _ _309 ---_EXTERIORr`LATH
mn r 6 rites not Ire ca n1hatol it the permit i1 for one handfed dollars 310 INTERIOR LATH i t
311 - SCRATCH COAT
i c oar a�t-in in p[rroflll a the weak for wn n this pc 3.13.:_ 'ROOF-NAIL , - -. .... .._ _.. .
issued,
nnau temple of n natio e 'nolo n'he wmpe,a 501 — FINAL ELECTRICAL ENERGY
Compos, LaofCalifornia
•��
Apps502' = - FINAL PLUMBING -ENERGY —
NOTICE .PPL AVT r ski ion C n' sac the
L pu 'you-
bcc "
. 1 tyva schen psoat spin rife, Lb cal.y rust 503 — FINAL MECHANICAL ENERGY
O forthwith c ply wnh such pro visions or this perm,shall be deemed resolve .
O ...._.. _ - _. _.. _. _.. ._' 504 -'---FINAL BUILDI-NG ENERGY
a'' " "' ' ('CONSTRUCTION LENDING AGENCY "" ... .
1 h affirm
by that them a'conswction lending agency for the pegormance 505 - FINAL ELECTRICAL
bf 0...,Q Lone N which this r (Sec. ... 506_.._.-..GAS TEST .. .. ....
t.I Leader', . . 507 — FINAL PLUMBING L,,
V'� Ictnf that Ih read this d.,, that the b frmaton s
508 — FINAL MECHANICAL C�
gT+ F. tone, I agree to comply wallO}F. _ II city eco ry
ordinances e state laws Metal,
U rob Io , e ahe bm representatives nn city to enter upon
509 - FINAL GRADE
he Mer , J Petyfi p , pep
9L., f`yl-g to save, adk ph the City reproagainst 510 - FINAL PLANNING
tiel hanl, - 'w ` ureas and . < nmay
in anY Y 8nv, oldU chJ or , annr
514 r-- FINAL WORKS
APyLICA VT UNDERSTAN S D A r ell LV WITH LLL VOV POINT ! '
SI r 1' ,r -0 Issued by: Date
g r r rAppl JC , - -Dat' Re-roofs
wuY pen nw Icor cn , s.lzaam x<en e's�r,y Pe.of Roof_ . __ _... .__.. ....o .:,... . ,,__..�_. „...._.
AZARDOUS MATERIALS D C SURE 0
' IF i , I um hadd'g cup , r handle h do '1'y
C Qs Mb ,h C
C sin zssJ tj w p If vui'. ' - rs;'° }"• pt I ' FI, ' ri 1 _a'.•y . -,':
❑Y.
.,,-All roofs sh_all be inspected prior to.any.roofing material being installed.
will drat pills nn building«c a BayAl use equipmento devicesManagement If a roof Is installed without first obtaining an inspection, (•agree to remove
Umu h e s Fit con, ,z as definer by the BayAf<a<1 Q I, htanagc r
1tr '" -
❑Y a all new materials for inspection. Applicant understands and will comply with
T�'No - - all non-point source regulations'. . ' - - - -
1 have mod,he et zCod . r<aals requirements d 2e Chapter 69S of be
if
ogdhealos Safetye ae.Ser,ave a tenant
that
ad 25534. itytorude notify
that
if the building dins not m currently have a m IF ,ria it is my responsibility a nmify the -
rccupf,m of,M1e requirement all mud n me,pr r m icsuame of a Cenificae of
Signature of Applicant _ Date
net nfaarnn eaagtn, Dare All roof coverings to be Class "B"or better'," -
:' OFFICE .-