01100063 OF
ci BUILDI c DIVIISSIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11092 BEL AIRE CT CYPREX CONSTRUCTION LAND CAPES 01100063
OWNER'S NAME: APPLIC4TION SPH DATE
SOUR DAVID P JR AND DEBRA M ET 354 MENKER AVE 10/ 10/ 2001
HONE: (408) 971-4274 SANITARY NO. CONTROL NO.
00 ARCHITECUENGINEER: BUILDING PERMIT INFO
to
BLDG ELECT PLUMB MECH
"-U I=] I_1 L71
8 m E
C LICENSED CONTRACTOR'S DECLARATION Job D sc n Q� G�
i Z_ 1 hereby affirm that 1 nm licensed under provisions of Chapine9(commencing )
.ytuj is infllforceandefect.' onJofthe Business and Professions Code.and mylicenu ADD 221 SQ. FT.
f m Z o full farce and effect.' O Q
O Licem<Clnsx Lic.s V t L b 200r1
LL o so
Dam 5 DECLARATION L
ARCHITECTS DECLARATION
Y 1 undersand on,plans shall h used as public accounts BUILD',tl
i 6 p O Licensed Professional
s OWNER-BUILDER DECLARATION
1 hereby aM.n that 1 am exempt from the Conooao,'a License Law for the
Iz a following reason.(Section 7031.5.Business and Professions Code:Any city m county 2 2 0 0 0
$� which rtquirts a permit w constrva,nlmr,improve,dkm.Iiab,m n pair any swmurt
i 3 m .polua,o its,ssuance also rtq dm appl cam for such puma to file a signed smmmevthat ho-is licensed pntuaml, Nemo sof the Conuacmrs License Law(Chapter 9 q�p p r a t , Valuation
(coat nc g.with Section 7")of Division Sof the Business and Pressons Code) i• fsf` � 3�O'Y��(7i�•,•!y®,r�f•,r y; 1� ., ,
or that he s esempt,nercfron and the bass fnr,he alleged a aemption,Any violation - '
of Section 70315 by any applicant for a permit sublet¢she applicam,o a civil Penal,y-
'of not mom than five hundred dollars fa5Boy 101APN r*T 9DATION Occupancy Type
vsownerofinepropengmmy employees with wagesaa their sole compenwtion, 1 09 -
PTERS
-will do,he work:and the structure'Is not intended(itoffered far sato sec.70q
Business and Pmrecsinns Code:The Contractors License Law does no,apply m an 103 - UFER Required Inspections
owner of propeny Who builds or improves themon,and who does such work himself
or through his own employees.provided that such impromen
vet:art not rammed or 104 - REBAR
offered for sail!.If,bow<vu,the building or Improvement is sold within one year of - —- ' - " '"'" _' - ---'- '------ ------ ----- -
completion,meowaer-wilds,will havem eno
eharafprovat
mingmnedida.build or 105 - ANCHOR BOLTS . . ....
improve for ppe,coful,), 106 - SEWER & WATER
'202 UNDERFLOOR' PLUMBING
- 1 none p�p ny .i x v ly , ti I. m I ed c ntractors to I "
onstruct the project(S 7t ,Bus nes and Professions Code)The Contractor s
License law does not apply to an owner of property who builds or improves thereon, 203 - UNDERFLOOR MECHANICAL
.
and who concoctsfor such.pmjecu witn.a conarec,orfs)licensed pursuant to Ne.
'cantrwmrs ut<ns<Ia t, --- - -- 204 -UNDERFLOOR--FRAME
\❑qlame p,undcrgc ,B&PCfar this reason 205 - UNDERFLOOR I'NSUL'ATION
O n<, Dmey/ 3[n��� 301 - ROUGH PLUMBING
WORU COMPENSATION DECLARATION
— \E� 302 - TUB & OR SHOWER
Ihertbyafrm,vaa penal,yorperjury one nnnefounwingdeclarations:- 303 - ROUGH MECHANICAL
❑ 1 have and will'mainmin o Cerificate'of Consent to self-insure for worker's 3 04 - ROUGH ELECTRICAL
Compensation, as Provided ]or by Section 3700 of'the Labor Code, for the
perrannawe of the work for which this pem,d i,issued. 3 0 5 - FRAME
❑1 have and will maintain Worker a Compcnsaimn Insurance,m mou nal by Section 306 - HOLDOWNS
7700 of the labor Coda:for,he peRormance of the work for which this permit is
e caffmr andalicy number am: 307 - INSULATION
sued My Worker s Camps s, Insurance H
cam r i i' ., t,r...�va'I N . ..�..308,•� , " nSHEETROCK .,
1 CERTIFICATION OF EXEMPTION FROM,WORKERS i • - %- t !3 0 9 = /•OXTERI OR�LATH�
COMPENSATION INSURANCE'
_- ---r._.,. .- --310:-= -
- INTERIOR-LATH- - ---
(Tn ucbbn a«a ao,bo completed tr me pem,h is rot one wnarte aouars
- .. - - -
fsloo)ml<ss), 311• - SCRATCH COAT
31--3 ROOF- NAIL
-
shut
emrl that u er Performance f, - k base
a a on object to t x ......
sueda
shill t ply a.,Person amannc as becom<sir . 'rrkers' 501 - FINAL EliECTRICAL�•ENERGY' -
ComMnwuon Laws of Cabfomn Dam
Applicant. 502 - FINAL.- PLUMBING- ENERGY._.
NOTICETO APPLICANT If,aft k ng th C n fc t !Exemption,you should "' -
P :at p 503 - FINAL MECHANICAL; ENERGY
becom h u ,heed ke C ons or Llys Labor Cade,you must
O p
forthwith amplywnn'such p ananxarro x . halls. medr<vokea _ -.5 504 -. .FINAL. BUILDING ENERGY
'� "' ''' CONSTRUCTIONLENDINGAGENCY1. "' SOS - FINAL ELECTRICAL '' -
... .•�
C.) attunes _ •.
Q Lender Address onswao 1 B encyfmth pegn„ _ 506 - GAS TEST
1 hertby affnn that Nere gg
Lea ora f h<h th s pc' t sat d(S 709]C g
Lenders Name
"LL .. .
507 - FINAL PLUMBING .
(7.O I tcmfy than ha a mad Nis eppl ca,on and Sam,nat,hc above information rs 508 - FINAL ME CHAN I CAL
lz F. t'vm.•ci.I agrte m comply with all city aril county ordinances end Stam laws rtla,ing 509 - FINAL GRADE
O („) mwilding conswmion.ma hcuby auNonze representatives of this citym<merupon
� faj, the ew<mei ndpropcnyf - .pectin prposs 510 - FINAL PLANNING
(; p, led) g <t sav code fy 'dke ph ml. ih<Cary fCupno against
m
VZAPPLICANwUNDERSTANDS AND wILCCOMPLY ?at said 514 - FINAL PU IC WORKS
WITH ALL NON PoIN'f (^
so E EGULAn s 3) o Issued by: Da
gneim<of APPliean oat uor� ^� r'
H AR pU3P i C aR1ACns DIS9;O,ne Ne Huhh end S Re-roofs
wuIn-awl rtu,<w'la g upon,sat nMI naraN seely T ._
azdcf edby,h CLpcn oM p uy - YPeof Roof, .. .. .._... --., .. , - ._.
Code S❑Y 25532(a)' 1 I [f g- - s : t t' 1s, :1Y ..
es
All.roofs shall be,inspected prior to an roofing,ma[eria] being.mstalled.,_
wErn ppbt r t b Imes p t aApate t e 2q wh'h If a roof is installed without first obtaining an mspecnon,4 agree to`remove
.m h docontaminantsas defined by N Bay q Air Quality Managem n,
'"" _ all new materials for inspection. Applicant understands and will comply with _
all non-point source regulations:
-" 1 ha lthreame hIY CN u. mammals qu minenu under 1,Ian 695 of ta,
h&Safc,y Cotl S inns 25505 25573 end 25534 1 und<rsand'bar
he btuldin dues no,cumn,ly have a tenant,that it is my.roponsibilitymhmify.drc' "'" "- - - - _
Califom a Heals
fl
occupant of tndrequircmrnts which mus,w mei prior m issuance of a Cenifidte of -
3I Y U .. Signature of Applicant _ Date
ownc tooaga gen ate All roof coverings to be Class "B" or better
, .:' .._. .._.. .. .._ `- 'OFFICE .