01120030 CI BUILDF c DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22281 BELLEVUE AV BATHROOMS BY REMODELING SPEC 01120030
OWNER'S NAME: APPLICATION SUB DATE
YUL INN & CHERYL MANDALA 1422 SARATOGA AVE 12/06/2001
( PHONE: SANITARY NO. CONTROL NO.
(408) 328-6700
qW O O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
g m BLDG ELECT PLUMB MECH
i I'_7 =_j LJ LJ
RATION
O Z m 2 LICE1 hereby affirm that
underprovisions DE of Chapter 9(commencing Job Description
y°-__ad withSection7")ofDivision3offleBusiness and Professions Code.and mylicense REPLACE 2 BATHROOM FIXTURES & DO TILING
x f 0 io full forte am effect.
S as License Class Lic.p
Date Contractor
—
0 O f s ARCHITECT'S DECLARATION
I understand my plans shall be tread as public records
wa o Licensed Professional MAY 3 1 2002
E OWNER-BUILDER DECLARATION
W 1 hereby anion that I am esanpt from the Contractor's License taw f"r'llm
F z< following mason.(Section 7031.5.Business aid Professions Code:Any city or county $21197
E 0 which rea,mat a permit to construct,alter,improve,demolish,or repair any suucmm.
Or 3='-poo ml.¢su nc,aB q Ne ppl tf s chop to fk 'g m mtemem _
this M1c licensedprom h,t theprovisions of theC o t r' L W (Chapter9 ✓ OC ea Valuation
a. n-_g nhsect 7M) fDi.. 3 of the Ban. ndPrt(.. naCod.) ( :.)?'T3?5t 7 b c: 0` .✓�3,1i_�:x;�:` I
."has
he Is exempt aldtefrom and the basis for the r l ft'od ciempom Any vitlinim
-of Section 70315 by any applicant for ap.if 1.bject the applicant to a Civil Occupancy Type
paraty-
,ofnot more than five hundred dollars($500) 101 APN�'ATION "' �.
❑1,as. .n,.fthepmpeny,urmyemploycc%withwageamtheirwlecompenmtion. _
-will'do'the'w.rk-bad'ahe strudurc'is net'intended'or offered for sale(Sec:70LL - ---- ---- -.. _ _
PIERS
Busimis'and Professions Code:The Contractor's License law does not apply to'an 103 - UFER Required Inspections
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements arc not intended or 104 - REBAR
�complle ion,Me w'weaved the l building bur en of rev is what within one y6v fir -"-- -"-""----
compinion,the ownerhiller will have the burden of proving that he did not build or 105 - ANCHOR BOLTS • ' - �
improve for m,ow of sale.l106 - SEWER & WATER
—'-
Cf.auowner.fthe property.amexetess and contractingismCodenseduontacwrs'to - _ ... _ _202 UNDERFLOOR PLUMBING __._.._.i,-.,_- _ -,--- _-
conswcnwdoehe snt(SpplytoJ,Business and ProfessionsildsormprContractor's 203 - UNDERFLOOR MECHANICAL'"'"
en W ewes not apply to an owner f property who builds o 'reproves thereon.
' um who Carol
acts for such pmjoef,w th nroemr(s) licensed puntort to
C. t t . License,Law th ""204- 'UNDERFLOOR '.FRAME-
- ❑le.. mmptCmCrSCc. ,B&PCfonhisaason 205 - UNDERFLOOR'`INSULATION
Owner Date ' 301 - ROUGH PLUMBING
_ WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
Ihent.1715.underpen.ray.fpfjuryormofthefollowing aeclanowne, 303 - ROUGH MECHANICAL
=r ❑ I have and will mmat6m'aCertificate Of Ctnwmt to self-more far Workers 304 - ROUGH ELECTRICAL
Compensation, as,provided for by Section 3700 of the Labor Code, for the
perform,nreofthewoa,mrwhichthisPC,�mvisissud. 305 - FRAME
❑1 have dna will maintain Workers Compensation Insurance,as required by Section 306 - HOEDOWNS
- 37W of the Lamr Code,for the performance of the work for which this permit is
isrum.My Worker's Compen...ion In...mCC came(and Policy number an, IL 307 - INSULATION
308 .= SHEETROCK -. . „_ i
t .
Cam 1 f.e os w5 t••.40ficy N.
T;I 'CF.RTIPICATION OF EXEMPTION FROM WORKERS -f-1 t3O'9- L„EX.TERIOR''L`ATH
COMPENSATION INSURANCE a
1 __._3'2'0' --;INTERIOR LATH— _.___. __...
(Thr ,dm need not beomplctedifthepermiaisforonehuMrtddollars
(SI00) r - 311 - SCRATCH COAT
kxc7 T '
- --I - '31-3' -...ROOF NAIL,.::.
,� 1c nfY th,'nth pet �e o(lh kf hhth' permt -zweal - `""�--- -
"all not ph y y ". y manner w as to become stbject ro the workem 5 01 - F I NAL ELECTR I CALENERGY
C.mpensaim Laws of Celdomiz.Date
-Appliicani ' -- 502- - FINAL- PLUMBING- - _.__..__. ...
NOTICE 10 APPLICANT.If,aper making[hisCer ificme ot Exemption.you should ' ' '-
O o orrtthmth subjectIY ithNn„ProCompensation pe ,shall th IahorCode.yotmust 503 - FINAL MECHANICAL ENERGY
visions t n.p tsnaBxa em km� JII4 5.04._.:. FINAL ..BUILDING_ ENERGY
"CONSTRUCTION 505 - FINAL ELECTRICAL
'1 hereby affirm that them ono t nding agency for the performance
of the work for which thisPerini[ Omed(See 3097.o.c) 506 - GAS TEST
Led •dame- -. . :e _ _ ..' _. .. _ .._ s.__. _. —
,. _..
p,Z Lea .Andres.• 507 - FINAL PLUMBING,
I nifythatlh dam,applici and statethat theaboveinfrmnmi.n 508 - FINAL MECHANICAL'
conen53 agree in comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
tobuilding Construction: dh by autho ce representatives.f th':city 01 enter upon
p 'W, ene1. . tyr dyand p p 1 510 - FINAL PLANNING
[� 6.'� e, )'g Bids n ly and keep is a an a,i firm,Carraraa'agaiaii
hamlipes,ihogmep,s,ends dna expenses wTaFn may m any w-ay accme again,raid 514 - FINAL UB C WORKS
V.Z City in consequence of she granting of do,permit.
APPLICANT UNDERSTsiNDS AND WILL'CObIPLY N'ITH ALL NON-POLNT'I S 16 =J F A I G
soulecc RecucaTlGNs.. `. I Issue y: Date
Signature
as ocf AppbcanaCmumetor "
Date
HALkRDOUSMATERIALSSURE a .. Re-roofs
Nil th pem future bind up u.,Qmonh die havNou ..f ideo ech Cuern Municipal Old,Ch pts 9.12q and theHealth d SftyTYPe Of.R
oof_...
CnJ SdhY 3553 (al it list tj�
._
--• _. ., , _ .�. .,... ., - _,._._ ..-,_
fj':.- -i
1- _ _ All roofs shall be inspected prior to_any roofing.material being,installed.
w B m ppio^mmmt,M;d w og a n,secgt pie t de aha what - If a roof is installed Without first obtaining an Inspectidd, I agree to remove
min
"amon, rm nnn¢as defined by th Bay.A�rQ Quality Management
D tlet?❑Y oNI _ all new materials for inspection. Applicant understands and will comply with .
• - all non-point source regulations: -
1 M1 read the h tl u.' mints rtqu nmm"that CM1 pt ''6.95 of the '
C�If aHezltp&Salty Code.Secdous 15505.25533and 75534.I undenfandthat
if a be building dues not criminal,have am..nL that it is my responsibility,.notify thea'
.ccuram of the requircmcros which must be met Pnor toNsunnee of a Cenifcate of '
.-. �
Occupancy,, ,
= - _ Signature of Applicant Date _
—se,oramncrom.agent _ Date All roof coverings to be Class "B" or better
. .. . _.. _. . ....._-'i OFFICE.. ... . .