01020039 CI BUILDING DIVISION
PERTNO
PERMIT CONTRACTOR INFORMATION:
B2L3y1627 RBLACK OAK WAY � / PERMITNO
L (0 01T
NO
°Y "ISAA` PP
ARCU/ STEVE WOO A02c707/200E1
PHONE: SANITARY NO. CONTROL NO.
Gap ARCHITEC(ENGINEER: BUILDING PERMIT INFO
y BLDG ELECT PLUMB MECH
a i =I 1=J 1 _1 I_..I
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm mat 1 am Ransad coder Job Description
Oi_� ya pov Padfieof Chapter (commencing ADDITION OF BONUS ROOM
FyFm with Section 7M)ad of Division Sof the Business and Pofesziom Code.and my license
t,e
.0g" is
full torte ad ellen.
at z a License Class Liv.X
w 3 d. Dae S DECLARATION'< ARCHITECT'S DECLARATION
I understand my plans shall he used as public accords
dad p O Licensed Pndcssionvl /
ff OWNER-BGILDE arm he RATION
I7^— 1 hereby affirm onthat I70 am exempt from the Contractor's License Law for my <�
C which rd mason.(Sermon]1111.5.Business and improve.
demolish.
CWe:Any city or county- YL $32232
which ts n Permit t t Im p d li h o eP,i any t.d.nI
a3_ Pn ( itsIssuance, I 1 mapplicantf suchpc to fl �g dsmmmeni _
(corn licensedin on hip, fineCouac( License Law mi,Cor9 344215r601'1�rs�a •, Valuation
-1t(coening ausiSu( n,]pX»af Division bsormealeged odion,Ayvmotiq s
or mat io is esemp(zany.,mbnd the basis forme alleged exemption,to Any l Pennon
if Section 41131.5 nbyu hundred
icon,dolhisvpemdt subjects the applicant toecivil penalty 101 VOT#NDATION Occupancy Type
of no(more than five hundrw dalLam(35(X1 APN
CI 1..1 manter of the par,day.a,my rouployid,,.,in rages.,their liflo r,m1m,umr, 102 PIERS
w111 do the work:road-the'swnure is not intended or oRcad far sale IS,c.]rw, 10 3 - UFER Required Inspections
BusinsIw and Professions cases The Contractor's License Law ds no(apply to an
owner of progeny Who builds or improv..thereon,and who docs such work himself 104 - REBAR
or thmagb his own employees.provided the(such improvements am am intended or _ _
oRerrd for sale If.howeber.the building or impovemem is sold within one yea o! --- ---
Completion,me owner-buiWn will hall the burden of proving Ina he did not build or 105 - -ANCHOR BOLTS .,
impmVemrmapn.em"ale.). 106 - SEWER & WATER
o owner ofthe.prop me:cii,tiriycontracting with licensed commuctis,to 202- ia UNDERFLOOR--PLUMB ING -:
constoct the p jet 1S .]6Lt.Business and Profession,Code:)The Contrator's 203 - UNDERFLOOR MECHANICAL'' ''1' •1
License Law no(a pan owner of napex y who builds or improv.th.man,
Contractors .(..tars projects wi(n a catnmetn s1 licensed pursuant m.th= 2 04 ----UNDERFLOOR--FRAME-
nOnO who<. i Bose _.._. .._ _
❑Iam.. - ;ii&Pcormiamawn205 - UNDERFLOOR-INSULATION
owns 301 - ROUGH PLUMBING
'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
mbr tmtt��d«penalro or perip:y onq ooh.htuowmg d..mra(inn,: 303 — ROUGH MECHANICAL
O 1 have and will maiotdii,Certificate of Consent or ulf.ura a far Walker, 3 04 _ ROUGH ELECTRICAL
Compcnsaion, as Immodest ion for by Sect37M of the labor Cade, for the
Ismomsanec of me work for which this p.mtit is ia,ued. 3 05 FRAME
o I have and will nWintmo worker,Corawar eiron Insurance.s,required by Section 3 06 - HOLDOWNS -
37M of the Labor cwt,for the perfomtana of the workfor which this permit i, 3 07 - INSULATION
rated.My W k 's C pe t m Insurance carter and Pol y be arc -
'can f, ,: ,-�I ..PoberN6r _ 3.08. .. _.SHEEyT�ROCK,_. . ,.. . . - .._....
'tl 'CERTI FICATION OF EXEMPTION FROMI OR KERS ' _ 369 — 'EXTERIOR LATH • 1 '
dnmbb Eomn ame cE 10 --INTERIOR--LATH _..__ _ ._ _......
(Th sect tisfaroneCOPNSAOINSURAMhundoddollan 311'1 ` SCRATCH COAT
a min or kss.1 . '
31..3.. - ROOF NAIL - -_ .:.
I eett tY th,i the perf f the 'k f which this p. r-I...Jd -
11 not ply yp. arta ,(o lver,he ,bit Ito he walker. 501 - FINAL ELECTRICAli ENERGY
co hep. ( Law, r. Ir D r _ 502 --- FINAL_.PLUMBING....ENERGY.. .. . . ..
.Appl c m, - .._. .._
NOTICE TO APPLICANT If. r( -making:n c,r,m rE pf y 0.0d 503 - FINAL MECHANICAL'ENERGY
Z he n e. q ,to the W k C pert l p 'om of m Wbo Cw<y u must
z0 p mrtn m ply with such paoon,n m Permitsnallhea -d re�okea. 504- _ FINAL BUILDING ENERGY
F.i CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL '
.�.> Iherebr n math. wr leadingagenyfrthepedomtaace 506 - GAS TEST - ..
'af(ti nAf hch th pc t :'.: edfS 309] Cs C1
y 0 Lernerdcr u - .. . - - 507 -- -FINAL PLUMBING -
. .0
LUMBING
�.Z Lc,d AIV s
V'0 _ lecr(ifylh:u thele re,Wmsapplir(ion and sum lot,1, w information is
U 508 - FINAL MECHANICAL'
_-, cone.(.I agree m comply all city and roun:y ardinance,and s(me laws relating 509 - FINAL GRADE
m budding amonarri.a.and hereby umhorix r.,m,mmtibes at miacl(y to enter upan
heam,vemismmtedprop.nyfaroo,.tionpnryn. 510 - FINAL PLANNING
- F..a. (Wdagreamsaocindemnity.adkeep haml..vthe Cut ofCapenlnongaiv"
h 1 514 - FINAL PUBLIC WORKS
Iiuhihlies.judgmnt
es,cans and expenses which may in nay way accme against said
;VIZ CryI.comeyuencc of he gaining of his permit.
APPLICANT UNDERSTANDS ANDWILL COMPLY WITH ALL NON-POINT'
SOURCE REGULATIONS. I Issued by: Date
Signature atApp1' uc (users, Dare
Re-000f$
HAL RDOUS MATERIALS DISCLOSURE .
Wllthe 'lcvm"finmbuddn accurect, eahmm bazmdoo tmserivl Type
.of Roof-
as J f ed by theC pinion Municipal Cw Chapter 9.12,and thr Health and Sufc(y - - " " O'-/^—•"'
'Cod S.mm�3551" , L s 1
❑r<- ❑h - -_...All roofs shall be.inspected prior to any,roofing material.being,installed. _
e Will the it rlor t farm b la a 1 �. ,Bey p d nage t If a roof is installed without first obtaining an-inspection;Tagie6 o.remove ---
cm(har d nu is as defnw by be Buse tai i Quality,vice,
Dist ' ON. all new materials for ins ec[ion.,.Applicant understands and will comply with
oY . 1 all non point source regulations:.- PP
I nave dead,h h dt un mama-I- p ire nems under Chapter 695 or he
California He.1th @ Safety Ctde.Sections 25505.25533 and 15534.1 undeatznd that
if the diilding does am cunendv have aunam,mat i i N my Fesponsibility to darry the
occupant of me mquimmenn ankh must be m.prior to isuvnce of a Cenificae o[ t
,- Occupany.
M
• -•' _. , Signature of Applicant Date _
L
o.as m aathunatia agent .Date All roof coverings to be Class "B"or better
• ... ._ . OFFICE.. _- . . . _ .. .._ _.... ... - .