02010017NO
CITYILDN.
CONTRACTOR INFORMATION:
C DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10889 S BLANEY AVE
EAST BAY REST SUPPLY INC
02010017
OWNER'S NAME:
APPLICATION SUB DATE
EDWARD LEE
49 4TH ST
01/03/2002
' PHONE:
SANITARY NO, CONTROL NO.
(510)465-4300
Z ARCHITECTIENGINP.ER:
BUILDING PERMIT INFO
D
BLDG ELECT PLUMB MECH
LJ O L-1
2 LICENSED CONTRACTOR'S DECLARATION
Job Description
P
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
wctionf000)ofDivisinn3oftheBusinessandPmfecsionsCade.andmylicenne
Wim
BAKERY
full faze and effc� Za�A/Oi
6
icrnse Class Lie. p
D Contactor
un ARCHITECT'S DECLARATION
1 understand my phos shall be filed as public rands
-
cLicenud Professional
OWNER -BUILDER DECLARATION
1 hereby affirm Sat 1 am exempt from the Contractor's License Law for the
a following reason. (Section 7031.5. Business and Professions Code: Any city or county
O which requires a to constrict. alter, improve, demolish, or repair any strvcwre
$3000
permit
. prior to its issuance. also requires the applicant for such peranu m file a argued sm us ent
p0 F[ OL [ea
Valuation
- that he is licensed paxualathe provisions ofthe ConnectorsLicense Law(Chap¢r9
(cnmmencingwith Section 70M) of Division 3 of the Budiminand.Professions Code)
/A
j'�V %'i36� 4 QJL.tV�r'P.i'
or that he is exempt therefrom and the basis for Or alleged exemption. Any violation
'
of Section 9031:5 by any applicant for a pnmit subjects the applicant m a civil penalty
of not more than five hundred druars($5um.
NO PASSIUq�Ell
Occupancy Type
INSPECT
ONS\�I^
O 1, as owner of the propcny, or my employees with wages as their sole compensation.
- will do the work: and the structure is not intended or offered for sale (Sec. 70aJ.
• Bfisiness and Professions CWe; The Contmnor's License Taw does not apply m an
Required Inspections' '
owner of property, Who builds or improves thereon, and who does such work himself
ar through ti ply provided ' rho such art not intended or
'
mpmoveprovemenm
Id g or mprovemem year of
offered __ IF If h thewill
completion, the owner -balder will M1ave the burden of proving that he did not build or
improve for purpose of sale.),
..Ol nsowrmrofthcp pa ty I s IY _ u..i gwth.licensed ractors to
construct the project (S 961J Business and Professional Code) ThContactors
art -
'
- License Law docs not apply to an owner of property who builds or improves thereon,
I
. and who.comorma.for.such. projectswith, co ... an ... (s),Iicaned pursrma.m.the.
_...__..___...._. _..._ _ ._._._.__._....__ _ _ -_ ....... _...____. -- -----
t Contractors License Low.."
_
0 _ pt under Sec. '' '•'"; B&:PCT this reason
!p:t
Ow Dat
WORKER'S COMPENSATION DECLARATION
I h<rchy aRrm d r pe 6y of pep ry n [the full g d 1 tions. -
❑ I have and'uill'mainmin is Cemficote'of Conanr'to self -insure for Worker's
Compensation, -as provided for by Section 37M of the Labor Code, for the,
'performance
of the work far which this permit is issued.
❑ I huve'end'will maimaia Worker:s Compensation Insurance: air required by Section
' 137M f t Wbor Code f theperf mr nee of th work forwhich thispe 't'.
tss d yW kefs Compe ( I c J Policy be
'I-Pat, N /w' /r 7S
c -.
y '. _ v.r•._....a..,.a .. Y •m e �. w.--'-.- -.
s' 1
r t C R [CATION OF EXEMPTION FROM WORKERS
r'•. i 1 s ..I �/ \ 4 0 1 i .
\
Y COMPENSATION INSURANCE .
fhis siition need not tie 16mplemed if the permit is for one hundred dollars
' \` •
13100) or Ices.)
nfY tM1 ti 0 per f t'fth work for th permit
- - _ -:- - _ -.`: -'-�,•,.:- —` .�..
shall mat employ any Ile son in any manner so as to become subject to the W'orkersl
Cf h s.-'
Co i n Laws of Cal to ia. Dare '
Applis
- '--' - _.
If aft g th C ri ^ f E room you
N NOTICETOAPffir
__ __ ____ __ _ __ _,__ _____
„ -
Work
become soh ccs m the Worker's Conrmalu
u mold
the Labor Code, you _q
Vons ppona
fonhwithcoml ill such all
� comply wi provisions or this iters shall h d«teed revalued.
CONSTRUCTION LENDING AGENCY'
1 h rm Oat War in construction leading asi) I the perform
- h
d
: of the A for h Oil rete: t sued (S 3099 Cis. C.1
'Leder, Name ..... I- .._a
. I eenlfy that l have mud this application and state that the above information is
cdrtect.,I agree to comply with all city, and county ordinances and state lases relating
m building construction, and hereby authorize mpresentmives ofth:s city to enter upon
NeabovenientionWprnpeny_forinspectionpurpaxs_ .
(WO agreeio save, indemnify and keep hamlcss the City of Cupenino against
0 .liabilities, judgnams, costs and expenses which, may in any way.cane against said
City ionone fence of the graming of da, permit.
' 'D\
r
:ApPI-.A". ONN'.RSTAreDS A .L COMPLY\YITHAI.CNON.-POINT"
s61' < Er ' ono . it
Issued by: � zldi =3 —C7�--
DflI
04 � 2
ignat of ¢anUCra rarlm. ':'"•a'.: _ Date's'
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE -
' ,
_Will tl:e'rprc t future Wilding o pam.ta or handlan and mate I'
.T e of Roof .. ••. -- +�..: ..,.. ... ._ ......
YP
[Codf dth C P M1t _ p IC d Chaps 9.1 and th H hh dg f yt'
CAI Section 25532(a)?.-
-. .... .... .......
'. }. ( `•, +, I
:. -
_All roofs shall be inspected to_a'
<mth N lllloOn, ppllc r future Wilding ap rt useequipmento d vee. hicn
poor y roifjng,material being. installed._
If a roof is installed without first obtained an'ins ectlon,�Ta ree to remove
g
contaminantsdefindhyth ByA aA Q'I,yNImag eh
Di:'' '
I Oyer—,., ow
P g
all new materials. for inspection. Applicant understands_ and will comply with
all non -point source regulations..
1 h e: coil she incallo . eiialrequirements undo Chapter 6.95 of the
'Cal fora : Health & Safety Code 25505.
,ion 25533 and 25534 t understand that
:Btl ab nddingdocsnotcure y e' event. thin it is my rtspgnxibility to no ti fy the'--
w
oc at of the teGhiremen met prior m issuance of a Cenifica¢ of
'
capaney, _Q
Signature of Applicant Date _
All roof coverings to be Class `B" &'bettei`
caner a t orired ^sent , . Data
.._..__ _. ......._- .. ..' OFFICE . ... .. .. . ...... _. ... __. ... _._