02030011_- BUILDING DIVISION v PERMIT I CONTRACTOR INFORMATION:
BUILDING'ADDRESS:
OWNER'S NAME:
126 SAN ANTONIO
(650)948-4727
ARCHITECTIENGINEER:
LICENSED CONTRACTOR'S DECLARATION
D Z �2 C 1 hereby affirm Net I em licensed under p vision, of Chapter 9 (commencing
WW with Section 7000) ofDivision 3 ofshe ButmesUbd Professions Code, and my license
�§ : I.
iin f cc and effectG'Zo -/s ! LI; --'1 61 Gy
W, a: < Lia . n Cmu l•J
a0w0 Dm o- _ Con 4
u. i -n ARCHITECT'S DECLARATION
0 O S 1 understand my plans shall be used as public records
C Licensed Profession.]
Eos
OWNER -BUILDER DECLARATION
m =' m 1 hereby affirm that 1 am exempt from the Coal tsi... o e: Anse Law for the
t ? < following reason. (Section ]onstr Business and Profession Code: Any city county
ante
p which requires a permit to construct, ehec improve, demolish, or repair any structure
i .. prior to its issuance, also requires the applicant for such permiuo file a signed statement
- that he is licensed pursuant to the provisions of the Contractors License law (Chapter �, frf•
(rommcncing with Secticn,70-QO)pf Division 3 of the Business and Professions Code) t : , rl,
N0.
SUB DATE
BLDG ELECT PLUMB MECH
Job Description --�
HVAC INSTALL.
$10000
101 - FOUNDATION
El 1. aowner rthe property, or an, employ., with wages so flick sole compensation,
'
- -' - --T02 - PIERS- ' -
Required Inspections •
10 3 - UFER
*Will do the Work; and'ther-swnure is not intended or offered for We (See 7094,
Busineis and Profession, Code: The Contractors License Law does not apply to en
owner of propertyWho Wilds or improves thereon, and who does such work himself
_ or throw h his own employees, provided that such improvements are not intended or
:comple or Iola Wading of
. _1 04----REBAR—
weer -Wilde the of int en ofp ni n fold within one year
' completion, thrower -Wilder will have the burden of proving shut he did not build or
+, „p! • r�
105 - ANCHOR BOLTS -
improve for purpose f )
SEWER...& _WATER..._.__ _...
T'7 F as n of the p pony am exclusively n+mmn ng with 1 sed convenors t
the project Tapp 7loa, Business and ons Code:) The convenor,
2 02 - UNDERFLOOR PLUMBING ,,f..
License does
License Low d«s not apply toromwavvof pm penywho buttessimprovesthereon,
say w
203 — UNDERFLOOR MECHANICAL
„and.who. contracts for mch.proJeea wiN a contmctor(x) licensed Pursuant m.the.
_....__. __.._....- _ ..._ .. .. _._. _..r._.—____-..-._._.._._._.......__ .. . _ ..-___.__..._.-.__._ ....
-
CounacroraLicense aw..,
'
204 - UNDERFLOOR FRAME ,.,
- _
❑Iamexempt untlerSic. .' ,B&PC 6r this reasonDate
205 - UNDERFLOOR INSULATION
Ownea''WORKER'SCOMPENSATION DECLARATION
301 - ROUGH PLUMBING
: 1hereby am. trndn,P9.1tyof;aj.,ymmothe following declarations:
302 - TUB & OR SHOWER
3 03 ROUGH MECHANICAL
i
1
❑ 1 neve end will'mamudii'it Certificate'of Consent to self-insum for Workers
Compensation; as provided -for -by Section 37W of the Labor Code, for me
_
304 ROUGH ELECTRICAL
_
performance of the work (or which this permit is issued.
305 - FRAME
-
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
306 - HOEDOWNS
3700 ofth Labor Code far the performance of the work for which thus permit is
issued M W rker's C mpersevon Insu a e c er rid Polio y number em_
..,..'�(�
3.07: . INSULATION. .-- - _
-
y/b°t�.YtGJJ��1 1, "Pm ey Nal'' ti
a 308'.`,. SHE ETROCK,,
1tt. 1M
,/' )It f CERTIFICAnONOFMEMPTIONFROMWORKERS
COMPENSATION INSURANCE��
t .' r',
3O9 EXTERIOR`f,ATH
^' •jib+s,.ironneednotbe�compinedd0epermittxforoathunertddollars
„_•-,�
3101-- INTERIOR LATH •' ( '- -t t't
311 - SCRATCH COAT
'i' slued. 1
.,sal -I eenfyshny
sofrso Is
_ -
313 —
person in to bewtueM1u ct
. annersoutobWnm 63Pnmrnewo,ken
Compensation laws of Cel fortise Dam
Coropc asti.. Low,
501 - FINAL ELECTRICAL ENERGY
. 'APPhcani. '. n . .. .,
TO APPLICANT If h , making this Certificate of E you
"become
T1-:-17
_'502 -'FINAL"PLUMBING'ENERGY
zG
Wpt
sub3 t t the W rkel Compcnseuon pro
Codyourr st
th L
503 - FINAL MECHANICAL ENERGY
p
hf
rano m naroply with such pinavisionsorthlp.it Unit rt the emeert ees.
k
. -..
AGENCY
P'CONSrm
504- ----FINAL-- BU'I'LDING" ENERGY
I, . eONLENDING
I he by affirm that there a n const Sion ]coding agency f w
the perf6ance
505 - FINAL ELECTRICAL '-
[g7
Q
ofths, workfohwhchthis permtt ssued(S J097Ct.C)
506---GAS-'TEST r- -- - ---- --- ----
U:p
<aerr nano •"' '- -
507 - FINAL PLUMBING .t, -i,
- igs P
-_+ „•
1 certify that 1 have read this application and Stam that the above information is
(correct. I agree to laws
508 - . FINAL MECHANICAL
0:U
comply with all city and county, ordinances and state relating
toWilding cosinuctimiadnebyauthon represemuavesofthis city toenter upon
509 - FINAL GRADE
Osnd
A
purpose
the W nue asp ny for inspxttimikeep
(We)agrtwe. tomdemdfyacphawl'stheCtrytCupeninoegeinss
510 - FINAL PLANNING
CA
V
liabilities. dglnenta, CO,IE and expeRSea WM1lch may In nnY WBY fiaNe isgunrillind
City m c n ce of the
514 - NA P WORKS �, 1
/
gNnung pemut
AlP U ERSTS WI LCO PL WITH ALL IJON-dI T�+'
ISSUedby Date
\oiR rl
.
us Mif
P _ Dm
Pp 'IERIALS DISCLOSU0.E
atawn
Re -roofs
n2 applicant nr 6ttaN nine—D
ung occvPent tom or handl hvaN sat tonal
Type of ROOF
Is defined by Ne Caparison Mmcipal Cod Chapter 9.12, and the Health end Safety
CodesOY n53321a)iyl a ..r .r..
isu-.�.,.tf `is
}.s Ips
I , l h� "> ••t t _
All roofs shall be inspected prior to any, roofing material being installed. – , _
Will the pplicam or future Wading c prem use equmpm tit ae ca_-mrh
•em
da roof is installed without first obtaining an inspection; D agree to remove
t M1 Sudo s ter coat i 0ned by the Bay Area A ry Q al Management
District?
,
all new materials for inspection Applicant understands and will comply. with
_
- all non -point s.6urce regulations.. :.t
I have rtatl the hazardous mnedels rcqulrtincnta under Chapter 6.95 of the
'ca
mlif a Health & Safety Code; section 25505 25533 and 5536. I understand that
• rc,ponsibiliry to noti(Y the
racd, bulldin
'—_.. _.. .. .. .. . . ... _.. ...._.._ ..:... _.... .... ...,...
-
..
., Y
emsmrcmmcmlyhaveetenant,thetitiYtnY
w e" mar be
Q + p rte IssaBnne.fa L'ertlficateof
,
Oc a -
3 4 Z
Signature of Applicant Date
..
All roof coverings to be Ci "B" or better
inn
Wn.ora t d agent
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is _ OFFICE u.. _ ._ ..._. - _. .. . _... ._ ... _.