02090043 CI BUILDI c my SIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10077$5,N7 BROOKWELL DR 02090043
9�`�.1'1G�1�lbsZHR APPLICIff jt/SD7l 002
Ip I PHONE: SANITARY NO. U IJ/`CONTROL NO.
`{u O o ARCHITECT/ENGINEER: g BUILDING PERMIT INFO
B BLDG ELECT PLUMB MECH
i vN=i Z LICENSED CONTRACTOR'S DECLARATION
o i-EI hereby amnn that l am licensed under provisions of Chapter 9(commencing KITCHEN & BATH tt
F H❑ with Section 7000)of Division 3 of the Business and Professions Code,and my license
is in full tome and effect. NOF ES--PER GREG C .
Lice
Date Contractor Class Con ractor -' r+�
CLL p I-ii ARCHITECT'S DECLARATION
so 5 1 understand my plans shall be used w public records
�n Licensed Professional
s o ✓/
OWNER-BUILDER exempt
DECLARATION I 1
th-w I hereby.(Gert that 11. exempt from the Contractor's License Law for rhe j+
�',?< following reason.(Section]031.5,Busineu acted Profcuions Code:Any city or county r-- Id [',{
X F O which requires a Permit to conswa,alter,improve,demolish,or repoe any srrucmrc ,
�3C$ prior to its sssannua also requires me applicant far such permit to File a signed somenum Q- --
rpathakli need puhu}m to the provisions of the Commctors License Law(Chapter 9 .s- a, Sq,Ft. ploor Area i ) aHanOn
(co m
being ,with Secuon7000)of Division 3 of the Business and Ponfitaons Codel p Ila, 7!v 4s.y�5
a that he a e.ethpr therefrom and the basis for the alleged mcmpnoiiAny violation
of Section 7031:5 by any applicant for 4 permit subjects the a............real pcnm.y Occupancy Type
;of not mom tint eve hundred:1.111.(25001. APN Number t
❑1......erudite property,lir mWemployees with wages m.heirsolecompcnsatim, 101 - FOUNDATION
wlu do-the work:sad the-afracture'isnot Intended or offeree for sale 7(344102 - PIERS Required Inspections " %
Bhsinmes'and Professions Code:The Contractor's License,Law does not apply tom q p '
owner of property Who builds or improves thereon,and who does such work himself 103 - UFER
or through his own employees.provided that such improvements am not intended or
-'co mrtd f.sale w Roweven.w budding or improvementn ofProv n sola with n nee Wear of - --
'imrove fnpupse o owner-builder have the burden of proving that he died not Wild or 105 - ANCHOR BOLTS
improve for puryose of sale.).
p _...--__ __-- -.-_-...__._202 - UNDERFLOORTPLUMBING --
i, I;u ownmrof the pmpenyameaclusively cuntmcung withliccnsed conuanors.o -. .---
constmct the o'ect(Sec.]044,Business and Professions Cade:)The Contractor's
License Law does not apply to an owner of property who Wilds or improves Merton. `
r i .andwho.conrraculor such.projects-with.a.connocmgq.licented.punuant to the_ ..--_._ _._2.03-.__.__UNDERFLOOR.-MECHANI-CAL._
., Comm for r`remain Lew -. ,
❑1 am exempt under ".It&PC for mreason 204 - UNDERFLOOR-t�FRAME:r,;i
Dw r
Data �/ D }� 205 - UNDERFLOOR INSULATION
:c R'S COMPENSATION DECIARATIOi4 301 - ROUGH PLUMBING
{{•� "• I,hereby ofp<rjorW)omofthefollowingaecmmtions: 302 - TUB & OR SHOWER
❑ 1 have uad'wiil maintain a•CeriiGcam of Consent.o self-insure for Workn's 3 03 - ROUGH MECHANICAL
_ Fampensmion, as provided for by Section 37M of the Labor nnCode, for the 304 - ROUGH ELECTRICAL
pe faer e f the work for which U,rs Perms is. ed.
❑1 ha a end will maintain Workei's Compe i n In urance,as required by Section 305 - FRAME
37M of the Labor Code,for the performance of the work'for'which this permit is 3 06 - HOLDOWNS
ismed-MY Workee.Compensation livansaw,Hainer and Policy number<arc:
Claner3' ,�* f b'x 1 s, 4:.. i 30,8'' -J''SHEETROGKt.+'3P,s t, - ._ __ =,'.• .r.,'
COMPENSATION MPTION FROM WORKERS
ory suRA cEr' ". --,3'09-:-- -EXTERIOR--LATH ---
tt TF,-,CERTIFICATION COMPENEX
- COMP
' fTh ssemmn recd not be completed if.he permit is for one hundred dollars 310 - I N`tfE I OR LATH
(s100) nd):.: `.. ,:. . .:.-. . ....311,,.--„SCRATCH,-COAT....,.- _ .. .._-_-.-. . .. ....,
y Ihst in Ne performance of
Igmthe work for which this permit is coo d 1 313 - ROOF NAIL t- I 1
shall not em 1 rsan t manners w io beaom ublect io the Workers'
ma motion I2 we of Calfnmiu any
""
-APPlrmni- 501_..-_,FINAL ELECTRICAL ENERGY__, ,,
IN CET AP PLICAM:If,after making the Certificate of Exemption,you should 502 FINAL PLUMBING ENERGY'
becomesubject t .he W races Compensation pr v sions of the Labor Code,,mumust
O in it idi comply with such provisionso this Permit shall la,deemed reoke.. 503 __ FINAL MECHANICAL ENERGY
call '-CDNSTRU(rtory LENDING AGENCY ' 504 - FINAL -BUILDING ENERGY** '�•-
l hereby ofFirri that there is e construction leading x,emy forto.crforinmce 505 - FINAL ELECTRICAL
Lend
r.
work fo which mu penmi a issued(Sec 3097 OJ C]
Mersrvame' _a- _.. -"' -1i -• . -- .. . .... 506...= -GAS-- TEST-.._
;;;):z aersAaa is " 507 - FINAL PLUMBING
V'0 d car ify that l have read this application and stare that the above information is
m=� eo sc-1 agree to comply with oil city and county,ordinances and sore laws existing 5U71”
A` MECHANICAL
GrV to Wilding construction:and herby authorize exp"ritutives of this city to mar upon 5A` E
the b . red p pony for inspersion purpmes.
g}y'-0. IW I agree- to indemnify and keep harmless the Ory re p rtGo e'gmnsr 5A`
F h
liabilities,j dg ms,mus d xpcnres which may in any y iugnnn said
U� at) -n uq as ortna g:a t'gonms perms ' 5RKSPALICANT UNDERSTpN AHD W ,L CO�'pPLY WITH ALL 9{l PO NT Issued b SOURCE REGULATION5 A L �PO Date
Sigmtym of ApplicanUCo toil.;,. /-" C - I o'er, Re-roofs
.HAZARDOUS MATE ALS DISCLOSURE- - .,-
Me Wit ho pplicart rr Nm Wldmg occupant store r handle hamraaarrwenal Type.of Roof - ._ z. _
WIIAeeCupmnmoMumctp.LCode Chaptr912,and th Helth and Safety1.,,
a p72(al t - , - 7 \ a :.. h'a .,
°• All roofs shall be inspected pnor.to any roofing.matenal being installed.__
._
s de med by the
C �
❑Yrs ,
Will Nea pliant or fm Wildingoccupsnt use equipment or devices which If a roof is instal iid'without first obtaining an inspection;'I agree`to remove
• t Yes Nefined by the Bay Area Air Quality Management
District?
mmrmnmamtnmta.aa all new materials for inspection. Applicant undefstands and will comply with
al(non-point source regulations,,.,,, ;.,
'Ire
havl read the haiordom'materials requirements Boder Chapter 6.95 of
Califomie Health&Safety CM,.Section.25505'25533 and 25534.1 taxim mad that
If the bulkimg,does not currently have st mount.that it ifmy iesporisibility to notify the ,
occupant of of requi eaten wtf must he at prior to issuance of a an. to of
_Signature of Applicant_._..- _ , _ Date
O upanc
d - _ - ._ .. _ \
Owner c ou orieed,gent�- Data All roof coverings to be Class B' Or better
OFFICE -