02090180CITYBUILDING UDPERTONNO PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10420 BUBB RD
PERMIT NO.
022090178,0
) 1� &D FINANCIAL
APPLICOQN]Sytr/E 002
LTJ 2CONTROL
PHONE:
SANITARY NO. NO.
ZO ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
i LICENSED CONTRACTOR'S DECLARATION
Ihercbyeffi,mNatla3ni nseunder p
]Igfry DivisionJof Bu['mJss
Jib De$C hOn
30 DAYS TEMP PERMIT `02080168)
so wiMS eci on of iM1e Pronso(Chapal and!
Id Professi°ns Cwl<, arW mylicenu
i'Ltr°rc`a"a` �J" 5r..�'
ueen n �.
(EXPIRE ON 10/26/2002)
Lina
cnmmctgqpp
to
� 1 urWersmnd my plans shall be used as public records
Hll let mead
OLicensed Professional
a. OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Commcror's License Law for Ne
following reason. (Section 7031.5. Business and Professions Code: Any city or county
D which ¢quires a Permit o construct, alter, improve, demolish, or repair any suuctom
m pn 10ui wx I minima N applicant f h permit to file a signed statement
- - -- -
-- _- - -
- Nalhgt 1«is¢Jpdis a ti thepion fN Com tors Li«nseUw(Ch px 9
(c n 'n8 th Sen 1]1)011) f Division'3 f theB iness and PrgD.ss ons Cadet
S FI Flo , r' ; Valuation
` (i I� dti . a r1 'a.
or N t h Id <mpi tnercfrom rN N bas f th lleg d c5empunn Any vi I t n
J. :Ig(y
3 .. ;• .:. ,I F R'/
of Section 4031,5 by any apt cant for a permit subjects the applicant to a civil penalty..
,ar nm marc titan rise nnnarca dollars rs50B).
+APN Number -Cy IYpe
AU F
❑l,u ownerork. propcny,mmy. employees with wages as their sole compensation,
lOr1�T„-4 EOUN'DATION
tintane Ne work. the smacode: The C incralended'or ense etandLaw does ina'(Scc: ]OJ4,-'
<B esfand Prof . colo Th C Law not apply m an
r p. -. .
102 - ERS Required Inspections
esmctor'a . and s In
ownerrmisma e l lesn iddesHereon,andwhoentsmmwork meddo
or through h' employees. provided Nat such mems ere not mended or
103 - UFER 'J
'dRercd fsale.If how a the Wilding or im
improvement
g provemem r: sola within one Wild or
----'"—T-=-- ----- �- --_
T0'REBAR - -..-.. ._ .....
sill have the burden of proving Nm he Nd not held or
completion, the oose
improve rim purpose or sale.l.
of sale.)
105 - ANCHOR BOLTS r
... ...
❑Las owner property, am commmomm
.. _.._ _ .. _...__.._._... _.. _.. ___.....
- _ _ __&...WATER__. t:Ct '�. _. 4t\I'O
psalm Business adPmnNgw,Nlmensed
the oes n(S«.](loan Business and Professions Code:)Theves denon,
LiConcense
- License law does not apply m an owner of property who huilds or improves Ncreon,
202 - UNDERFLOOR PLUMBING _r. „ \L: Et I:
- � � � -
torsacn.proi u.wiN.a.cnno- ,o s).Ecemw positions w Ne.._.
_and.walm"
__.__ . __2 0 3-.._-__UNDERF-LOOR--MECHAN S CAL-----------
Licedl
] Commnors lfaunder
nde Law..,.
❑lam exempt under5i�' " "s b ;B&PCfor Nis reason
- -._._.__..
204 - UNDERFLOORr:F.RAME'. is n
14)"
•'
'"' "'oat -^ -
205 - UNDERFLOOR INSULATION
•i.. i r l.._ "' WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
- " -I hereby aRrm under penalty of perjuryona•o(the following d«larationm-
302 - TUB & OR SHOWER
!` ❑ 1 ha.e iincl wlit momaii.'a caoific,da a Can.., to self-m.urc for W„ner•s
303 - ROUGH MECHANICAL
Compensation,- as provided for by Section 3000 of - the labor Code,' for ,he
per(armancdorNn,.n,k,rnrwmcM1Nisamilni...ad-
304 - ROUGH ELECTRICAL
O 1 haw, mal'111oamitin WV kcr'x Co pen t I suran e i gained by Sect bn
305 - FRAME
.nud of'h"�ha Cit' ri lh perform a or m work r which this Pe t
W
306 HOEDOWNS
'sx <e rk ria nns_
copIJ cy' be
:P°.
�l
307'_-. INSULAROTCIOKN:j' - ---- - ..
r-CRTIF
ATONOF KaElM'yn N FROM,WORKERSl
Tf-1-A
a 308,YnSHEET
,a,r1e
coMPgNgAr10N wsuRnNCEEXTERIOR--LATH''--
ini 111c1((h
__._____
set meed dot he completed it the permit is for one hundred dollars
310 \1`I. INTERI OR LATH '_s• r i/^C,11 t, .. :i3�.
(SIoWni'l )
i
•-,. 3.1 -1., -_:SCRATCH .COAT ' .. ., a.,�.. �. ••�"
�fymnyn pert' can si as tobwedhrimslx rise:
h p not ploy any a n 1 Y an s to 4 nx bJ t t Ne Workers'
313 - ROOF NAI�=T;;!c !,, ti.,ainu! ,;.,, f' L
Compc t nLa splCat 'Ore, -"
___ __ 50.1--7-FINAL.-ELECTRICAL ENERGY
.NOTICE TO APPLICANTII rte, making thc1mr, fEe pt nyeshould
bee sublundthe Workers Compcnst tuition nuns of th Labor Cale; you muu
502 - FINAL PLUMBING ENERGY'
j for,hw,Ncmdttywith inch fouskinnsorNisycnmtsaaBthe d«medrevaked._503
- FINAL MECHANICAL ENERGY
"n 1r CON5_ RUC10NLENDINGAGENCY
''^ Ili by Irl Non t yr°rNapelrerVname
---- N - - .
S -O4 -- ----- FINAL----- BUI--LDING EERGY-_,_
Lith rtto ch reds pc t 'ss
rode 3W7, Cis.
3W]'--. C)
.
505 - FINAL ELECTRICAL aL`'
.h _...a
1 -Londe Name .__. ._.. 1 i �_.c._... .._
IindcYzAddrcas
_ _..
- GAS"TEST----"---
p.,., ..; 1 v. ,:r_.r':. ., 'iL,': :,'. ;-'._
507 - FINAL PLUMBING
r,: v 1Certify Chat C h read thisapplication and state that h information 's
coirect1 gree to comply th all city and my ordinances and tri 1 relating
i ebulengconstruction. dp6y bin N° p'. tt'e. nn city to t poo
is
the bo t -J p pent for .Peet P To
-
5 - INAL MECHANICAL
5 9 - INAL DE
(We) g' t demdfvand which
hama n any wit fC pen "' nst
1 Cub 1 t ems, cot cid expenses n h m y n any againu said
51 - INAL V
o seq y
City' consequence elDtRS1agmmngof this DWILLCO
APyLICA\7U\UERSTA\Dj AND WILL COMPLY WITH LL NON -P INT'
514 AL RKS
,:.v,,,.
Issued bye Date
Appean contractor '
j Ii, -HAZARDOUS MATERIALS DISCLOSURE s - 'I
Re -roofs
1
wll Oie applxant or (wre W IJingoccupam tae am edl naa,d mm I
J f
Type of Roof -
eJ by th u vino Muni c pal Cada. Chapter 9,12,d the Health aha Stiff ry
Code,Semon 25512(a)
- - ._'-• . _"' - ` ..; - - .'-' :. --. „ .
'jt`t)E 4
f_
i ❑Y 1 t �No 1. .41 11 51 rt
-
1. �ltil ,'{31 ll.t i>.y Y;ry; •
All roofs shall be mspected.pnor.to.any
Will th tat Wilang cupant use equipment de.,ccs wm`h
emit h rrcontaminants . defined by theBay Arca Air Quality N agement
roofing.material.being installed. .
If a roof is ins talled'witb'out first obtaining an'ins ectifin' I a ree�to remove
g p g
District?
_I; ❑Y a. -,
al] new materials for inspection Applicant understands and will comply with
non -
r •, ,,
- 1h a read the hamrdrae'ale -
mq rementa and Ch p, , 6.95 of the
all point source re ulauons; .y 1 i
g L. Iu.s ,,,,
Califiannifia Health & Safety Code, Sections 25505, 25533 and 25534 1 understand that
:dthe building does nm Carmody have a tenant. that it isany - do ibiliry to notifylM1"
'acu -1,
.. ._. ...__.__.... _.__ .__.
ant oft ere quiremcnrx hi
T, a he" prior. b issu c f a Ce (terse of
_
.a. -
ancy _. ,. _.
.._.
Signature of Applicant.,_,. _ Da[e
..,_ "" --
All roof coverings to be Class "B" or. better
iter r f..n r tee cnt D x..
___.. _E _.. .___