02080087 CITY
urnSIONO
SINPERMIT CONTRACTOR INFORMATION:
21161DCANYON OAK WAY PERMIT 02080A0�8,7
{�sb"FBRIEN GROUP APPLIcf�1$N/etY?J002
\ PHONE: SANITARY NO L CONTROL NO.
a0 ZO ARCHITECVENGINEER: j BUILDING PERMIT INFO
Car E BLDG ELECT PLUMB MECH
L= u u
zH LICENSED CONTRACTOR'S DECLARATION
ZIhereeaffirmJutIamlicensedunder of I��ypesenption
oi_o previsions v= (Commencing REVISION OVER TRUSS--
F=kW is in Sllpro 1000)of DivisionJof th<Busincss and Proressionscode,and mYlicensc
f prom
and IN HOUSE USE ONLY (ORIGINAL #01080142)
a a License Class Lie.p
3
C.
✓n Data ContraARCHITECT'S DECLARATION
tor
te-
l: O.ai 1 understand my plans shall be used as public records
SN
wOLicensed Professional S
o ce LL OWNER-BUILDER DECLARATION
m I hereby affirm that I am exempt from the Contractor's Ctt Law for the C_
ria
follng (Sation7U3i.5.BusimssaMProfmCodo Anycityorearanty \lam
F C
CaO
which req Permit to construct.alter, p demolish, p yucmre
v ' -.
. ..... 392.100 ..__..--u60T to i reqaapplicant .aha a fl signed statement
ser he ' _
par,am toJcpn n ftheCo use r L La (chapmr9 r , ,Sq: c Floor i t g "s,
Valuation
(c 9 Ih5 Io-1Q00) ID'v" 3 fth Buvn JPuf< -o sCM<) f.{) k x 11 4`, l A�, .r'Ll es
or Bad h Is exempt th f m d the basis for the.][egad pt n A y rotation 3'4 25900'9'. 0 0
-
ofs tion 703 L5 bysaya,licrptfar apermitsub,aathe applcammacivilpCmdW
of am mare man eAPNNumberve hundred dollar.(S5rn, Occupancy Type
❑l.as owner of m<property.or my employees with wages as their sole compensation, 101 - FOUNDATION
will do the work:and the slmeone'is'nm intended'or offered for sale(Sen,law: 102 - PIERS
Business and Pro&'skins Cede:The Conlmcmr's License taw does nm apply to an Required Inspections 1' '
owner of property Who builds or imp rov=,thereon,and who does such work himself 10 3 - UFER
or through his own employees.pnvidin mm such impnvemenm art not Intended or
_
o avec for sale c the IF.-howcvebuilding of impnvemcni is sold within one year of — REBARcompletion,the own of a e.).will have 0e burden of proving mm he did oat build or
improve for Purpose nr sale.). 105 - ANCHOR BOLTS
_ -106 - SEWER -& WATER _..
❑P < fthe (See
am Business
seta eonrmalng with I cense)convactors to - '--
cn mi r m p n, r rsa toga,easiness ana Professions endo,The Contmcta.a 202 - UNDERFLOOR PLUMBING . • I - \
License Law does not apply to an owner of progeny who builds or improves thereon,
_and who coatmc¢.for...such injects with.a commemgs)-licensed pursuanl.ro the. .....". ._2 03._-_.UNDERFLOOR_MECHANI CAL.
- - -
eonuacrnrs License Low.
_ ❑1amexempt order SeeB&PCfordons reamn 204 - UNDERFLOOR FRAME.' , .
owner Date 205 - UNDERFLOOR INSULATION
- -
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I herat affirm ander penalty of petjdr;.mu,or me fell..in,dalaratmns: 302 - TUB & OR SHOWER
- - ❑ I have and worm attain a cendicam'of Consent Io saH-insure for Worker's 303 - ROUGH MECHANICAL
Compensation, as provided for by section 37W of the Labor Codefor the 304 - ROUGH ELECTRICAL
perforenance'af the work for which this permit is issued..
❑I hale oul will maintain works:Coro 'tion osumna,as re 305 - FRAME
Compensation required by gado][
_ _ _ 311A0 of he Labor cafe for me perMnaaa<of he work for num this permh is 306 - HOEDOWNS
'x d My w k rs C pe ion Insuraae carrier and P I'y tater arc: '
yN ry t 30:8°'i='PSHEELATION
307- - INSU
Policy No.
CERTIFlCATION OF EXEMPTION FROM,
WORKERS- . TROCK4t 1.I. ,
.,_. COMPENSATIONINSURANCE ^ '; - _._. - _309 EXTERIOR -LATH------
oh.section needmai hecompletedifthe Permit isfor one hundred dollar, 310 - ' INTERIOR LATH ! s
fS 100)or less)
311 . -_-SCRATCH.-COAT
- nr,that till
Performance pnhe-workfor which this permit vissued,t 313 - ROOF NAIL''
shall not employ any p coon
in any ommur as m become subject to the Workers
Compcn,aunn Law, Iclfrn D'Ie 501-._- _FINAL ELECTRICAL ENERGY _
.APpI t _. - ...-. .-. ._ .-_
NOTICE
subj APPLICANT Worke nnoticingm.Csioneo rE moi you u mum 502---- FINAL PLUMBING ENERGY
z becomes milly th<Work r Comic Ironp onsofia lento Code,you must
O O
forthwithcnmplyw;m such ♦;'On,p m p<rr�td,anb<a eJre�nkee. _ _503 - FINAL MECHANICAL L ENERGY
z`� CONSTRUCTION LENDING 504--=--FINAL BUILDING ENERGY
E' herebymrm mar me i.aennstmnionlendmgagencyformepe Onnan" 505 - FINAL ELECTRICAL ''
aar,. ser the work for which this permil is issued(SIC,3007 civ.C.)
'9Z -EerdersName .: .__. _ . _ .... 506-- GAS TEST.. ... _...... . . .. ..... .........." ".. ... _.....-_ .. ... .
D.z a Aad .:
Icthat I haeti to art maim rw in][-,
507 FINAL PLUMBING :
,Ecorrect l greet comply city d t d' c and uric laws mining 5 INAL MECHANICALO , wbuilding wnio and hereby authorize prem set.e rmacrrt mer upon .
5 9 - INAL DE
the M t to
propertyfor' pe u purposes.c:
-0. (W)agreei isand
indemnify and keewhich hmayin me Cry ofC pert against
said 51 - INA 1,
.. u-4, city.liabin consequence
costs and expensesgofthi which may in any way.came against said
U;z APP ICANT UNDERSTANDS AND WILL.Cnir. 514 - I AL RKS /
'^ APPLICANT UNDERSTANDS AND wILL'COl1pLY WITH ALL NONPOI\T
SOURCE REGULATIONS.. � � _ f' ' i Is$OedH3g' — Dale
Signature fAppin.m/C tiao Dare Re-r00
.HAZARDOUSMATERIALSDISCLOSURE - Type oof ._RO IN-PROGRESS
W"the
pplc I futurebolding upon r handl m
hardo ate'al
u def edby lh Cupm N tic oil Code Chapter 912 road N Health and Safety yp - "` "' "° '- —••
Cant,
M Scor ps'srn
it
All roofs shall be inspected prior_to.any roofing.man
teal being installed. . -_
Will the applicant or future bolding occupant use=quiprmal or duces which If a roof is installed'with'out first obtaining an inspection; Pagree'to remove
anti hammous au cnmamin.nrs as defined by the Bay Area Air Qualiry Management
°"tncQ I I
„,all new materials.for inspection. Applicant understands a%nd will comply with
.. ❑Ys. -
-ON. .. .. .., .. , ..
i all non-point source regulations-.., ., -
base lead the h rand materials req ems,under Chapter 695.of the -
Cal
.in
Health&Safety Calc.Sections 25505 25533 and 25514 1 understand that
if the building does not currently have a mnant,that it is my respbesibiloy m notify the
occupant of the requirements which must be mel prior to issuance of a Certificate of `
i” Occupancy.
Signature_of Applicant
.' _. Date
t
ow^"][Torn"oneepagen. Dine All roof coverings to be Class "B"or better
,I
OFFICE - '