02050082 CI BUILDING DIVIISPERMIT
SIION ° CONTRACTOR INFORMATION:
B�I1eTblj"."RES CENT RD DIVISION TWO CONSTRUCT 101 "M� ' 02050082
lMYflT'SON STEVEN W AND LAURA L 1961 MEEKER AVE AUYG/ 14 nbM
AdW
PHONE: (510) 215-8188 SANITARYNO. CONTROL NO.
O O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
z u BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION .Ifyh p�
;Z2t:- hereby that lamlicenxdunderprovisionsofChapmr9momm¢icing SINGLE FAMILY DWELLY{&8EMOLITION
+2 t: wi,n seIherebya of DhatI m drthe Bmmerpoo Professions code. (commencing
. In full pone and effect,
i p n a Li<cnsc Class Lic.a -
O`c U Dae Contractor
1 3" ARCHITECT'S DECLARATION
O I understand my plans shall W used as public medics
r
t i o O Licensed Professional
xm LL OWNER-BUILDER DECLARATION
to-y I hereby affirm that I am exempt from,he Contractor's License Law for,he
L?a following rtawn.(Section 7031.5.Business and Professions Code:Any city or count' $8800
E x O which requires a permit to conswa,alcor,improve,demolish,or repair any structure
ru an t ,,!,issuance.ralsorequirsah applicant fch permit trile a signed.,¢men,than he is liccusedPrs ,lr mepm%islons ofn c t mr License w Icnap,=r9 .32AIR &T:a&a...ti - - Valuation
Ic ec g.'th5ea ]oW1 fDvi.0 J fth B mss MPofesso Code) •int :.5. ,z a +:♦ •1-fit,' I
Or that he a exempt,nemfrom and the basis for the alleged cscinnu n Any violation
of
Seddon 7031.5 by nny applicam for a permit ahjau,he applicant ivil penalty r r
er not more man fine hundred dollars(15M. NO AEMM(illibilD INSPECT ONS'.:' .' Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work:and the x,mdum isnot intended or offered for sale(Sec.7616,
Business and Professions Cade The Contmcomr,License Law does no,apply to an Required Inspections t "
owner of property Who builds or impmves thereon.and her does such a ork himself
or through his employes provided chat such improvements are not intended or
�offeFedf- l.If,however.- the building or_improvement, ld within one Year of
cempl i - ,M1 c builder w ll have the burden of pronng that be did no,build or
improve for purposeof sale.)
ueI,ase,'he of,be p(Set.7 am Broad ly n, n g Int de condors, a
ronswd Law
pre)<ct Lapp ]to a Brininess red property
who
Code:)The Contractors ti _
License who
Lawdoes nmapply,omiowner th property whobuilds seimproves,hereon. - -
Co who,ommens for such pro( .with.a.convador(s)(deemed pursuant w.,he _..-
•:' -Commdurs l-teens¢Law. _ -_.-.._.. ._.__._._ .._.. ... - . ._.-... .
❑la cop,under sere ., .'i"" + B&P C For this reason r•+, _,
, sen 'WORKER'S COM n'SATION DECLA�ON /
I hereby affirm under pcoa y of perjury bnc of ba following declom mns:
o ❑ 1 have and will maintain';Cenific6m of Consent to self-insure for Worker's
• Compcnm,ion:ns provided for by Section 3700-of ,he Labor Coda. for ,he
pcRomor ance of the work for which this permi,is issued.
_ ❑1 have and will maintain Worker's Compensation•Insurance,as required by Section
3100 of the Labor Gide,for,he performance of the work for which chis permit is
vsued.My Worker's Compen,.ImnInsurance carrier and Policy number arc:
Greer i .v( L' I.4i. Perlis,N , - 1 Y .. .__- _ --.v`- ' __ _.. _ -
t k CERTIFICATION OF EXEMPTION FROM WORKERS',"
1',.
COMPENSATION INSURANCE I _._,_--
_.......
t (Thissection need nm Wcomplci<d if the Penni,is for one hundred dollars ' 7 ' � t ` ,'. '- - �-_- ----�
(1100)orinsd '
1
cam fy,M1at in the pert a of,h ark forM1'h this permit is sued'I - ,' .•- -..:"'..' _. - ,
Coll not pl y a y pc orkers
C t o }Y of C I'f m e � b'd�
Ap am_c�-AT�r/I CANT I ... -_ ._.. ... . _ . ..
NQRCETtlis CANTI ais,
zO ' reate- x Pt ny should
became become h 'he W kes Compensation pod s softh t Celyu'must
forthwith with Such provision,to this permitrni,shall ba reamed
-
- - '
revoked. ,
CONSTRUCTION LENDING AGENCY - --- - -_ •, - '-"
- ' I
WO h mfrom thathe''_ construction lending agency age cy f ,he Iefo-i_m ice
of,h which ch top.it issued sec J097,Civ.C
M_ Gmd Nam ..
..._ _ ...__ .. ..
;;"z Lanaeis Address• .. -... .-.
Icenifydra,I hav mad this application anAsam,hat theubovs information is
W.'t..: dirt, I agree locomply with II ',u a county ordinances red state . relating
gee t ppony f hereby
t6m.and b ed iu
>o the W d purposes.rpo -,fes f th�c ty, <mer upon
U4 end=) g ems a indemnify and keep namle the City f C pen 5gaina
to cr liabilities 1 dg ts,costs d expenses which y tiny y g ins,said
V �Z cry 9 c of,h grand,of th, D
AP^��C T UNDERSfAN IND ILLCOMPLY WITH ALL NON POINT�•
'RE � � �nfs Issued by: r Date �� l -z-
sgnaaanerAppnan:rcdno-addrRIALS DISCLOSUR`—OSZR ..
HAZARDOUS MATE
e-rOOPS
Will Ne applicantof,re Wilding occupant start or handle haaametS matmel Type Of.ROOf _
ii;def d by.M Cupcn no M c pal Cod Chapin 9 12,and the Hcahh,red Safc,y
Code See,on 25532m) - - .. .. .
El Ya, ONo i ,. F 1. +. ..
All roofs shall,be inspected poor to any roofing.material being,installed.
Wrnma-iyslaat rfmnu sa%de edbytheBay eaAial devices rent If a roof is insialledwithout first obtaining an ins ecnoTi;'I agree.to remove
broths d air cdmam manb a.uildin by 0 Baant y eq equipment Quality or devices when g p
Dwr n all new materials for inspection. Applicant understands and will comply with
. . ❑Y - ON-
on-
N .. _. _
all non-point source regulations: , ,.:
1 lre' ad the h z d amdals q -rements under'Ch p,er 6.96.of,he `' '
C61 forea Health&Safdy Code Sections 25505,25533 and 2553; I u l.e .red that
,f the bold does ata dy base am t chat it my responsbilty to notify the -' - ---- - -_--
OE P f h rrq ret <hmost be ,p r'.i....re,of a Canham of -
G�k�t - (5 f Signature of Applicant _ Date
ow u r,amonaw ag , ae All roof coverings to be Class `+B"or better
OFFICE -- ..