01090003 OF
CI BUILD NC DIVIiSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO.
10536' DAVISON AV HARRISON ROBERT L AND REBECCA 01090003
OWNER'S NAME:.•. ., APPLICATION SUB DATE
�HARRISON ROBERT L AND REBECCA 09/04/2001
( (( PHONE: SANITARY NO. - CONTROL NO.
r.
_Opo 'ARCHITECTMNGINEER: - - - - BUILDING PERMIT INFO
❑❑ s BLDG ELECT PLUMB MECH
d U 1:=7 L=) L_7 1-1
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Z 4. I . ' LICENSED CONTRACTOR'S DECLARATION Job DDSCRphOn
O z In C I hereby aFr I Thar I am licensed.under provisions of Chapter 9(commencing
p;_t-Lia ,'wiN.Section /of Division 3 of Ne Baunas til Pmfcssions C°de,and my liana ADD 850 SQ. FT. (2ND STORY)
�,w iLian¢I rs''�a`I` < f� tt 4/10/02 .PER JOE A-EXTENDED PERMIT APPLICA
Fa a0 I-n -1. ARCHITECT'S DEC.�`L`LyRATION s �� I LL. 10/10/0 2 . ,
1 de lad y plan shall be usedu c recoN i
m 0 24, Fmf ooalii77777= ..
-yftJ ya x , .'?^ OWNE0.6UILDER DECLARATION . III 2003 a `e,i,- ;, ..
^•- ill hemby affimt that Pam eumpf from the Contractors Li ccn for the
C? following reason.(Section]03 1.5,Business and Professions Code:Any city or county'
F O 'which require a permit m mmmuct,else,,improve,demolish,or repair any anscruse
an prior to its issuance.also requires;the applicant for such permit to Elenit$$i]m(tdrgen{ -
thatheisliaensedPursumtoftPrivisionsoftheCormorant cen�Lshrpf�q{p(r9 Sq. Ft Floor Area- :', yy- sy1ua[ion
:fc`omivcricing with Section 7000)of Division3of the Business and Professions Codel i..'•• . , la�c s„ ft),'. „?L(.`t. $S28�G
or.dief lie ii eaempr NemfmmSiN me basis for the alleged etemgmn.Any violation
-of Section7031.5by.nyapplican{foreperrinn ubjecmstheapplcamto.civil pennhy P Y
;of nota a than five.hundred dollars 1S5o01, m e 'Pi C'•S' '-a Occu ane T YP
e
369MYd .�b
,
O 1.as owner of the propeny,Lir my employees with wages as their sole ampen,mion.
--anit do the smrt,'and rantruc
smuis not intended or oRertd far snle'(See:7014: _.{}� -tluired Inspections
--. -__. - ... .._._.... .
t IBusmcss:nd Professions Code The Contractor's License law does not apply to an 101 - FOUNDATIVi •'. :vC
r owner of property Who builds or improves Merton,and who does such work himself
or through his awn employees.provided that such improvements art nee intended or .,.1 02_7__P.I ERS.... ... ............._ .._.-_
"l completion.ihelwChobuildethellhave to titers of provii that within one year ofe nr:
r 'completion.the owner-builder will have the burden of proving that he did not build or 103 - UFER
impooaf.,Purymeofad'.). .. .. 10,4.. - _REBAR
[]l as owner of the property,am Cieunvely contracting with licensed comments ° 1O5 - ANCHOR BOLTS' ^-V, "Ir �-,
cont”the pmjem(Sec.7(A4 Business and Profession,Code:)The Contractor's
Licietwo Law does not apply to an net of property who buildms or improves thi ar, 106 - SEWER & WATER
tend ho e°mracts.for inch.projects with.a.conmacl.fs)1'ccued.pununt to dm .._.._... ...
£qa mor'aLians.L. . 2"02'- ' UNDERFLOOR',' %UMBING
�d1 ame, pin der ' Bq2&PCfonhis rcas°" 203 - UNDERFLOOR'�MECHANI CAL
KERS COMPTij;',fl[TIO(NECdlRTiOP 204 - UNDERFLOOR FRAME _
f1 t IhertbyefOrm nderpetultyofl'e0oryoneoF,thgtouowmgdttlamdone: ., 205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
°( ''° 1 have and'will maintain'a Cirmussins of Camara,to self imam for Workeh 3 02 - TUB '& ,OR SHOWER' '
v,Compensailan rpm Ided Pdr byi, lt II10 3of Ne Labor Code, for the .&,,OR ;f
+perfosuana cd the work f r.whmh thisgecPermit
s issued 2 '
303 - ROUGH -MECHANICAL'_ a, . ,
`°1 have ad will manta n Workcr s Compensation Insurance.as required by Section 3 04 - ROUGH ELECTRICAL
7]00'of.the Labor Craft,for the performance of the work for which this permit is
isofeclMY Wo k Is Comperivation'lasurance carrier and Policy number arc: 3 05 - FRAME
”. ..
came'v ' f r'+ I' "'!PI YNe..:.:'' - ., 3,06�• .HOEDOWNS
y .fCERTIFICADON,OF EXEMPTION FROM WORKERS't 1 '. s3,07 �! INSULATION. I
'r' f ATION INSURANCE v
-., This union need not bePEom..mul . ., ._._,.__..,..,.,. ... ........
if pinedifineperms sfnr°nehindredJnllars 308`': �SHEETROCK��-�`
309 - EXTERIOR LATH
1<enfy'Ihan person
pe fommnce rte work far heli ran permit-.is n'1 -"' 3'1'0^' INTERIOR;a$TH , , ir. �I„ :,1. ,
;hall not mploy any penin in an mo mer so os mu hecnme cabled 1.'he'Worker.' i
compensation LawsdfCulf �o. �e - '" ' • - 311 - SCRATCH 'COAT
' cA4or�ceTo'nPP .-. ...... 31.3. _..ROOF-'NAIL ...... _
pp
LICANT If afar making thsCnitcam of Exemption you should
. 1 1
Z bcbmsbbjntothe workeraciiipemminpnivSionsbthe Labor Code.you 501 - FINAL ELECTRICAL ENERGY
Q Ponhw mcomplywm such Provisions or this permit shall be deemed revoked 5O2 FINAL PLUMBING ENERGY
Z
.w ... .. . .. . _ _ .. - .,. . ..
••+ - CONSTRUCTION LENDING AGENCY, t
H y ( the by affirm that there aco tract lending agency,'for the performance503 - FINAL MECHANICAL ,ENERGY
a' of the work far which this perm t 's ed(Sec 3W7 Ci C)y
W ndersName.':.. .. . ............. . a 504....- ..FINAL BUILDING_ ENERGY '.' ._. ._
we
OZ Ufdiu'l Address 505 - FINAL ELECTRICAL, ,,
UO i. f /l
Icer fy thatl haye rtad m.applct n J stethat the alio informations 506 - GAS TEST U �_
OG_[� Correa 1 ogre t o ply th II cit and n ty nrJ nonce and tam la s relating 507 - FINALPLUMBING
fJ rob ildng coas, ch n;a he bytithm m oprewrovives of in(scity i enter up n -
p W
he,"°vc " (a int.' npumus 508 - FINAL MECHANICAL
agree to sae demoify and krep harmlcasih Cty of Cpenino game
ti ed liahnlific judgments cut and capers` h ch may u y y ago; a said 509 - FINAL
rym
Qcomeq em
or of m trig of this -
' `s ING*ILRt!G� '4E"14 Ds,RNoWlvl.comldtviviT 'nL., .v.POI�r'" 0 r 'F VY
11. Z Issued Date'
servo App s,. ommcmr .` """' ONQ
re Re-roofs
AZARDOUSMATFRIALS DISCLOSURE
W II t0 roam or future bit le ng tamarsen,trom or handle'hvioplous mammal
Type of Roof--- ....�. ,. ..._.
as dcRoed by dm Cors M m t I Code Chapter 9..12,and the Health and Safety YP PCS '-""•""""" "P"i•3
Code S non 25]71x) 't •.`:• s,' f n y.{•i,aF .,•
° `'} All roofs shall be inspected.prior'to any roofing material,being installed., ,-_ ,.•,.,
. „ Wdl theappluamorf t re bddu
occupantuguseeynipri ntordevices hien If a roof is installed.aithout first obtaining an inspection,pagme to remove
'emit hazard an s an r cnmmnunism red by the Bay AuaAir f2oaliry Management
Dismct ,, all new materials for inspection.- Applicant understands and will comply with.. -.
_ . ❑Y , : i r " all non-point source iegulahons: 1•
11 hale read the habitations materials req,inemetu under Chipmr 695of the
California Health&Safety Code,Sections 25505.25533 and 25534,1 understand that
dm Wnldin6does not rre dyh ea ricin that tis my rtsponsihdnymnady the '- " ' "" - - -' - - -- - �' -
a.pant of the Z6 era hich man be m t prior a ise...or of en�tTTcam of
V Signature of Applicant Dale
net° mimn m ge t,,, nate All roof coverings to be Class B or,betteY - ••
-.•:a .<.,.�.:':,•�.;.:_, - : : ... . ..,.. .. .. ' •. --'OFFICE