00100070 CITY IL of c DII SS116NNO CONTRACTOR INFORMATION:
PERMIT f�I-•
BUILDING ADDIir S'
2.'.6@@ EDWARD WY ASSOCIATED BUILDER ERMIT NO. 001,00070, .
_
OWNER'S AG ;
NME: 4026 3RD ST APPLICATION SUf QfyIVi C��G`@@@
HARRY H. SHIN '
PHONE:
\ - (415) 285-62@@ SANITARY NQ. CONTROL NO.
'
a O O ARCHITECDENGINEER: • - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y a a ill I.�J Ci
LICENSED CONTRACT'OR'S DECLARATION
c S h a 1 neem Rind dust I ant licensed under s or Cha to 9 Job Desc ton
c a,-p Y a provision p nddiy license -
r tru w,mScotian ea in B ad re e a,tyrun,e HARDWOOD FLOORMEW CARPET AND PRINTING
6k�-r Ls Il to ud fie' {I�, r t
iz tecta Cl V `/ 1 q • ,.
X O i O Dat �(. tFl
t -
w 3 w 11 L?S DCCLARATIO '
S-m I ands at td m)pubes droll Inclosed as public retail -
� tim�C
LiucanowdP [s 9
OWNER-BUILDER DECLARATION
w=LLI hereby art,—that l pt f tl Conal t L I' birth
CZQ toll g real.(SO 9031, Borsint,,andP f..in Cd A it,do County
X� who yin. permitt a t,alter, p elnlhrepair' tinyst ire
o prier t ':.o q th pl mfr' hpe 'n fl '.6 dstatemem d
that lie ko�ucaad,lnwrradhilly,parrvusican,totd c m yct c Law(Chapter9 - S Ft. Floor Area , _ Valuat
(ere tang w7001lt Seennn 9ooDivs 3H'the Rtdme: dPretest Cure) ,. q' ' E500 -
m that he is exempt themfrom and the bust,fertho alleged exemption.Any vlolentan
of Section 703 15 by any applicant for a perinit subject,the applicant he a civil Net
of not more than rive hundred dnlmr,lSN)f APN X I bir8@15 @@ Occupancy Type
❑I.a, rofthc r rt-,ore all withwa es donna,enle mm ensntial
pole 3 ue p n in g D
will ne he well,and the n&T e is not intended Li or License
roe snot apply
to an
Business and Profession,Code:The Contractor's s,and w Low does not apply to an - lion,
owner(if property Who builds or improves thereon,and who dines such work himself 1.01. '- F V lIF1Ur�'-1 LJIW
or almugn sal host employceI promdin That such impnrvemenn arrant inlander or
offered for see.It,howuva,hit l Carpo or urge ovematt i,s Iso he did hill year or 102 — P T E RS
empiodara,the owner_ntiiajrwiB Haut me Women hrpevms drat be did hill build tot f03- — UFER
improve putpowo ,
❑I,it,ocollector the properly,am exela,ively nmhacting wan licensed artmcmn to 1,04 — REDA R _
construct the prdjeot Rec.70,14,Business and Profe,smns Cede:,UN Cmthaem" 1.@5 — ANCHOR- BOLTS ..
License Law doe,not apply m on owner of pmparty who builds or i...peva,dancer. "
and wnn cnnmtcts for such Perilous with a ommnman3.Bcensed pur,aanl to the ].@E, SEI TER 8 WATER
License Law,
❑Iant exempt tinder See.' B&PChnthisradical 2@2 — UNDERFLOOR PLUMBING
Owner Dare 203 — UNDERFI'OOR MECHANICAL_
WORKER'S COMPENSATION DECLARATION
Inlareny lon hadc,p alts fps, y nn 6:11dwin,t r divil 204 — UNDERFLOOR FRAME
�.o l Ounce and will a contain a CerEcau,of Consent to self-insinal for Wo ken 205 UNDERFLOOR INSULATTON
Coen tip sired In, by Strafed 37D) tif he Lab., Cod,, fnr the 3@ 1' — ROUGH PLUMBING
perrrmanceormework fmwmenm,pemtsswee
302 TUB 8' OR SHOWER
—
❑1 have and will r Cedain Worker's Compece of[iewait,f as ryuired by Scotian ROUGH MECHANICAL,
CAI_. -
J]0o of the Lobar Cade,for the performance of me work far which this permit is 303 — > '
towed.My Worker',Cnmpenwti Ineumnee carrier and Policy number arc: t t
crrir, Pow, — OO 304 — ROUGH EI_ECTRICRL
C•4 IFI AT c EX"EMPI'IONFROM ORKERS' 3@5 — FRAME
COMPENSATION INSURANCE 30F_. — HOLDOWNS
(This secdton geed nm be completed intoe Sordai,is protein,hundred aonard t .. ?@7 — INSULATION
(SI(sh lc,,,) • _
I eeniry that In the pufacremce of the work for which this perm,,Is issued,1 t 308 — SHEET ROCK
,hull torn employ any Penna in any banner so,as to become subject to the Workers'Laws
Com@C3 — EXTERIOR LATH
pensation of Culifmda, Dam 3 I
App0can1 - 31@ — INTERIOR. LATH
NOTICE TO APPLICANT.11,after making this Cenifi"d,of Evariptioo,you should
recces sthrOGm the W..ker,Contpmtsaamt pre,myrnef'he Lab.,Cade, eY1n
yust 311. — SCRATCH COAT
O p rhnhwion comply will,such pevidihns ar this perm,,shall be deemaa revoked.
CONSTRUCTION LENDING AGENCY
313 — ROOF NAIL
1 hereby aff tnet there is a construction lending a enc fnr the fommnce
04 nfthewerkfarwhichthispertut1,minWesea3091,Civ.C.)y p`r 5@]. — FINAL ELECTRICAL ENERGY
i p Lend°''^Name 502 — FINAL PLUMBING ENERGY
o-• z Lender's Address
O 503 — FINAL MECHANICAL ENERGY
„y 1 acfdfy but 1 nave read this city
and co and,tmealat lheabowestat maws winni u
i F inrmet.1ogee aero,nnlrwith all cityandetoaprohrdmauee,andstalelaw,mlatmg 5@4 — -TNAL BI, 'LDTNG ENERGY
O V to building eon,hucon Wed hereby oumcrize reprwnmtivcs of this say to ester upon ••
gyp�y, ty theabove-mutfionedpe earforin'hurn,pwpescv. S@ — -INAL, .ECTRICAL `
Lr 15 liabilities s judb reants, t nd expense, hr Ih y iu anyC tar 1tt pe"s imgi viA 9 .fD _w f
V � AIPle LICANT ND STANDScc A tthI C PLY WITH ALL NON DINT 5 - L -LUMBINC
•UI s Issued by: _ le
IT
Signamru o' p i71AiANia Ar MAT RIALS DISCLOSURE °oi Re-roofs ,ri — FINAL GRADE
wmmea7fieamo' in thaldm,wic.,ant,tnra...handlehazanlcnsn.atere] ']ypeofRoof ]@ — FIMRL, PLANNING
;is tleflned by the Cupaninn icipul Code,Chapter 9,12,and the 1ladtn and Safety 0 [�I A "
GWa, O`Ycs'255320tT! IJ Nn r � S C 1SY��p P�TJ I I r- I f�K .
All roofs shall be ibs�e ted pf3ny ro tlfg tt]'ate t,a et g installed,
Will the appticar,or future building oconPant,ae eyaipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmardou,air comantinanG as defined by the Buy Arens m
Air Quality Manageent
District^ all new materials for inspection. Applicant understands and will comply Willi
El Yes 11 No, all non-point source regulations. _
G� 1 have read the luteamous maternal,requirements under Chapter 6.95 of the
Call fnmiu Itailor&Safety Coda Scmiom 25505.25533 and 25534,1 understand That
If the building dem nut plrretnly have a tenant,that it is my inspan,ibility to notify the
ccupuw r the i,i j t ants which must�e met prior to issuance of enifi to of v '
oeau ,ay. �� �. Signature.of Applicant, Date '
X11 roof coverin s.to be Class "B" or better ownerorat -edasem fon - - g .
OFFICE