02050105 C➢ OF CUPE
BU CONTRACTOR INFORMATION:
eun.otnc DIVISION
stoN PERMIT
BI'WT'D SLLENLEAF LA PROGRESSIVE GENERAL CONSPERMIT No. 02050105
�T22 Nt;AINE F AND GENE S 1691 PHANTOM AVE APa Sc PN/j�l°�r�2
E N PHONE: SANITARY NO. CONTROL NO.
(408) 371-8007
QO O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
z w{p BLDG ELECT PLUMB MUCH
LICENSRD CONTRACTOR'S D1iCLARATION
y- I M1ertby affirm thin I am licensed under provisions of Chapter 9lcommencing EF ] n Description
`71 ) podProfession,Code.andmyrcense EMO
L
:Ti: with oilton 7d00 of Division Sof tM1e Busi 1'R
is fuel fo
rc 6 LiLi'c'eys Cla c c S I Lic.a I
o a .�° '�� S DECon' ' ogy - MAY 2 9 2002
a.h CHITECT'S UE
0 g 1 underhand my plain shall h used ublic records
r
i ed 8 O Licensed Professional
' es OWNER-BUILDER DECLARATION BUILDING
�'1Lr1'��i
1 hereby iffirm that I am exempt from the Contractor's License Law for the Y
t K-< following recon.(Section 7011.5,Business and Professions Cade:Any city or county $10000
Which requires a permit to construct,alter,improve,demolish,or repair any structure
u3
m piss he u. also .. :me ,itc applicant for such 'ufile asigned statement i -3 k�, 3IF'IDBl. C:haC�F_S_a :t,.
math sol sxitP mann th-pro . of the Contractor,inead I (ChapterCock)
4 Valuation
(w g nScct ours of Di 3 fneB soca dP f 'ons odd s', s . \ .
.,,but he rc ez<mpt th rcfrom ane the basis for the alleged exemption.Any violation
..of Sennet 7031..5 by any applicant for a permit subieds the applicant to a civil penalty Occupancy Type
for not more mhundred five ndred dollars(55.0). 10 7APdY7 P)Fi1diSA3DAT I ON -'t
01,as owner ofne Poi or my employees with wages anneir sole compensation, 102 - PIERS
will',.the'work,-and'the'structure is not intended or offered for sale'(See.'7(Wl.' - --
euainess and Professions Code The Contractors License Law does not apply to as — Required Inspections!
owner of property Who Wilds or improves thereon,and who does such work himself 104 - REBAR
_.r Ihivugh his own employees.......led mat such improvements are not attended or_, ___ __ _
'otrerea lo;"sale:If however.the Wilding or imli ovem=m is sold within one year of �"' 105--" —ANCHOR
comple,ion,the^woenWilder will have the burden of proving that he did not build^., "" •" -
improve for purpose ofmle.l. 106 - SEWER & WATER _
ai.n:' rieEonedoacerr.amex=maiveycontraningwiinucen.&econtactnrsto - 202 - UNDERFLOOR" PLUMBING -iii: ci >, -;, :. .
e
^natmc,the project(see.7044,Business and Profico,mrs Code?The C...ren...a 2 03 - UNDERFLOOR MECHANICAL.r<
-- License law docs not apply loan owner th property who builds or improves thereon, -
_Co who=onvaense L such projmu.win a.contrectortsl heenaed.pursuam.to.the. - ._ . _2 04 - UNDERFLOOR_-FRAME-
cIr.exemptunse Sec. .. 205__---UNDERFLOOR. INSULATION-------- -loll. ---... _..___..._..
., X01 ora exempt under Sec. ;9`&P C for reason
-_ Gw� f� +NDate 5` 17-'o'Z/ 301 - ROUGH PLUMBING
WOR R'S aCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby affirmunderMrhyofperjuryone ofthe following declarations: 303 - ROUGH MECHANICAL
D 1 h66e'6rd wiil maintain a Certificate of Consent to self-insure for Workers 3 04 - ROUGH ELECTRICAL
44• Compensation, as provided for by Section 3700 of due Labor Code, for the
perf.mrance of the work for which this permit is issued. 3 05 - FRAME
❑1 have-antl will mainiain Worker's Compensation Insumnk.-as requirca by Section
306 - HOLDOWNS
37M of the Labor Code for the performance of the work for which this permit is 3 07 - INSULATION
rued My Workers Cmu,narnica[.so re e'J Pol yminalse,
308•= '-SHEETROGK - _ .. .....
Ca m' ..Poli y No: a
CERTIFICATION OF,EXEMPTION FROM,WORKERS,' :.3 0.9 EXTERIOR" LATH'
coMPEHsnnoN lNsuaaNce.., .,,; _4 :;__ . .--------3.10.- -INTERIOR-- LATH--loll_.---..___.-------
„: (" leer an need mi W completed ifffic permit is f.r one hundred dollars 311-" SCRATCH COAT '. 1 •P'-
(g10o) I .)
::,_,_. 313 .. .-.__.ROOF--NAIL.,..
nfym P h 1 flim ofm kfr h stn .anti L: e'1
'ball employ ype n so� t pt,° 31, ttoth'whers 501 - FINAL ELECTRICAL.!ENERGY
Com n to s (Calf ""` OL
Ap t r+ 502 - FINAL PLUMBING ENERGY _
NO sari...
1 r Ir glfiPr rtr t r�"� E ct y an i, 503 - FINAL MECHANICAL (ENERGY .'
- -
,z me s b1 uo i N ke C pe t pro x ons of ro Lebo Code'y t
O O ortn m .mplyw;tn hp va.na.rmspe t hall be deterredrev^ked. 504 - FINAL BUILDING ENERGY
CONSTRUMDNLENDINGAGENCY SOS -- FINAL ELECTRICAL --
,y, " I h¢by Rom that m swoon lend ng agency for the performance ' S O 6 — GAS TEST '
bnM1 krr n nine t aal,ap(se< 3097.e..cl' .i ,
7-Z Lemic sAec,ess, .
507 - FINAL--PLUMBING-. -
u o 508 - FINAL MECHANICAL''
I cagey that read thisapplicationand stateance aabove!laws ciai is
Rc:Q t orWild 1,gree to comply with all city and county ordinances and scam laws erming 509 - FINAL GRADE
7 O"V tobuWvs- Ccti..connoperty rcbYamhmixmposenntives.fthiscity toemerupon 510 - FINAL PLANNING
nc abo c t o'eJ propcny for' pectin purposes.tr A. (w) grelosae indemnify oil keep bamd :mocty fC.k. .against 514 - FINAL PUBLIC WORKS
Qi)Z City liabilities.judgments,c t. and expenses which yin any way gains(dare
V-Z Cary - see a ceof the costs dexlic, foss Permhit
. PPLICANT❑NDERSTAND5AND WILL COMPLY WITH ALL NON-POINT
- OUR' _GI ATI •;. ,'" " Issued by: Date
/ .
signaw of he Jc.n.anmri'., •, " ,'• Date Re-roofs
' HAZARDOUS MATERIALS DISCLOS "
-6rvhtant r t b Lia ng r i t r na el nae. : 'Ster;al ._.Type of Roof._ .. .
az der M by Cupen M pal Cad Chapter 9 12 d n Health d Safe
ry .. -
.Cade Section 355311 - ` -
All,roofs sfiall be
ir . mspec[ed.pno
W plc t any roofing materialbeing installed.,_p If a roof Is installed without firs[obtaining an mspectFon 'agree to remove dous
air comhommadefoldbYmi, sy Area Air QurlityMg nt
°isi ' _ all new materials for inspection Applicant_understands and will comm ply With
°v " all non-poihf`source regulations'
a I, -!trio
-A' 1 ha ad of hanN mammals regwrereents under Chapter 6.95 or me
CaI f -a Health&Safay Cad Sections 25505.25S33 and 15534.1 understand oat
it ifd' gdces of cu entlYha amnatthat t'.my resp -tiltymmufy the' 0=4 remit hbh usi W et p r to isaa fCeciBcote ofSignApplicant Date
g=q Data. of coverings to be Class"B" or ,betier''
OFFICE .. mmol loom