02030138 CITY
DSIONO
IVIINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10335 FARALLONE DR SOUTHWEST ELECTRIC 02030138
OWNER'S NAME: APPLICATION SUB DATE
BRUMM CHARLES F AND CLARE T 14510 BIG BASIN WAY 03/25/2002
PHONE: SANITARY NO. CONTROL NO.
' (408) 999-8721
Mai
0 0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
zu 0 BLDG ELECT' PLUMB MECH
a a. f"_ l-1 I= L7
y w LICENSED CONTRACTOR'S DECLARATION
5 1 harem mint that d atm fianad ander
S z- y a provisions of Chapter 9(commencing Job Description
with Section]000)of Division3 of the Business and Professions Code.and my license UPGRADE ELCT . SERVICE TO 200 AMP .
x E is in full forte and effect.
On License Class Lir,B
Date Ci m uchn
a LLt ARCHITECT DECLARATION
al 0 5 1 understand my plans shall be used as public records
i a p O Licensed Professional
-. OWNER-BUILDER DECLARATION
lEi -v. 1 hereby affirm that 1 nm exempt from the Contmcum's License Low for the
C Z a following mason.(Section 7031.5.Business and Professions Cale:Any city ar county $1350
a
E=o which¢quirts a permit to wnmme,olSn.improve demolish, file repas, air any nmcturt
to— ,prix.m'a ,al qts es th applcant for such Pennluo hlea ngned smumer, -_- ......
S .�f �toprp�H� Valuation
- SMSA 31'licensed a t oche Pro bns of the CommnorsLcense taw(Chapter t7 'S t�Ua Y•."IYVi, \'
or
g lb sen ]000) The ision 3 of the Business and iori An vi Code) ,., ,;t. ;3 Cr s\,�,?j O t
or Shot he Is 3IS b Ncufrom and the bans for the alleged the exempnoa Any violation '
�of Sermon]03 IS by any applicant for a permit subjects the applicant to o civil penalty
of not more than Five handrail dollars($500y 304°aPN 9l $ ELECTRI AL" " Occupancy Type
❑1,as owner of She property or my employees with wages as iheirsole rompcnsmion, rni _
will"do the work: ad the someone is act intended co offered sale(Sec:7040,'
it usmeds'and Professions Code:The Contractor's License Law docs oar apply to an 505 - FINAL
EHDQ'Ii G3pbctions^r• ^ r
comer of pr.,my Who builds or impmvcs thereon,and who docs such work himself
or through hos own employees.provided Shat such improvements are not Intended or
..:offered for side:If.howeve0he Wildin _-"-.. .
gonalan of proving
within one Yeor of :s�;, .t ;W
improve
She owner"builder will have She burden of proving rhos he did not Wild or
improve tar pagroae ar.ale.).
c 1,as owner of the Pr^PcnY•am exclusively contracting with licensed contractors to ;I.�, 1-e. —-- -"—
onwenucr the project(Sec]014,Business and Professions CWc:)The Contractor's "' "
License ladoes not apply to an owner of property who builds or improt
ves therein,
i. and.whocontnen.for such projects with a conunetorts)licensed pursuant to SheCommences License Law.
_....
❑I exempt
underSc -B&P C for his.,,in
wOrv�' f I�fl t� IK A n/dPLra. •. 2 "}�•I���-�
F0'PE NSATIONDECLX?0� ( (J����®
` I hereby afar under penalty of perjury ooe of the following dttlimakins: APR 2 5 2002
A•O I have and will'mainiain a Certificate ct Co wrt in self-insure for Worker's
44 Compensation, as provided for by Section 37W of She LaWr Cade, for She �a
perfomuanee of She work for which this perem is issued. L
-� ❑ ns
1 have maintain Worker's Compeation Insurance as uqulrad by Section BUILDING
3700 of the LaWr Code:for She performance of Ne work for which this permit is
is'sued.My Worker's Compensation insurance carrier and Policy roomer are:
1 CERTIFICATIONOFE%EMPIIONPROM.WORKERS"' - •'�%•" 3 .1 r1;. G i 41.::Kjl?~tit Aa�i, i;
MPENSATION.INSURANCE' ..._^„___. _,_„___._„__ _ _
`lT3ds union neW not W complcictl if the permit is for one hundred dollars '� " - • . - .• ----� i_�1”
(8100)or less) '
1 certify that n theperformance
in (She wart for come subject
ct t issued I -
Cc tcm,laanyperson to any manner so as m become ubAea So the Workers .. ,
CompcnsationClass of California.Data' t
.Apel cat
•Ncome suj APP LICANTIr n making this Cenf t fEx -pt o hmr 1., r,
Z becom bjenmNe Wok sC 'pe al po 'starts ofN'lab CalYy umusS ”'
C
O fonhwnn comply with ch provrsions or Na perm S shall W d creed rtvaked. •
r - . .. .,_ .._ _ . .__ ...... ._. —.. .._.__
CONSONLENDING AGENCY '„' or
I he by affirm that them is rs a a conxwcuon lend ng ager y fictiffimperformande
of ate ink for hick Nrs perm i s rssued(Sec.109] Cry C) "
0.`m "Landi Ninim ..-. :. ., rn.i ..�. .: . __ .... ..-_._. ... _...._ ._.. .......... .. ......... .. . _ ...__ .,.. . __ ,
5•Z Lfndcrs Address
V.0 1 candy that I have read this application and state that She above information is
E.O to Wilding
agree to comply with allcityaut'and county cpcsidinances and state laws relating
C.f,J m Al vin-mentirociion; hfwins ctioierepreuntativex of Nis city So enter upon
[aj Nc above-mcnrioncd pmperry for inspection purposes.
(Wc)dgme'm save, andexpeandk which
in Tan woof Cbpcnind against
V] liabilities,judgments,cora and expenses this
whmh may in any way accrue against said
.U z City in conuqurnhe of graining of Nls permit "• 2� O
PMICANT,UNDERSTANDS'AND WML'COMPLY WITH'A-L N`�'-I`UgNrp
Dyt�ry5j ,E�cuLAI., •'` - Issued by: Dale
sit rreL �r .1 t Re-roofs
PP HAZARDOUSWilding
ATSR1ALS DISCLOSURE
hvallous
w n the applicant° rattae tat ld' tt mai dad T e of Roof
defined by N C pen Municipal Cod Chapter 9 12 and theH IN and Safety yp
(.'MC Sect On 2S$32(d1 .. , '/ h I 1 a. .e. 1 1 , I I•
❑Ye 1 u J° t v 0 r 'It 5 y. s , t
�n ( All roofs shall be inspected prior to any roofing material being Installed.
W mu .irccuento (mnrt defurng« pamuuequtp m tee a winch If a roof is installed without first obtaining an'inspection�I agree'torremove
emit he dons t m i.asd fiord by limits,AreeA Qu d'tyM nagement
District?
❑Y« t all new materials for inspection. Applicant understands and will comply with
�r Lw
I ,� all
non-point source regulations: 11T.4..
✓ +arire d Nc h z cius arena) gwrements under Chaps r 69$'of Ne - `W&Safety Code Sections 25505,25533 mM 25534.1 undersand that
g does not'c rrently have a tens tN t t 'ria n Y y.,heh 'q ire nts which mI,,W t p to' .Y s S S nntf S su Ce Of C rticdl ar
�. /B _Signature of Applicant Date
ep_a6< 1 '�"T— All roof coverings to be Class "B" of better
OFFICE-