01010028 CITY
IC o VIN
SIONO
ILN
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
10345 FARALLONE DR BATH ROOM INC, THE 01010028
OWNER'S NAME. APPLICATION SUR DATE
MIYAKAWA YASUHO AND JULIA E 1910 W EL CAMINO REAL 01/05/2001
PHONE. SANITARY NO. CONTROL NO.
(415) 968-7666
G 0 Q ARCHITEC'IAiNC,INEER: - BUILDING PERMI']'INTO
6 u❑ BLDG ELECT' PLUMB SUCH
yZm I= CI 1_1 1=1
LICENSED CONTRACTOR'S UECLARA'I'[ON
z S H I ter n Il inn thin 1 am licensed under r Chan 9 m�,mmenem - Job Description
OZ_ cyu provisions per e .
f=y�
with seenon 7axnuromismn3Pnno Bndne,5nw rrtte,xlnm c«m,ttna.,y Rccnsc
Y s is in fill bunco,and effe BATH REMODEL
3 LL y License C�u, Lie.x
N Dme cmnneo,.
ac 0 ARCIIITECI"S DECLARATI(IN / v
to I understand n,y plans sh4all used os public reaoNx
w s p O Licensed Profession tl
OWNER-BUILDER DECLARATION
w= ` I h<mM1y afdmt That I am exempt(inns the ComtazuTs Licenm law for the
i—?< following reason.(Section 7031.5,Business end Profe,inn,Code:Any city or many
SFO which requires to permit to cunswet,clan improve,deme Ibh.or felon,any sma,bire
uatl3� prior to its issuance,also requires the applicant far such pamtino E lensi,ned smicuumn
that he is hoauel pnrsaannn me pro,won-a the Carom ars Limns LPw(Chapter 9 Sq. Ft. Floor Area alu&tion
(commencing with Section 7000)of Division 3 of the Business and Pmfcmlon,Calc)
or tent be is exempt murellom old the nasi,Print,alleged eve "Pt,Any violation •AIV W'
of Section 70.31.5 by ua,applicant for a permit auhjcets tee applic,nt e,a ol,d penalty
of ttn,dInn,live natdreadaums(s500) APNNumberOccupancy Type
ol,a.awne,af me propert,or my employee,wit,wages us@en,ole conaursatian, 36931015. 00
will do the work,and the structure is not inici nr Offered lin sale(See.7190,
'Ilu,iness and Professions Crede:The Coatmeur's Liame Law does not apply to an Required Inspections
r of p upeny,Who builds or improves thereon,and who do,,mch work himself
Or through his own employees.provided that such improvements are not intended or 101 — FOUNDATION
offered for sale.If,bnweved the building or improvement is sold within one year of
nmpleia:,the owner.hnime,will have the barren nrpmving that be did nut nand a, 102 — PIERS
nproveforproposeaf,.Idf, 103 — UFER
C3 I.as owner of the property,am exclusively connoting with licensed cnmmemrsa, 104 — REBAR
mctmn the projem(Sec.7UW,Business and Prufmsion.s Code:) Due contractor's cense".due.,Out apply ma a Posner Pr prope,y who build,mimprovesmne.., 105 — ANCHOR BOLTS'
and who summa foe such pmjca,with a cnmmcv,rsl,sena puns...m me
CotdrwPu,License l.aw. 106 — SEWER & WATER
❑I nm exempt under see. ,li&Pc to his Person- -
Owner Dore 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSAT?ON DECLARA'ION 203 — UNDERFLOOR MECHANICAL
• Ine<bynrdnttunder penalty ofperjury one olthe tdnw10gdo0lanioas 22_04 _ 'UNDERFLOOR FRAME
a
o I have d will mamtnin a comficne of Coarsen, Po wlr.inmre m,worker, 205 UNDERFLOOR INSULATION
Compen,rawn, m provide) far by Section 3700 of the Lunar Code. for the
perfnrtternee.renewurkforwhichhisFerem,isi„Ped. 301 — ROUGH PLUMBING
01 have and will maintain Wnrker'.s Compensation Insurance,m required by Section 302 — TUB 8 OR SHOWER
37x1 of the Labor Cwe,for the performance of the to k fur which this pem,it is
I My 303 — ROUGH MECHANICAL
issue W'nd.er.Compenseho nwnnce canis,and Policy n inner arc:
canie7 eieNa:
C !jAI OF EXEMPTION PROM WORKERS' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE 305 — FRAME -
fl'his mninn need not be completed ifthe pannit is for on,hundred dollars 306 — HOLDOWNS
($10(h n,Ie".)
307 — INSULATION
anpl thin in the pest air,ma of the wore ren which ti,o,P, a orke.I
Chau not cntn L any person m my manna,se,aC m nea,mt,,anise to me wu,kee. 308 SHEETROCK
Applica,mionLawxurcmimtlr.Dnm 309 — EXTERIOR LATH,
Applicant
NnncIi TOArt)the ork If.after Puking mi,Rnmcmo of Exempdtde on you 310 — INTERIOR LATH
Oz CMorons nnbject m the Worker's Compunxmon provisions of me Lubt C,xle,You most
roohwid,c,imply with such provision,or this perthit sham Ise deemed revoked. 311 — SCRATCH COAT -
(Z) CONSTRUCTION LENDING AGECY
E~ 1 henhy affirms that mere is aconsttuction lending agency to,the performance 313 — ROOF NAIL
ay ollheworkfee which this .,it isissucd(Sec.3rl97.civ.C.) 501 — FINAL ELECTRICAL ENERGY
'� Q Lender',Name
D z Lumber',Add.,, 502 — FINAL PLUMBING ENERGY
I verify inn l have resdmis application and amethauhc abuse inhumane.is 503 — FINAL• MECHANICAL ENERGY
F.. correct.1 agree u,comply with all city and county ordinances and state laws relating
meb nl.sconsumerou � lonlonr hereby authmin
pm, ttive`of city to enter upon 504 — FINAL BUILDING ENERG�jj
F p (w)agret fyaadk ph i' meCity fc p snag mt 505 — FINAL ELECTRICALL/�//
.. y line t ) Ig t. n. d pc ses which h n Y m any way Perna,against Pia 506 — GAS TEST �!�- _
U Cit) tcovsngharecut the gr antingor this permu.
APPLICANI'UNDERSTANDS AND WILL OMPLY WIT U At.] f/ON-P/1Iy�T/
SOURCE N' �1LA 1
S. 1�.5 //'// Issued byS07 — FLNpI pl I]MR INS, Dale S �•
S;gnimrei SpPrenn tmnactor - Nadu - Re-roofs 508 — FINAL MECHANICAL
' IIA•LARDOUS ATFRIALS DISCLOSURE �.�p FINAL GARDE
NY JI the applica I or 1tore budding weeup P.nonen,handle hamNou,material Type of R59•' —
as Jelii A by the Cnpenino A mcipal Cude,ChrFoe 9,13,and the Health and Safety
Core,suction 25532m)? 510 — FINAL PLANNING
GY” No All roofs g4il4bo-inipaoRALpriWWBinlEboNfib9KEerial being installed.
Will the applicant m fnum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hv.allous at cotnxmino I m defined by me Bay Arta Air Quality Management
minae(, all new materials for inspection. Applicant understands and will comply with
❑Yes . No all non-point source regulations.
I have reed the IntraNau,material,requirements under Chapter 6.95 of the
Califorma liculth k Safety Code,Swions 25505,25533 and 25534.1 undentmd thin S
Soex oat currently masse a tenant,than it is my rnMmsihility n,notify the
11 requ mium s ch must be net Pnor to invnanm of Certd tie nSignature of Applicant Date
r,.2_„gen t: C o� All roof coverings to be Class "B"or better
OFFICE