00100099 CI DINuwvoND
BUILDING
UI iNPERMIT CONTRACTOR INFORMATION: - -
BUILDING ADURM72 HOLLANDERRY PL PERMIT NO. 001,00099
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GWIBER's NAMIEDWRRDS CATHEY L APPLICATION SL#STWF] 2/2000
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ONE: - SANITARY NO. CONTROL NO.
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O O O ARCllffl!Cf/ENGINEER: .. - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
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LICENSED CONTRACTOR'S DIiCLARATION
0 5 y 1 acrehy allam mm 1 din ueensedunder f cna,tcr 9lconnmencin Job Description
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p_C q wimsecamnaamrrn,,,mnJanneea,me.,amrmlcx,nm,enaeandn,ybc<na< HOT TUB
i,in lull Trace om�adl alf•t.
x z License lax �%1 V uc.a r•g �Z�.
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Dole
Contractor
H=O ARCHITECT'S DECf.ARA'rl /
,g 1 undenamnd my plan,shall W used as public record,
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a a 7 o LicemeJ Pro(a>ional
n
OWNER
rn exempt
DECLARATION _
I hereby affirm thin I am exempt from the Comms Cu ldvvur Law far the
�?� Influalwhich inquiresaalmaim. it tooJLS.Rusinosandive,ilsinm Cr de:Any city or county
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which t ymre almait t t he p , I'h p any structure
a 3�
priorh d. requires' theapplicantclaim
h Permit t illBilsigned aw(Chapter
hapteem
be it :rc with
. . 0 p fm C mmct r I eneL,.am,Ctdr9 Sq. Ft. Floor Area Valuation g0
(cnfue he eada,a therefrom
om adf a halt,
J, he em tuns and Prnfeany AllorammoO ,
m Sero Ira 7 31.5 b zany applicant
li antl he nasi,fm the cs'lal exemption.Ani,vialoary
ofnla muIID1Sby troyapplicantrowpermit xnhjcaa Sha npplkam macivil pmwtry
.,Toon man do,ia d,e hundred drillers tasnnl, APN 6`JM�TqQiOq 00 Occupancy Type
1:11.as own<T of the pin'tod"army employees with wage,as their sale cmnpensorina .
will Aa the work,and the mmenre Is not intended or offered bar sate(See.]r W, ,.,t��� ,,f.y�a� —
Bu,iness and Irafermum,Coad:The Convaem's Licen,u Law Jae,net apply to an 1.01 — Fd4lfi dmf Jr0p$clions
owner of pmpeny Who builds or improves thereon,and who Joe,such work himself
it,ramal his awn employees,provided but such nnpmveinenb are nm intended nor 1.02 — PIERS
offered for sale.If,hon ever,the building or improvement is sold within one year of
impletion,the owner-builder will have the burden of proving that he aid not build or 1.03 — UFE R -
mp rovefar pummeorsale.} 104 - REBRR
O 1.as owner of the pmpeny,am exclusively contracting with licensed commcmrs to
construct the project(Sec.7044,Business and I'rofcuima Cude:)The Contractors 105 — ANCHOR. BOLTS
License Ltw dues not apply a an now net of prapeny who builds tar improves thereon,
and who,contracts for such projects with a caatrammty Ecensctl pursuant in the 106 — SEWER & WATER
Oia e uea'
mlntra drs , ,R&PC mrmi,reason 2202 — UNDERFLOOR PLUMBING
Owncr Ddc 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSAHOND1:CI.ARATION 204 — UNDERFLOOR FRAME
I al,ebyWrote under penallyofpcop,ere athe fa0how ingAaclarafoo ns: 2051 — UNDERFLOORINSULAT-ION
brae dad will maintain a cdrtificatd of canned m self-m,nre far WToo's301 — ROUGH PLUMBING
Cnmprison., a provided for by Section 1700 of the Lam, Code, for the
perhannanceoftheworkforwhicnmisNomili.issued. 302 — TUB & OR SHOWER
0 have a„an ill mountain wmaiCnmpen,aiiotInImurce.its regairedbyseedian 303 — ROUGH MECHANICAL
1100 of he labor Cade,far the pdrfcar anc<of the work fur which this permit is
issued.My worker,Compensation Insurance carrier and Policy number am: 304 — ROUGH ELECTRICAL
canner: Policy Ne.: 305 — FRAME
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 — HOLDOWNS
(Thi.,section need nm he camplaed it the permit is h,r are hundred killars 307 — INSULATION '
Cof)(0)mll,
• It'fy 111' th pef �, Ith rkl Ill the pc ram 'esucdl
308 — SHEETROCI<
xln:u t p nt r t n 11 hidtt d Nmkers 309 — EXTERIOR 'LATH
ni plrI'll
ta:Dt 31.0 — INTERIOR LATH
NOI ICI TOA l(CANT If h k g th C A 11 t o xct pl n Y shoulJ
-rou
Z on< ,a,anl,e mew rk<r,eampen,attnpr n:done Labor e,ctc.yea mast 311 — SCRATCH COAT
”mutwimc.moywimsadnpmvaxion,onni,p<rmaxhwtnedcemearevokdd. 313 — ROOF NAIL
f 4 CONSTRUCTION LENDING AGENCY
I hereby affirm'hatIn=is a construcimn lending agency for the performance 501 FINAL ELECTRICAL ENERGY
7 of the work fur which oris Permit is issued(Sec.7097,Civ.CJ —
e p
Lconalf Name 502 FINAL PLUMBING ENERGY .
o z Isr,aer,ndere„ 503 — FINAL MECHANICAL ENERGY
UI aci ify that I have read this application and state that the above information is
crectr l agate 1.comply with at)city a ad raimyodmances and,tell laws admin,
— FINAL BUILDING ENERGY
0 (J rahWilding construction,and nearby authorize represcatative,of this city to entrr�upon 505 FINAL ELECTRICAL
.r, W me nbave.mentitmed property for mspemian pumasc,,
p p, (We)agree In,ave,Indernmyuadkee,larmlessthe City afCu,am , mars, 506 — GAS TEST
r. A liabilities,judgmenlx,costs and expense,which may in any way acerae against said
v ser' p nada grananganni,per'ni` � 507 — FINAL PLUMBING
AP .I NDF AN SAND WILL COM PLY WITH ALL NON-POINT
50 C. FALS, - Issued y: ate
Sign eco pplicanUCoalraem Date Re-roofs 509' — FINAL GRADE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding necupam Hare or handle hazall mmenal Type of Roof 510 — FINAL PLANNING
as defined by he Cupernao Municipal Cale,Chapter 9,12,and the Health and Safe,
a,de, a tido 25532m)? 51.4 — FINAL PUBII„IC WO.R�S
°}" ON. - All roofs shall be inspected prior to any roo mg mater a being installed. .
FNill the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
•mihnzonlous air contaminants as derinel by the Llay Area Air Quality Management
,aey all new materials for inspection. Applicant understands and will comply with
t
t n0 yd; °No all non-point source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
calbi Health&Safety Cnde,Sections 25505,2553 and 25574.1 umadden
Il the buil ng do snot carr dy hnveatemm,thm it is my resrymsihilityanmify the '
Occup to X11-11 mhe treat be met prio, u I,,uance of a Cenlfc r of
met prior a Issuance of a Certlfc r of
ncmt y.
, Signature of Applicant Date
d agent
Date r All roof coverings to be Class "B" or better
OFFICE