02010059 OF
CI BUILDING DI ESIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
8147 HYANNISPORT DR
OWNER'S NAME: APPLICATION SUB DATE
HARRY PAUL A AND DORISni �� /FnnT
�\ PHONE: SANITARY NO. -CONTROL NO.
q..
4089962852
WOO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
u� O u CJ
aiw
"z LICENSED CONTRACTOR'S DECLARATION
z Job Description
OZy" I Iherchyaffim,thaltenlicensed under pmvisiona nr Chapter9(commencing
P5t with Section 7000)hf Division 3 ofthe Bung Ivhd Professions Ccle.ond my license
<y is in full force an if (� Q /7�,
i as Liceme Class 'LSc.a
a�3LL .Dme Contnisor er4 �<
rn ARCHITECT'S DECLAR ION
O g ; 1 cnWad myplan Ilpelp hegscd vs public recoNs
Z.� .LAi6��
6 a p O ofcssionvl
OWNER-BUILDER DECLARATION
1 hereby.ffund section
ect on 1 A.exempt from the C Professions
is License Law trade.
M?0 following reason. emit t 7031.5,Business and Professions Cade:Any city stcounty
Ey€O pdwhich req res a perm.I construct.epee nt far se h Permit,.
erdemolish, repair y station.
P sot ss once. B nalm.the applicant for such Perm s t f e signed sr r t
thatma is licensedwith Sar m theuproeiNtlim 3 of theContractors L Law(Chapter 9 I, a Sq. F[ Floor Area I p q ,- „� Valuation
,( th c,exempt
Seundin And
fhe hamana thealt sinee{{ JP!( nyviolation
il de) •, .s l• „ 1Y• I.
or that h v exempt therefrom and the baso for the ct%thet applicant
ape f n i
,.of Section than v any hundred
rot fora permit aubjeas the applicam ro v civil penalty l
valuer moremanr�ehunarcaealmr,(ssoo). APN Number Occupancy Type
❑1,as owner of the property,on my employees with wages as their sole compensation,
-
will'do the work:and the structure'is-not Intended or'oReSed for sale'(See:-]010,
Busaxim and Professions Code:The Contractors License Law docs not apply to an, �A[R.Q Inspections `
owner of property Who builds or improves thereon,and who does such work himself
-or through his own employees.provided that such improvement are not intended or ....,".._.. __.........._
,; ID
ff rpRfr3l Ifner twill havetrqi e burden vemeinngthat within one Year of - "".JFIN 1 7 ZOO
improve,
the o nm bit Wer ill have the burden of prov ng the he did not Wild or Q
improve(or purpo--of sale 1 L
-.OI a tutee property,am exclusively contractingi withlicensede noSnctotsm — - - - - .. ,
construct the project(Sec.70Y1,Buse andProfessionsilde)Thevesthreon, BUILDING
License La docs not apply m an owner 1 property who builds improves....eEn
rT�.".end ho cLie=n for such prolecn wiN n mntmctor(s)I'cnscd.pursuant.m rhes -
01Contractor'sextot License Sec.
❑lam exempt under Scc.' � • ' `S' ,B&PC fonhis reason' ,,„ tlg,,r^ '• ,
+bw'nei ••t; Dae" .".
WORKERS COMPENSATION DECLARATION
-Iherebyeftinnu de penahyofpej rybne fthcfollowngdeclarauons.--
,�It IO 1 have and will iddrnnn cm
v Cenifie-of Consent to self-insure for Worker's
a, 71 ',Cona,dwation. as provided for by mine. 3700 af-,h, Lebo-Code. for the
_ performance of She..,it for,whiah this permit is issued.,
❑1 hove and will di Worker's Compensation Insurance,as required by Seciion
'3700 of the Labor Code,for the performance of the work for which this permit is
numit My W qricer's C' p t d s c ier)a�nd Pol cy numlxrr ire:
Cartrcry h \;:Pat icy No0 10 + , r f 2:I1'' . .•
CERTIFICATION OF,EXEMPTION
TION FROM WORKERS' sC+ _.ss4' trJ '
COMPENSATION INSURANCES"+"'t " 1 _
.._ .,.. _-._.._.. .. . ,,_. __
pph's s von Aced'am be coinplend lithe pe mit hs f r one hundred dollars
v.(S 100)nr Ives 7 ;
shall not employ� tion m an manner so o m become sub ea m the
1 t fy,that the'rperm anydomma f th work for which this ct mite issued,i, -
. ws6f any 1 eWarkm,
'Com'Applitant icn Laws of Calilomip.Date
.ofN i6orcFTOAP.one W.T If Compre k gth ownicic to f, Lintxa codrn.you should
'bceo it 1)e comply wi W rk P C mpen on,pro ,tons of the Lab Cale y um'r'
0 0 forthwith- .-.sv,[h such pro dans o th s perms nhall bed ed oked s
"y-CONSTRUCTION LENDING AGENCY
} ""'1 hereby affam that Nem is a construction lending agent,for She pedom,ance
.w
N ora forwhich N s permit is ns ed l5m l
09],Civ Clander',Name _
L c
ad Address
t� .t.. v.t ,7—
I citify that I have mad this applicationd state that the 'nfommlo
rn s
ti. c nett.I agree to comply with all city ltd county ordinances and n te laws rdming
-Q ;to building .truer n d hereby anothamoIc rcpmsemtive :frh.cry to eater upon
} gym
nine bo atoned p pony f -aspe a n purposes.
(•" d 'IW jagrce di ae far
and keep hatioult,7,iiii,Cry fCupceino agamn
to '.lialbilides,judgments,costs ndxpens which may,in any ay acme against said
C,7 .Z., ...City consequence f theg i g of thi petr,i I. 7�
Af'PI[CANT UNDER$rA�NUS/rN�b WILL:MNIPLY WRFI ALI NON-POINT' Issued Date t/ V
(SOU L NEe UTA.TIONISI _ V'� n, Q� Y
. .16.,uterd ApplicanJContracmq - •/ Dale Re-roofs
-'HAZARDOUS MATERIAL$DISCLOSURE -
} ;,t' Wu the applicant or future building occupant store orhandlehaaanlous material .,_._Type.of Roof ._.._ , _. ...-......a ..... .., ..,.._.._,......_ .._
ev defined by,the Cracow Mumctpal Code,'Ch Pmr 9.12 and She Health and Safety ...
,CdeSection
255320 .,
$'• _ All-togfs shall beinspected prior to_any roofing,material.beteg installed.__,
Will the ppl t or future building ocp nt uxec,tipment orticsiceswhich If a roof is installed without first obtaining an inspection;1 agree to remove
earn hti rdmx no contaminants as def d by the Bay Area Air Quality Manage r
n mer all new materials for inspection Applicant understands_ and will comply with-:. .
• 1 ❑Yek l
,F, ,'% - N° I. all non source regulations,",(
{ 1 hove mind he hat dot.,,...renals reqs imments under Chapter6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand chat
';o c occupant
of
d«quirem mady nts which
must its,mbm it is my responsibility oiBry mnBcate of - -
oc u a t f th r 'rem nn which m u h met of a Cenificme of " '
P 9 , � p
"Get, `Y - /// �1 Signature of Applicant _ Date
issuance e
n+ ne or atihar,zeaage t '; ogre, All roof coverings to be Class B' or better,
r
. _ OFFICE. ._.. .. .. .._ _ . .... ..