00070127 CITY UO NGUPERTONNO' PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: ��• '' t /� �/ PERMIT NO.
OWNER'SN UR APPIAI:ATIo r:
EN
ZONE: SANITARY 07 7`2a
�
MOO BUILDING PERMIT INFO
f
F w BLDG ELECT PLUMB MHCH
2 b v= LICENSED CONI°RAC'IOR'S DECLARATION Job Description
OZ_� Ihemby allinn dhatlum limnud under pmvisionv of Chap¢r 9lcnmmencing
FmC is in full sone0W)of Uivlsion3 of the lfnsincss and Pmfevshmn Code.and mylittnsc
6 m 8 is in full three ec
soap Lieenxeela., ,�'�rc BATH REMODEL
3 e,a• Uate Contra or
ARCHITECT'S DECLAIIAfION
h tour—{'O g I undersand my pl...hall be used.,public amounts
ON
Licensed Prolcssiunal Imo.
Uat lam erupt from
DECLARATION S
w_H 1 hereby.then that I am exempt from Ne Contractor's An,,law for the
t_ < following reason. errs Section]onstr Business and Professions Rale:Any city ,county A
Ser�i❑ which requires sperms m construct,L alley,impmsu demolish,or repair any ewaure
3$ ,has he slive,uied pu an temomires the applicant for such paminoiverole ac aw(Chaoem
(commencing
licensed pursuant minep f Division the the Busmrs Liccmefiewmes Cale)
or
Sq. Ft. Floor Area Valuation
Icnmmlie ins x'iN theref]qp)of Division 3 or the Business and ion Any vi Calc)
or Incl io is exempt zany application
li and the Pers lin the alleged exemption.Any violation
of Section 7031,5 iv any applicant for o pemtit subjects the applicant a civil pennhy
efnetnm,minanr.ennaNedaenars(s5uh). APN Number Occup$ e
❑I,as ow nor of the properly.or my employees with wages an their sole compemmion.' -
will do the work,and the structure is not intended or oBored for sale(Sec.7044, I/I ,
Bu,,mr,s and Profexslonla Code:The Cnmraclnrs License Law arias not apply a3561 1020.
n an. v00julred Inspections
owner of property Wbo heads or improves thereon,mad who does.such work himself
on Ihroagh his own employees.provided thaLcnch impmventants are nm intended or
offered I'm sole.If,however,the Willing or impmvcment is sold within one year of 101 -- FOUNDATION
completion,the o Boor l u1Wer will have the harden of proving that he did not build or
improve for porm,c of sme.I. 102 — PIERS
❑L a owner of the pmlkrty am exclusively contracting with licensed commerce,to 103 — UFER
constmet the project(Ser.7044.Ro,ine,and Pmfcc,ion.,Code:)The Contrtcia c
License Law does sad apply to m ov her err pmpenr who buimr roves m
or impotion. • 104 — REBA R
and who comf rt, for m¢M1 project,with n wntmcargel liwnaal p....wnt,m the
Coursed,;.LieenwLaw, 105 — ANCHOR BOLTS
❑I am exempt under See. .It&PCforthis reason ].06 — SEWER & WATEROwn Date
WORKER'S COMPENSnf[ON DECLARATION 202 — UNDERFLOOR PLUMBING
I hemby affirm ander Penalty of perjury one of the following declarations: 203 — UNDERFLOOR MECHANICAL
G I have mod will maintain a Cemfiewo or Consent do ofif risme fm Workers 204 — UNDERFLOOR FRAME
Compensation.as:okwedwfornby Section n37091 f me Labor Cade. Int the, 205 — UNDERFLOOR INSULATION
performance of perm
❑1 hate and will maintain Worker's Connpcns:nion Insurance,as required by Section 301 — ROUGH PLUMBING
3]q)of the Labor Code,for the performance of the work For which this permit is
nxow.h.worker.coin n,atioh msaramce eerier an Parcv nannbet.tt; 302 — TUB & OR SHOWER
Carricr:J`� PowynL SU' 303 — ROUGH MECHRNICAL
CERTIFIC ION OF EXE xI
COMPENSATION INSURANCE
304 — ROUGH ELECTRICAL
(This,edenneednatxeampleleddtheperndiaforIohundreddollars 305 — FRAME
a100jorles,.) 306 — HOLDOWNS
I certify that in the performance of the work for which this permit is issued.1 . 307 — INSULATION
shill not employ any person in any tnanncr so as u,Pectin,subject a1 the Workers'
Compeoation Laws of California.Dam 308 — SHEETROCK
Applicant
NOTICEI0 APPLICANT,If.after making this Certificate of Exemption.)on should 309 — EXTERIOR LATH
become subject m W
the aloces Compensation provl.dons of the Labor Code,you must
Z0 forhwith comply with such pmvisions or this perm shall W deemed revoked. 31.0 — INTERIOR LATH
E o CONSTRUC [ON LEN DING AGENCY 311 — SCRATCH COAT
a herby which that mereisanamed(Seconstruction. leading agency fin Ne aarnaaee 313 — ROOF NAIL
of the workfar.,which Ih6'pemtil L issued(Sec.3119].Co.C.j
C. Q Lender's Name
5 z Leader',Addre, 501 — FINAL ELECTRICAL ENERGY
C 1verify that I have read this application and state that the above information is' 502 — FINAL PLUMBING 'ENERGY
comet.I agree to comply wird all city and county ordinances and pate laws relating
O
to building commection,atud hereby notherim representatives of this site to color arm 503 — FINAL MECHANICAL ENERGY
r�
he above-motioned property far inspection m,am,
p a (We)agrccmous,odenumly ad keep himle,sthe cit,mCmctinealmost 504 — FINAL BUILDING ENERGY
m liabilities.v judgments.copx
s and expers which may in any way accrue against said
a e I - ,z City In Gtnsegnrye grunting amts prsuut. 505 — FINAL ELECTRICAL
�' AP Orr ' ST D. AN WI H ALL N NT
y ' Issued by: SAS — GAS TE9S Date
Sigammot'Appielnvcon oar ate Re-root's 507 — FINAL PLUMBING
HAZA DOGS MATERIALS DISCLOSURE
WillthcnpplicunlarfutureWildingnetspumporeorhandlehtaadou.matenol Type of Roof 508 —•FINAL MECHANICAL -
as dello d by the Culietino Municipal Code,Chapter 9.12,and the Health and Safety
Code Section 25532(a)7 - 509 — FINAL GRADE '
°Yes 0N All roofs shall 1,btlipspectgtl]prjA1 to piltypplllftlpaterial being installed.
Will the sipplicant...future Wildingeimpanl use cyuipmem or device.which If a roof is instc ye¢witht�ngl'URiI"b1n1719fi�tCin1�PE]FpR�1 agree to remove
'mit hoarders air contaminants as defined by the Bay Arca Air Quality Management
ytntrell ❑Na all new materials for inspection. Applicant understands and will comply with
0 Yet all non-point
/source regulations.
Ibase mad%c hazardous meatenat,tals hitis is cras
under
dloblyono95 err the �//uiLl.•1:�sri_h .h/�-�/"�
C.hood.l lealih&Safety Code,Sections 25505,25533 ad 25534.1 undcmtand that
if the building does not currently have a tenant,that it is my resplm.xibibty n,notify the
c pantpI if m ire j/s which tuua hu met print m iss a of a Canificme of
°Ce J'y Zm /n �— Signature of Appli ant r Date
Mrc,,rrnutnar;,ed,tatoms -'=�• Dale - All roof coverings to be Class "B"or better
OFFICE