01070150 crry OF CU['E RTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22331 KENDLE ST 01070150
OWNER'S NAME: APPLIC TION UB DATE
SCHOOLEY LOUISE B 0731/2001
PHONE: SANITARY NO. CONTROL NO.
OpARCHITECT/ENGINEER: BUILDING PERMIT INFO
Fu.2 Bj_DG ELECT PLUMB MECII
�<i C 1 I= LJ
LICENSED CONTRACT'OR'S DECLARATION
z 5„? Job Description
z_C 1 hereby affirm Sha I n 3licensed under provisions Professions
al 9lcommnming
p_t_u wimSation 70001 of Division3ofmc Business and ProfcssimntCod�^nil ter Rance REPLACE WINDOWS & DOORS .
a I< is in all force and t.
Eicz¢ is in alCorc c ` � Lic.p 793LLX F
w3 u DamContrition,a.
F g ARCHITECT'S DECLARATION
1 undemm�d my plans shall be a tib a records
y' tionax r 9 dY b"'i ��iiv
2._30
Licensed Profcs,iomll
oPe OWNER-BUILDERE LARATION
I hereby affirm that 1 um exempt from the Contractor's License Law for the SEP P 2001
t_z a following reason.(Seed 703 1.5,Business aad Professions Cade:Any city or county. J L $8380
E=7 which requires o Permit m construct.almn improve,demolish,or repair any structure
w 3 ce—=. prior to ill issuari also requites the applicant for tach permit to rile a signed statement - -
metheislicnsedpursuannotheprovisionsof the Contractor'sLicense Law(Chapter 9S Valuation
(,..,act. an
with Section 7WO) if Division 3 of the Business d Profession,Code) 32'tP V.1 H��W7N\A
or r Wt tie is exempt therefrom aM IM1e basis for the alleged exemption.Any vWmicr
f Scai.7031.5 by any applicant Tor a Permit subjects the applicanno is civil penahy- �,,aa�,.,,�
Vmore than rive hundred dollars 6500). 101AEN lNeV.VYJAT I ON -"<`•:' " Occupancy Type
/y
willd ownerofthend the structure
my amplot inwithwagesfeedfsolele(S .compensation,
will do the work,and the rwame e,-int ia¢neeace offered for (Sec. W an 103 - UFER Required Inspections
'Buiiitess'anJ Professions Cradle: no Comranor's License Law does no apply to an ' -
.o
owner of vi Who Wilds or improves thereon,and who does such work himself 104 - REBAR __
or through his own employees.provided that such improvements art not intended or '
-:oQered'foi ehle'If;M1ori:the buidin - '--- - tis sold wit6nn one_. -f- ---- "-"-_-._ _ _..__,_ ._-t_ ----_--_---.-__-- ---- —__
ger nmproomrn r=aro 105 - ANCHOR BOLTS
idrprove far me comer-budder sow have me Widen of proving that he ilia am Naim are
mprove Tor parpote ar,am.l. 106 - SEWER & WATER �
- - - - - "-- - -- ... _.. - - -- - — ---. .--- - - ----
❑1,as r of the propenyl am exclusively commaung with licensed contractors to
- - -� --� '..
= construct the project(sec.7044.Butimexs and Professions Cafe:)The Contractor's 203 - UNDERFLOOR MECHANI CAL`11
License Law does not apply man owner of property who W ilas car improves mereon.
2 _and who coatrads for...h.pmjccm with commandants)licensed!pertaam.m me. _ _. -- --2 04- - -UNDERFLOOR--FRAME------------------ -"-------'--
elptund
Contractor,Is.W "` "1 " B&PCfor this reason 205 - UNDERFLOOR'''INSULATION
OwnjDar �` C7 301 - ROUGH PLUMBING
5 MPENSATIO DECLA ATION 302 - TUB fie OR SHQ?ER�- -._.._��.,
Ihe2hy aRrm amaer power or l=ri�ry meofthe mBmvingdenamtionc 303 - ROUGH MECHAIiI CALzk\ �l '
❑ l have«ta'will mainialn'a''Cerdic:ne.r cmusem'oo sell-in.me for workers 304 - ROUGH ELECT I�lt'AL L.1
Compensation. as provided for by Section 3700 of the Labor Code, Tor the tl'
--_ pxrrarm ines'of the wodi for wmm mi,, 11 c nxf5a.. 3 0 5 - FRAME
�v and will mainima Workcr's Cmiupnisation Insmmnec,as required by Section 306 - HOLDOWNS JUL 3 1 2001
Nat fine Lahor Code Tor to performance or m ark r which m,permat is 307 - INSULATION V/�
issued MY Workers C pe I.Pm - d Policy be arc '
_ _.,. 30.8,.__._SHEETROCK g r,.--. _ . - ..
t ( ICERTI ]CAI ON OFEXEMPTIONO WORRIT'� eas, 309 --r 'EXT'ERI'OR liATH •�-�--�
COMPENSATION INSURANCE "" '
rTnttumdnneed�otxtnmpmtedlrtnepermir, ,..•�. -INTER3'OR-'--liATH--------- - --- ----'--
'." 1 i,Tor come haalree dolmra 311 11- SCRATCH COAT I
31-3 - -ROOF NAIL �.
I fy ma In IM1' performancehe k f loch Ih -p t` ',sued,I '
'sM1nll trot a nploy any person In any manner w si m beconm sob set to the Woikers 501 - FINAL ELIECTRI CAI,'`"ENERGY
co t u ,,q- ' : I.. _,_.. 502 .--.-FINAL._PLUMBING..ENERGY_-.
'AVN m - .: -_. - _.: _. ..
.NOTICE TO APPLICANT:It.after making this Certificate of Exemption,you should 503 - FINAL MECHANICAL"ENERGY%
become subjat m tM1c wtirk'eIs Compcnsarion Orovisions o(me LrWr Code,Too must
pLed. ._.__ _ - _.... ._504....-_-FINAL_BUILDING..,ENERGY_:..._....__.._..___ ._—.-..
(CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL It'.
E-4I heleh9 arms Lha mem! c nsmacron lend g agency f m peifomance lYr '
> mflhexmrAflrcwhicM1lh PeLx,.,a�a(e �uq7 ci..c, - 506 GAS TEST
n LtndertName.' .w ---, -. - -' " 507 - FINAli PLUMBING
U%Z linden's Amilea._". •. : ... - crP
U:0508 l tacitly that l have r<ad,hi,application and nae that me aW.e altimeters is FINAL MECHANICAL
-
k*" F �uurect ! gree w reply 'tit JI c sy nal counsy o d Ila roe xf s't 1 s rclnOng
509 - FINAL GRADE
Q U
to building construction,andhereby authorize otp . tai e.!df this ly to enterupon 510 - FINAL PLANNING
,he W i d p IKnY r P<t P fpm.'
p...n. (W)aaoie to indemnify andkeep harmless th'etyofCt'per gain,` 514 - FINAL PUBLIC WORKS
to (lab fides judgment,,caws,and expenses which may in any way accrue against said ^� ,y
U-Z Cityiriconuqucwcofihegbantingofthiipermit."'
APPI.ICANT UNDERSTANDS'AND WILT 0. PL WITH ALL NON-POIZ-Tr
SOURCE REGULATIONS. Issued by: Dille
- Date" -roofs
•srig a rcofA'ppl anVC rocw
;HAZARDOUS MATERIALSDISCLOSURE I
Will the pplii I or future b ldm p I: or handle hseasmaterial Type of.Roof ......
os del edbyme Caper ohluq opal l]We.CM1apInr91_.and the lleahh and Safety
Code.Section 3553_'1 1 ." _ •
'Dues .. ,All roofs-shall be inspected. rior.to an roofin material.being installed.-- ..._._
.. ,;.;.,.�yai,Ihazppboanw�rawm WiiCfngoccup:Inidseegaipmemard=,'iee:wn;en, If a roof is installed without first obtaining an inspection+'I''dgree•to remove
. enot hazardous air contaminates osdefned by the Bay Arra Air Quality Management.
r
District' � all new materials for inspection..Applicant understands and,will comply with.
nY ry",IT I(ruN6 f r -''i' - ` - all non-point source regulations,
I hose read the tr iadout mien 1 req Immems u J rCh ptei 6.95 of me '
Culifoirma tlealrh&Sorely Code,Sections 35505.355.33 and 1 534.I urdersand that
riheblJng doe. Ic alyh tenant:athlt myrcpon.'blty r roily the '- - '- -- '-'- - -' ' - - - - -
6c6upmad of the requirement. which.' I he t a an f C nirica f;
.14
Occ p cy ? /(jfy�.a I
�7/I /`v`/// _ SignatureofApplicant._. Date
Owner aamonaea nay—ti- 'I
Data All roof coverings to be Class "B" or better
m
7
ila)
N , - - OFFICE.. . ..