01060027 OF
CI
BUILDING
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'5 NAME: APPLICATION SUB DATE
PI{ONE: SANITARY NO. CONTROL NO.
o¢z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
i7 H z 1 hereb report that I ata Neared under f Chapter 9(commencingJob Description
_C yprovisions o p cr
•or
with Scxhm70d(B ff) tion 3ofine Business and Pmfessions Code.and my license
Y< is in full force and of
,��U Date Cl' , Lic.p a�UC INSTALL SHOWER SUB-FLOOR DAMA�
Dam Canlmc,or
v.O Yrs ANCHITECI"S DECLARATIO
I rule.pard my plans shall W used as public,mord, /
E p 5p Licensed Professional .S /
OWNER-BUILDER DECLARATION
u� 1 hereby affirm Ihit 1 um<a<mp,firm the Comraanra License Law for the
following reams.(Seal..7031.5,Business and Profession,Cale:Any city or county
E 0 which requiresa permit to a Lac, alter,improve,demolish, p Y structure
n 3 c Ino i ',.issuance.alsoeq thet such pe nitt fl signed iatenem- - - - - p - - -
tnathe 1 c dpursum, Thep Inn fin C evaanr'.wce. La (Chrphnit S - Ft. Floor Area Y ation
(commencing with Sect 7000)of Division 3 of the B lies adProfa ns Crile) �f .-a q'. ,--� - � v _s' 3•_{ t-) •� � 38-
or that he is exempt therefrom and me basis for the a ilegrJ'eifmpubri.Any violation
of Section 70315 by any mpplicam for a permit mbjecis the applicant,o o civil penalty �f�y� f�
:of not more than five hundred dolmrs a50XF. 3 5�P1 U "`b .I Occupancy Type
°1,as owner of the property,or my employees uhh wages as tneir sole compensation. I
win dstreet=o the work,and the set=is not intended'or offered for sale(See:7044,
'Buxines and professions Code:The Contractor's license law does not apply to an 101 - FOUNDAT j!bWired Inspections
owner of progeny Who Wilds or improves thereon.and wW does such work himself I
or through,his own employees.provided that such improvement,are not intended . .. . 102 PIERS
offered for rule.If,however.,he building or improvem<ni is sold within its year of
.completion.the ownerhuilder will have the burden of NownBma,he did in,build or 103 - UFER '
improve fur purpose of sale.).
_. . .in . ... — 104 — REBAR. —
°L p owner of the progeny,am Business a contracting with licensed:) he C.I.r„o j
(Set. pooie,aproirorwmilxender) unecnntraopup 105 - ANCHOR BOLTS
and wh i.aw doe,nor apply man owner of a amar won,olide sed ymorme 0emrn. .
..
and fie eonice"'a aw, pmjuet,tush a enmmaI Ban.ua pu uam.m nm .. _. 106- — 'SEWER....& WATER... t....__. .
EIImoreexempt`��dersc. .0&PCR istea,or 202 — UNDERFLOOR 'rPLUMBING
Owner Dam' 203 — UNDERFLOOR MECHANICAL
- ' WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME
• Ihereby affirm under penalty ofperjury yonc,orthe following declambnn,: 205 — UNDERFLOOR INSULATION
? have'md will maintain a Certificate ficate of Conem s<I4mtn infor Worker,
compensation as Provided for by Section 37W of the Labor Code. for the 301 - ROUGH PLUMBING
peerormanee ohne woek ror,wbmn mix pemtp is ix,tmd. 302 - TUB & OR SHOWER
❑I nate rina'wnl n,amtam.aorker>Compensation Insurance,as mgbireu by Sector.
303 — ROUGH MECHANICAL
3700 of the LaWrCode:for the pinfahounce or the-usurL for ohich this pent,is
issued. W�t? r�px./cRninPg ix n1.ur aPur bi304 — ROUGH. ELECTRICAL-= —___ ._--- —__ . .-
_.r�, I fTriY_li -.'Posey No t.�.:. ,. � .,. . • .
c FRAME .
CERTIFICATION OF EXEMPTION FROM WORKERS f - '
COMPENSATION INSURANCE;' .. -. -•. .3.0E-,_ HOEDOWNS -• ._ ...rl_.__ -_. .. ..
P. 305
(Tit.. c n nrcd not be campl<&d if he porion is f tune hundred dollars 3 07 — INSULATION
(SIW lesP),. „
__ .. ... _-...- ... ,.308 — SHEETROCK' —
-- ''I eenify mm'm Inc perfrnxime,of'
f the uvrk for which,his pemti,ii issued.I ' •il,��n i':4., •
';n5n'nbt employ my Person in any manner,o as to become subject to the Worker 309 — EXTERIOR LATH
AlpCn,lecom,tun Laws of fxlifomia.Date
NOTICE _ '— ion .. ho '310 - INTERIOR 'LATH - . .. -
NcomesuOAPPLICANT If.otheWorkersCmrmnsati this povis Certificate of Labor Code,you
must
,
for'omehunieam it worker Compensation previsions nnbe Labor coag roa'rlaxi 311 - SCRATCH COAT
O z
forthwith rnmplY will;such provisions or nix permit shall Jeemcd revoked.
z � -- . : :. —_ .. - _ . :., . � ,, 313 — -ROOF NAI ---. __.
F ' ' 'CONSTRUCTION LENDING AGENCY
"l hereby afro that,here is a conumaior lending agency for the performancd 501 FINAL ELECTRICAL ENERGY
of the work which ohsy-q _upet is issued(Sea;3097.Cv,C)
dr N - "
•'-" —"— - 502 — FINAL PLUMBING EN_ERGY
--
Pz. L .d Add 503 - FINAL MECHANICAL''ENERGY
U O II ,nm torn ply.readmlany ml ioa and sumaricbid,hruml,m information is 504 - FINAL BUILDING ENERGY
�_Ir obuil 1 agree t mel{ lh II ly and a mineoN ve s d cal relainm
O U ion building a dh nr W P . i e, rn. yt mrnwn 505 - FINAL ELECTRIC7jLO
men r pdp pnv.r ' .pe, proposes
H �' (W) F tos I Jmn fy dkttp harml'. iheCtY fCUPn aga nst
V t fiat lite I dgr,!em. o d exper us which ma)In any y ecruer agmn.0 said 5 Q� GAS TEST
G'z Ciiy consequent fih gofd per , [�, �,Q
APPI ICAVT ' ANDS NO WILL CON 'ITHALL\ON. I Issued -FIn� �'f""" Date
G� G3—��
50U TI 'S
Sillom a [tp i mtic muo'etor, Out . .. Re-rool�0 9 — FINAL GRADE
i{q RDOUSMATE LS DISCLOSURE ''
tun apprcm rota Wld,ng ant rore bol ne Nobxmaenal TypeofiAcef - FINAL -PLANNING _-_. __... -,.. ._ .._. ..
- asdefimd by Cu MunicipalC Chapter912 and,h H Ilhund Safeq s -
cod sap z . t ) r p 10- 514 FINAL PUBLIC WORKS
oY x ; . .Al 1.roofsshall be.mspected pnor_.to.any.rod mg.materdal,being installed..._ .
Will be ,ha t r n iltin,ce,Wm,usecq p r d e' inch If a roof is installed without first obtaining an inspection;I agree to remove
en,n rd . mo t. .an ea me Bay AreaA Q fl Nf g est
District? _ all new materials for inspection. Applicant understands_and will comply with .
n °Y all non-point source regulations:
1k-r 31 have rmd me hurardous material,requirement,under Can pier 695 of,he
Caln irnio Hcalm&Safety Code,Sections 25505:25533 and 25534.1 understand that -
thebuilJingdocs mmnuni,iM10iit is my remonsinility to nutify,ne 1jei1, df the ��ca�cnl
mon a mei " ezuance ora Cetii(cm,eof
hearcy. '�'' _ Signature of Applicant. .. .- .- ._ Date
Owner anmoda asm .Date All roof coverings to be Class "B" or better
_. .
..e - 4 OFFICE .. - . .