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CITY OF CUP);R'fINO
BUILDING DIVISION PERMIT
CONTIZACTOI2INFQR MATiON:,
N
BUILDING ADDRESS:
PERMIT N04 10 0 13 9
135 KENTWOOD AV
OWNER'S NAME:
PERMIT ISSUEDATE
RODNEY BEAVERS
10/20/2004
IFNE:
SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLOG ELECT PLUMB MCCH
0
LICENSED CONTRd
Job Description
underSDECLARATION
I herby affirm thnl 1 am licensed under provisions or, 9 (commencingHemmg
P
with fonder, ]01%b of Division J of me 6usinms and Pntfcsainn� Code, and my lincnsv is
C.dc,e
in full proceederrbC1'
inmense
BATHRM REMODELF�����D
Caand
Cla
Cas, Lie.a
Date Conlmelor
ARCHITECPS DECLARATION
1 understand my plans shall be used as public records
DEC 2004
LicensedPme,sinnal
OWNER -BUILDER DECLARATION
I hereby .(Sero that 11, exmnpt from me Comments License Law the
co
mason. (Section ]1111.5, and Code: Any city ter county
follwhich
which hcquirea a pctmit nr construct, abbe, improve, demolish.
t, alter improve. demolish. repair any.clmantoo813000
fi
thin!e1,lcense ptinsn rCy.he thesisimom(11es11morch cmlll0fies, L iw Ch;,,c,9
thatheisfcliv,kharcfion7meprDivisianflheCnusbousandProeLawtchamcr9
`/
Sq. Ft. Floo: a Valuation
(cnmmcncing wish Section ]fX%B of Division Ja[thc ❑uslness and Prafcsainns Cndc)ar
Nat he is O.nm,t therefrom and the basis for the alleged cacmplion. Any violmina of
Section 7031.5 by any applicanl(of a permit subjects the applicant to a civil Penally of
be
Occupancy Typo
or
not me than five hundred dollars (5500).
I, as owner of the property, or my employees with wages as thcu rule compensation.
will do the work, and me structure is not intended or offered for sale (Sea. 70u 1, Business
Required Inspections
and Professions Code: The Commomr's License Law does not apply to an owner of
property who belles or improves thereon, and who docs such work himself or through his
tun employees, provided that nch improv.men is are not intended or offered for sale. It,
however, the but ldi ng or am movement srold within one year Of sionsplehim, ffiC Owner-
ow er,thebutldingorimmovementisxoldwithinoneyearOfcomplctinmtheOwner-
hudder
hudder will have the burden of proving that he did not build or on prove fur purpose of
sale.).
1, as owner of the property, am exclusively commeti ng with licensed contractors to
c smut the project (Sec. 70,L, Business and Professions Code:) The Contractor's Li
conic Law docs not apply to an owner of property who builds or improves the men, and
who contracts for such prnjecu with a contractors) licensed pursuant to the Contractor's
Licenu Law.
❑ 1 am exempt d Sec B & P C for reason
ownel Par'� z "
a'S OMPENSATIONDI!CLARAt
Iheodo, f under penally of perjury one of the fallowing declaralinns:
l/,,,VVV!!!/o
t have and will maintain a Cenifcme of Cnnsen to ulf-insureforWorker'sCompen-
.etlon, as provided (or by Sermon 37M Of the Labor Code. for the performance of the
work for which this permit is issued.
rI I have and will maintain Worker's Comeriondinn Insurance, as required by Section
37(1(1 of the l.ahoh Crete. for the performance of the work for which this pnmrit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
plobi.clion need not Mcumticmd tithe perntlt lsfmuna hundeeddolla DIOO)
nr lay.)
1 cenify drat in the perfmmane. of We work for which this permit Is issued. I shall not
employ any Person in my manner so u In become subject to the Workers Compenselion
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, afar making this Cediticatc of Exemption, you should
become subject to the Workers Compensmion provisions el the Labor Code, you must
forthwith comply with such provisions or this Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Beat there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lbridcr's Address
I eenify that) have read this application and smile Nat the above information is
correct. 1 agree to comply with all city and county nodi mmoes and state laws relating m
he ildi ng consuudion, and hcrchy arnhooim representatives at this city to enter upon the
ahov.-mentioned property, for inspection purposes.
(We)agree to save, ind.nmify and keep harmless the City of Cupcnino against
Liabilities, judgments, costs and expenses which may in any way accme against said City
167
in onuquedec Of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON -POINT
Issued by: Date
SOU'}�E REGU
Re -roofs
Type of Roof
=" l' z��oy
Signy cor� icanVCunt rr Date
((// 11 HA OUS MATERIALS DISCLOSUR
Will me applµant tar furore building wcupant start nrhandlc ha'rarduus material
az defend by (be Cujadmm Municipal Code, Chapter 9.1; and the Hcallh and Safety
engin, safes 25532(an
C] yes Nn
All roofs shall be inspected prior to an roofing material being
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will In, appfcmtt or fotam building ocemse. use egmpmbnt nr device, which
it ha/amens air cnnmm'manu as defined by the Bay Area Air Qnal'ny Manougcmem
all new materials for inspection.
nidal
❑Yes kko
I have read the haranlnus materials requirements under Chupar S.95 of me Califon
aulicahh&Safety Cod., Sectiontn505,E5533ind 255M leadnrsorm mmifibc building
does not embody nave a tenant. that it Is my reapondmillty to nndry the rebupant ol'the
require mbnts ich aetlemalpmrtt annonflcenin.amarIX.upan`y.
Signature of Applicant Date
All roof coverings to be Class "B" or better
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nor or umodi Dam