00100150 cl TY
BUILDING NPERMIT CONTRACTOR INFORMATION:
IIUI LDINO ADDRESS: PERM n'NO.
OWNER VIP 9 APPLICATION SUE DATE
3 O
PHUNIi: — ' 17A L771 91
SANITARY NO. CONTROL NO.
O et Z ARCIII FECTIENCINEER: `•� ]WILLING PERMIT Liftsm— LIK ELECT PLU MACH
Got _I
FF�h Z I,ICI!NMID CON'IRACI OWS DECLARATION Job Descripti
0 O✓+O I hereby b nit mal I a;n licensed under provision.of Chapter 9leon,mewing .
�as xi"Section]fMMp of Division J(if the Business and Professions Code.and my license
a�Y j in ,If force and effect.
m "" L "Q? MASTER BATH REMODEL
6 a luno 1_ � cr,;tlmLAR
ARC'III'I HCT'S DUCLAR _
C , I understand my,plat„hall Is,used u%public mcaNs /
u°61 p CI.iccn,ed Pndc„innul 0
p.as ceOWNER-BUILDAIf UCCLARA'IION /
I hereby;Illi.;..that I ant exempt from Inc Contractor's License Law for the 3
following reason.(Section 7011.5•Business and Professions Code:Any city or county
o which requires a permit to construct,alter,improve,demolish,or repair unit smrcluae
a
3_` prior III mreqs its i.omce.also fres the applicant or such pematto f le a signeA stmnnent
sino ImIIr,crwrlpnsuanit,dmfto,istour,at heComra,ua,Linam,elavv Chan,,q Sq. Ft. Floor Area Valuation
let renin,with Section 7(XX))ofDivieiur 3o(the business and Pro@uion,Coded .
nr that he is wenn therefrom and the Iasis tor the alleged exemption.Any violation
of Sec,itn 7031.5 by any applicant(m a pcnni,objects the applic rm a,a civil penalty
mf a,,,tome man live hand,,,[dollars s5ap. APN Number Oceu a pe.
❑I.,ts `rm the pmpvriy.o es,try employee with wagtheir tic cnmlw.otsariun,
will do the work.and the structure is not intended or offer,,[Iia sale(See.7(Nq
bu,ine.,and Profession,Cldce The Contmenr License law duce not appy Rt an:mna , ylllred Inspections
r of property Who builds or improves thereon,and who doea,uch work himself
nt laou8h h,,,,,,,snrploycc..provided than such hnprovemens are not intended at
of,real lot rale.II:haves r,the building in not I,vmar is Hold wilnin one ra.,at 101 -- FOUNDATION
iompletion.the owner-builder will have the burden of proving that be did not build or
mprove for pr,ave of sous.). 102 — PIERS
01.as owner of sire property.am exclusively contracting with heeraed contractors it, 103 — UFER
Limnrue me moj,,,(Sec.AOL liminess and Prof ssi)ns Code.) 14,Contractor s
cense Law does not apply m air owner or I,mperty who Holds or initiative,mere,.., 1.04 — REBA R
and who comma,(or such projects with a wnuactorts)licensed pursuant 10 the
Contmvtoe%License law. 105 — ANCHOR BOLTS
❑Ian,esmmprnad,,See. .BxPClet Ihis rea.ott 106 — SEWER & WATER
°woes
WORKER'S COMPENSRnONDECLARATION 202 — UNDERFLOOR PLUMBING
N. Iherel,y:efinounder finally ofperjuryone of,hefollowing deelumtionc 203 — UNDERFLOOR MECHANICAL
0 I have and will mainmht it Certificate of Consent It sel6imme fir Wtrker'. 204 — UNDERFLOOR. FRAME
Conrtpan,ation. as provided for by Section TIM oT the Labs Code. for the 205 — UNDERFLOOR INSULATION
performance ofine work for which This permit Is issued. -
0llurvo;rl In tai era` ..per;..tio..bsanmee nsreaniredhysen;,,t 301 — ROUGH PLUMBING
37(X1 or name of Ise work r,,,wldel,mi,pvanit 1, 302 — TUB & OP, SHOWER
'swat. c nsf armee cor����ia,___ian���d������P���'onnnlicy manna,me:
Cmtien y hu,iO,v4! m 303 — ROUGH MECHANICAL
C,Iila'uICNO
, NOf ExEM1T1ONI'ROlI OWNERS' 304 — ROUGH ELECTRICAL
COMPENSA'I'BININSURANCI? -
(Thi,section reed not na completed if the penal is fur one hundred donors
(S101111les") - 305 — FRAME
306 - HOLDONNS
I ca.it'y that in 0e redf;.nnnrcc 4 he work for which;Hie panni a, sad,I 307 — INSULATION -
,hall m,I employ any person in any tanner so as m,nacotre,.bject ,,the Worker, ''08 — SHEETROCK
Compensation laws of Califomia.Date J s
Applicant
NOI ICE 10 APPLICANT:IL ane,otaklogrhls Cendieme of Exemptior.In.should 309 — EXTERIOR LATH
nee
mm1cu,tato me worker.Ctrimer,mn
ioa pn,,i,i.,.I.I ib
me Lur Cele,you itos1 310 — INTERIOR LATH
O 0 fonhwlm comply with s.eIr prevision,or mi.pvoNt shall be dcunted revoked. ,]
F4 CONSIROCIIONLENINCAGENCY 31.1 — SCRATCH COAT
0.a IherebyaRmrmmthereisacommctmnlendingagencyfortheperrmmance 31 — ROOF NAIL
of ata work I'm strict this permit is,mcl(Sec 3097,Civ.C.) _
p ',cutler"Name 501. — FINAL ELECTRICAL ENERGY
Larder',Address
U O Icenllythatlhavemadchisapplicmionandtimesitusrheaboveinfaminnonis 502 — FINAL PLUMBING ENERGY
w p. n reel.IagreeionrnnnywIII,Iftry a..,[c;...tyordiu..aeand.tme 1.11 lating 503 — FINAL MECHANICAL ENERGY
O V lin building e..mwndon.nd hanchy call 'arepm,enlanoc,ofthiv dty toemcn.por
y theaho.e.r •miomd amparry9,rinafiction porp 504 — FINAL BI,.IILllIhIG ENERGY
1
(We).,.c msmc.indemnify and it.,handless the City of Cupemm..,.ins, iQ
,F, lin B01it" ) ms and expense which may in any way accrue agaiml said 505 — FINAL ELECTRICRLU ;Z CImgerig of this panni,.NDWILI,COMPLY WITH ALL NONPinst c Issued by: 506 — GAS TEST Date
" an,C, actor ora Re-roofs `
Hnz Doul Mn'n:R1Als D1scLosuRr `508 — F I NAL MECHANICAL
Will n,a;gtoicause,Inane mudding Ixenwnl s,o;a or name In.ardon...,rand;d 'type of Roof `
a,defined by she CmpenintMmdniml Clde,Chapter 9,12,and the Bnalth and Safety 509 — FINAL GRADE
Code.Section 255320)!
0 Ye, oNo All roofs shall`66 QspectFcfpolitLto@h)P"ffffit4rnaterial being installed.
Will I,e;;til,heano,omni,bildhagocrusta,n aeq.ip;ran.,en devices wld,h Ilia roof is ins(5]lc4 withal WAI-OKAJI1111t;bOnlif0litl4G l agree to remove
mods haenretms air
.. all,as as delined by the Bay Are.Air Quality Manage
lZril' all new materials for inspection. Applicant understands and will comply with
❑Yes 0 N all non-point source regulations.
I has,read rho ha,;...I nmmrial,ou,ar arts miner Chapter 695 of the
Cul ifol ra IledBr h Safety Coale•Sections 255115,25533 and 25591 I understand that
if me bedding d/e,not auncnBy have a noun,,rho itis;ny m,pun,ibiliy m nmily the
I;3711/pJ�rc cru which muss M ran prior m mminaso(u Cenilia.m of
tk.' (/I /./p
V s• _Q _9 siTne Signature of Applicant Date
i cr ,. Mori,, . it, one All roof coverings to be Class `tB" or better
OFFICE