02020117 OF
CITY
UPERoNNOPERMIT CONTRACTOR INFORMATION:
IT1611/1D1RIEt BANON DR. AURELIA CONTENTO PERMIT NO. 02020117
�XS 24T'A CONTENTO AVLctn)"216'U2
PHONE: SANITARY NO. CONTROL NO.
19 O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
kC Fpy BLDG ELECT PLUMB MECH
S w i LICENSED CONTRACTOR'S DECLARATION
i z—❑ He by a m two I am licensee ander provi:ions orshaper 9(commacmg ADD 224 SQ. FT. (*�'Pn�O WDD I T I ON)
C with Sac ion7000)of Division 3ofthe Businessand Professions Cade,and my license
is is full force and efmc,.
License Cl... Lisp
Data Coaamur 9 @9 A""+4
F0 IlA II pa L,E
O n O
a,O I-n ARCHITECT'S DECLARATION
ot
31 undersmnd my plans shall w nscd as public records
:' 0o LicensedProkuional MAY1 (3 2003
o2 OWNER-BUILDER DECLARATION
1 hertby affirm the,I am exempt from the Contractor's License Law for Ne �s1/�
?� following mason.(Section 7031.5,Business and Professions Code:Any city orcoumy BUILDING $21844
h
E ❑ wh q e permit t con win,alter mprove demob h o repn'r y structure
-prior to its nce,also requires the applicant for such Perrot to flee signedstmmem
th.t he 3l ce dpit5 pm lgtl prgvisimis of the Controno Lice a La chaps"9 vh T• a) 4 r'^ Valuation
(commencing with Semon])(10)of Division 3 of the Businessand Professions Code) Y,v ! ,X4 t..l r 2+. ,_,v l l r.,4, •� V i S t I,. ,
or that he is exempt therefrom-end the basis for the alleged exemption.Any violation '" -
-of Section 9031'.5 by any applicant for a permit subjection,applicant to a civil mpenalty Type
'of not ore than rive hundred dollars f55W). PN JATiUN Occupancye
°Las ownerof the n,ur my em to eeswithxa csas meirsole cold Han. 102 — PIERS
pope Y p ) g penia'
'will do the work;and the structure is not intended License
Law for sale(Sec 7Ba4,
'Business and cn,Who
h Cd,.Thc mse,lberso Linnw Lew does not apply m an Required Inspections:'
ownerof his wy Who bnilas or improves meth,and who date such work himself 104 — REBAR
annroaglt his awn a l y p ata ytxt al improvements are num intended or .-105... — .-ANCHOR--BOLTS _ __...._.
offered far ion,the w s oh ll 'ave t e p t x sold within one year of .I
improve
for
one Purpose
of
will have haNen ar proving that n,am Hat wua or 106 — SEWER & WATER
improve for putryse of role.).
— -.- - - -. ._._ -- _..202 ._ -UNDERFLOOR-.PLUMBING..-__ -----
_ 01,as..net of the prnpeny,am excursively eamracune with licensed eamracm,to .I',n' -
consumer the project(Sec.7/ .Business and Professions Code:)The contractors 203 — UNDERFLOOR MECHANI CAL ._ ••
Lie`wn Law does not apply m as owner of pmpeny was wilds nr mpro.ea metean 2 0 4.. .-. .UNDERFLOOR FRAME_
contracts for.such,project,with a comracmrp)licensed.pursuard to one.
•C emar manse Law.. 205 — UNDERFLOOR,. INSULATION
no ,ptnnecr gc. GJe��&rcrortmareasan 301 — ROUGH PLUMBING
WOR 's CONNSATIONDECLARATION 302 - TUB & OR SHOWER
•. Iherebyaffirmundcrpenahyofpmjmyone othe following declumions: 303 - ROUGH MECHANICAL
0 1 have and will maintain',Certificate of consent to self-insure for Worker's 304 — ROUGH ELECTRICAL
Compenxatinn, .,provided for by Section 3700 of the Lebo, Cade, for the 305 — FRAME
performanee'afm,workforwhichthisymtitisissued.• 306 - HOEDOWNS
01 have and will'main uo Worker's Compensation Insurance,na riimaxi by Section
37W of the Labor Code,for the performance of the work for which this permit is 307 — INSULATION
issued.My Workers CompensationInner n a carrier and Policy ndmber arc:
308 SHEETROCK__ . . — -
—
_ cd PolcyNe.: i tt 5309', t 1EXTER'IOR ;liATH - .. • 1
CLRTITICATIO
N OF EXEMPTION FROM WORKERS': I f.
coMPclggn'rIoN INSURANCE -..._.....3,10 ..= .._IN.TERIOR_LATH _
($1000.11 a) ,n the vlei,ann win sf tenpd,aamlars 311'x" SCRATCH COAT ti
��-(J' 313 ROOF_,NAIL
I rffyt t pet m kfrwmhim�-oi�aed,' 501 FINAL ELECTRICAL •ENERGY.'
z NOT TO A y on person m y, n er so e t become aub)ttt t one Workers' 5 0 2
aha t 1'ewsiefcahfpmta m" — FINAL PLUMBING ENERGY
Comp n at o
Ap " APPLICANT.If.after making ih 'Certificate of Exemption,you nyia - 503- "FINAL MECHANICAL' ENERGY-- ,---.'.,-
_.
bee lib)cn the Wi kersCompensation p s softheLOMnCards,yo must 504 - FINAL BUILDING ENERGY
Q Q fah d'simply with el p o this p t 'hall be deemed mocked
_.. _ ._ _ .
"" ' ' `505-"— "FINAL' EliECTRICAL '
-tA �'st �' � '`CONSTRUCTION LENDING AGENCY
' '
F'"�' ''Iheati affirm mat there is a conswction lendin ny•' 'pe 506 — GAS TEST
y gager for the rfonvtce _
of Ne work far which this permit is issued ISco.3099,Civ.C.) '
1;cniName .._.,:.- '----. .,. . ._ ._...,..:..... .. _ ..._ 507 — .FINAL PLUMBING "-- — -
D.z Le111.1.aarcas ' •- ' 508 — FINAL MECHANICAL ''
U-0 r ..i ' ' ' .,
�+ ''certify non ply read mlcityapplication swethat ances and
einaws mating 509 — FINAL GRADE
W ,r borrcct.I ngme m comply with all city and county state
end state laws relating a
O'U mbuildingc,ns onion;antlherebyauthoHimmp;k1mIrlivesofmiscity,tnenterupon 510 — FINAL PLANNING
�,-Ig] the above-tenoned pmpny for inspection purposes.
[r:4 (We).,amsav,.indemnifyandkeephartnleastheCityofCspcninoagainst 514 — FINAL PUBLIC WORKS
rn.y liabilities.,dgmems,costs am expenses which may in any way accrue against said
Q z City i,n consequence of th,Starting of this pen t
_ APPIICA r UNDERSTANDS AND WILL COMPLY VVTPH ALL N N-POINT" !
s�o rR EGULATIO s '� \ Issued by: Date
pp fig p° r '15i�'"tom
a-rOOf$
t6'il pprd-AZAARDOUATERIIAS DISCLOSURE
oof� a1A ied some�r Hale nmadou torpe of R
deft d by.the Cupen Municipal Cde Chapter r 9 12,and the Health a Safety
V - - -
Code 5 t 25532(al n t Y d s i t :v.•.6 a V
❑Yea o . i All roofs shall be inspected prior to any roofing material being installed.
w n m ppn t rV�bquding«e wad use andilsomado,devices which If a roof is installed without first obtaining an ins ecnon, I a reeao remove
`cont M1 lira a cont mmam as defined by Bay Area Air Quality Management g P g
District' 9n .i all new materials for,inspection Applicant understands and,will,comply,with ,
all non-point source regulations
I have read the hm
azy -us arents's mi uiremems under Chaper 6.95 of the
Caltforom Hc.I1K&Safety Code.Seniors 25505.25533 and 25534.1 understand that
t t e ,oft ems notcunentlhich ahs,be myssuancsiofa enificfy -
d2cupam of the uirtmenis which muse be met poor °issuance of 1 Ccnilicme of
.. Occupmc. ,.
• -' -' — Signature of Applicant Date _
Ownerpr. : Damis X _ A]I roof coverings to be Class "B"or better
.OFFICE. .. . . . . .___ _. _ .. ..