00090142 CITYOFDIVISION
ONO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING AUUNF'_SS: PIiRMLT NO.
csY�-t1Nt� I�Lt—C.�
OWNER'S NAME: APPLICATION St , ,
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PHONE: SANITARYNO. �Cf]NI'll(Y,
C 9'2-1
ARCHITEC IENGWE 21UI{UILDING PERMI T INFO
w BLDG C:LIiCI' PLUMB MUCHries IJ f—I IJLICII'`I
a
Z F y a fiauil SI!a n ONI licensed
model ti"IiC"ARAl ION Job Description
O Z_ 1 bemby dfirnt that an 4116,Il under provi.' ,of o,CroChapeau mnnnu'neing
P vj e w
will Section eland ell'Divisinn 3 of the❑usinc,e unA l'ndvulonv Codc.and my liccmc
Y ; is in full farce and elftto.
0 z a Date c Clau Lic,x
d u Date crnamuor KITCHEN REMODEL
3 e.G ARCHITECTS DECLARAI ION
t_LLun
g 1 understand my planv shall M used us public becools /
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LiecrocalP f of /
o� OWNI R BUILDER DECLARATION
= h by R II I p,f fare L los,ou,Licer,Law I'or:he
If: a following reason.(Section 70315 fi,inevsand1 :Code:Any rity IFrounly
F F❑ which leyu re.a pvnnil a con,moL ale,,improve Jel ilsh.orm,an,an, wclam
et
i3efi
� Poorer its issuance,also rcquims the applicant for such former to file a signed statement
Lha he is licensed pursuant to the pronvirms of the Contractors License Law(Chapter 4) Sq. Ft. Floor Area `dation
(commencing with Section 7000)of Division J of the Iuninex mrd Professiums Code)
or that he is exempt therefrom and the breis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit wbjcns the applicant to a civil penally
of not mom than file hundred dollar,ls500). APN Number Occupal
01,asowneror he pinpeny,army cmployecs cal d,wage,m red,sola on,rn....on.
will d4 the work,and the,tiamure is not intended or offered for sale(See.7144, 35 A�
I ineas and 1'mfe,siun,Code Tile contractor,Lit, Law docs nm apply to an `Rl;la 1 ed Inspections
of pmpcny Who build,or improves here........ who does such work hi Of
or through his awn anplayas.provides that such improvements ale not intended or .
offered for sale.If,nowcvcr.the boll or int,wemcnt is sold within one year of 101 — FOUNDATION
completion,thenwnm-builderwill hate the buNcn of pmving that he did not huddler
impomermparfoutof.ale.). 102 — PIERS
01,us owner of the prolserty,am exclusively contracting with licensed contractors to 103 — UFER '
antrucl the prujec,(See.7044,Business and Professionsde:)Th
Coe Carmelo,',Liicen,veL,wdoSm„apply ,,an..weer..rpmpanycan,:bairn.o,in,pm.u, fit e..... 104 — REBAR
d who cnnlmns lin'.emI pr.jccw m
with a vtnaao,O) lwen,un
l pm uns to the
.recomruclor,ueen,eLaw
0 l ata exempt rade,Sm. .I n re in,this meso„ 106 — SEWER & WATER
own”
WORKER'S coMPN`sABONDECLARATION 202 — UNDERFLOOR PLUMBING
hereby affirm under Penalty of perjury one.. the following declarations: 203 — UNDERFLOOR MECHANICAL
0 1 have and cam marine. o Cenifiemc of Cniwal to,dr-ina me for worker, 204 _ UNDERFLOOR FRAME
Compmradon, provided for by Section 3700 mme Labor Code. Inr the 205 — UNDERFLOOR INSULATION
Iwrlurnutncc of the work fur which this pem,il'11 Mold.
and;dl...inminW..rker',Compensation bmumnce,asmyninedbySellioo 301. — ROUGH PLUMBING
.7,'If`'he Labor collo,for he perfnnnan r of the work for which thi,permit i, 302 — TUB & OR SHOWER
issued.My Worker,C�on,p/e±ma�0o�n�Insurance conic,an Policy number are:
carouea:e�r_vr �,hcrNn.: 7 --uy 303 — ROUGH MECHRNICRL
CERTIIICNI'[ON OIC ENfl"IONITONE_WORKERS' 304 — ROUGH ELECTRICAL_
COMPENSATION INSURANCE
This mion need not be completed it the permit is for one handed dollars 305 — FRAME
aHk)erlea,.) 306 — HOI_DO14NS
1 choly m perr..m,anne f the 00x, rat cane h mix phrase i,i,Sacd,1 307 — INSULATION
,hall not crap Y pc min any mast ,os I heves s M1lce,e,the orkcra'
compensai L°° r Mrun,`.Da _. Lf n 308 — SHEETROCK
npplieant you 309 — EXTERIOR LATH
NGTIGET I':If.ahs ak' , ni n c non, houlJ
F'omewhjegl h Workdc Comps mien provisions of the WM,r Cute.you mus
p tonhwim comply wilh Such prmh.aan,in this pomrit Mush be deemed recalls. 310 — INTERIOR LATH
CONS'I'RUC'rION LENDING AGENCY 311 — SCRATCH COAT
I hereby arlinn Amt there is a con,mcti:,n lending agency Punto,pe,fomrance
C ansaworkfar whlehmi,actioniSi...cl(see.3097.C'tv.C.) 313 — ROOF NAIL_
y ❑
laredcr Name
Adder, 501 — FINAL ELECTRICAL ENERGY
lan ',
U O herder1 cleffify that I have mad this application and%late that the above information is 502 — FINAL PLUMBING ENERGY
fz p.. concel.I agree to comph with an city and county ordinances and,rate laws relming503 — FINAL MECHANICAL ENERGY
O t„) u,twilling construction.and hereby authosom representatives of this city enter upon
i W mean„e-mentionedproperty n,rinspocYonpaH„s`s' 504 — FINAL_ BUILDING ENERGY
W (We)agmear oc.inden ify and keep baronies,the City C" of Capenin.rgain,f
.t m fmhddie,.jadg,nenl,,earl,;"III expanses 1111111 which way may h,any accrue ttgnb,,t,tdd 505 — - I RL ELECTRICAL
U ,Z City In rlm,cl ucacu orfbe germing of Ihls permit. r 2 1 J
SOUUN ERSTSNDS AND WILL COMPLY WITH ALL NON-MINT Issued by: 506 EST Date
507-- FINAL--PLU1iTBTNG_—
Signature of Apprlmntr Re-roos
canllconeDae f
HAZARDOUS MATERIALS DISCLOSURE 508 — FINAL MECHANICAL_
WtEme apNican,or future building eacun7nt liver or handle hanardsu,mammal Type of Roof
a,defined by theCupemnoMmdcipalCode,chapter9.12.atmmeHealthslidSafety 509 — FINAL GRADE
Code.Section 25532(a)'1
❑Yo, All roofs shall be.'lids�2cted Fr.T(Nftll.anpi-(QhltkT[hgterial being installed.
Will the u.am,.rmmrun,tildingoccapnntmeequipmetumdeviee,wbl=It If aroofisinslallEil,4ilhnulflilJtNLai8fhl#ltnivGpdaJ@RKHtgrectoremove
District?
hoardo.s air canNml.anfs as defined by the Bay Area Air Qualily Slnnngeme t,
District? all new materials for inspection. Applicant understands and will comply with
OYa, - h, all non-point source regulations.
1 has nd the harerdou,material,requirements under Chapter 6.95 of the
Calif hal &Safety Code.Sections25505,25533 and 29534.1 understand that
e mintcuncmly has .renonato is n,y,espmsihilifymnotil'y the
terms our pror a,issnanee n a C'er"rSignature ofApplicant Date
uraN L/b All roof-coverings to he Class "B" or better
OFFICE