02070016 CI BUILDINGUDIVISION'
N'PERTOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10746 LINDA VISTA DR 02070016
WNER'S NAME: APPLICATIONS DAT
-4ARRIS KENT S 07ro2/2002
s PHONE: SANITARY NO. CONTROL NO.
0 a0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
= LICENSED CONTRACTOR'S DECLARATION
i
:,fl
1 hereby rffrm that I am licensed under provisions nr Chapter 9(commencing ADD 139 $Q. FT. &JoREM N A LE
yt with section 7")of Div,mm Sonne Busmessand Professions Cede.and my license
is in fun force and effect.
a< LicenceC1.s Lie.r NOV 2 6 2002
n U Lam Lier
3 3 u y ARCIHTECT'S DECLARATION
Oy 1 understand my plan,shall be used is public records
;goo Lireto,dProfe„ianal BUILDING
OWNER-BUILDERDECLARATION
I hereby.flee that 1 oro cBasic from the Cession, o Lleesa Law for the
t Z a following arena(Section 7631.5.Business and Processions Code:Any city or county $125000
f.FZ which it,i...n pemtit rol the aper.improve,demolish,or repair g ed structure
a.3 m unit
t t dp n q ' ein.applicantsuchpemit to Ties signed statement
thorn edPunart tnepf wins nhetheBuctohLndPrefawonesCor9 „- ,.,,3�®•C�$f}'joydl:,@q�a•, { • t ; '. Valuation
or
(commencing is with Set om a rDivi Division for
Burmese and PmfAny vs Code)
.p . ( ` „ x - A r ;-.�• s(-{ ,
or that io a exempt therefrom and the pis for the alleged esemant to Any violation
of Section]Ohim by any applicant d ll fora Permit suhjcns the applicant m s civil Penalty
of net mnrctnanfv<numrcndmlam(SsW) 101API`I hhQDRIId17AT I ON •' Occupancy Type
Di,as nwnet of the property,or my employees is hh wages as amirsole conipensat inn. 102 - PIERS
will do the work,”and the'suucwrc is not intended or offered for sale(Sec.7610, 103 — UFER Required Inspections'
'Business and Pmfasime,Code:The Cmarelm's License Law does not upply m an
owner f pmpeny Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.pmvWed that such improcemetns an not intended or _ __ _
.offered for sale.IL however,the building or improvement is sold within one year of 105 — ANCHOR BOLTS - '
improve for jurpn of sale.)r win have the bonen nrrroving that he did not build or 106 - SEWER & WATER
X
owner drfhe propenyam 1uhasively contracting with licensed eortranorc to
202 ' — UNDERFLOOR PLUMBING.. .. .--
conewct the project(Sec.7ow,Business and Processions code:)Tse Contractors 203 — UNDERFLOOR MECHANICAL
License law dee,not apply to an owner of prapcny who builds or improves thereon,
.t ane who coemcts has such projects.with a contmctorfU licensed pursuant to the. ._ .. ...._2 04- -- UNDERFLOOR- "FRAME
coson-an".norauc<gae ce 205 — UNDERFLOOR'-INSULATION
-., ❑1 nder Sec.' "' � " � •� ,[f&P C for this rcasnn '
-'gate 1 Z 301 — ROUGH PLUMBING
s e "'\ RKER'SCOMPENSATI NDE RATION 302 — TUB & OR SHOWER
"I herebyaffirm..dee Penalty,.Bury one of following drolamti... 303 - ROUGH MECHANICAL
ti_� D I have and win mamai
in a Cenlfcare of Consent to selLurc insfor Weaker" 304 — ROUGH ELECTRICAL
]b Compensation, as provided for by Section 37W of the Labor Code, for the
perfarro nce or the wort for which this pemtit is issued. 305
- FRAME
D 1 have and will maintain Worker's Campcnsatiohlosumnre,u required by Section 306 — HOLDOWNS
_ 37W of the Libor Code,for the performance or the work for which this permit is3 07 — INSULATION
:e .. _
issued.My Worker s Compensation mon Insuc .mer and Policy,number
308 SHEETROCK
arte
s Ci;., l'\'Poky N-. x
CERTIFICATION OF EXEMPTION FROM WORKERS ' 3O9 s JiEXTERIOR.`LATH�: '
COMPENSATION INSURANCE'
.,— _ -- —.3 10_, --INTERIOR—"LATH---
"s (Thissenion need not be completed if the Permit is for one huMad dollars 311 '—s SCRATCH COAT _ •"s '
(SI W7 or Icsa)
1 hmm
edify ',loom 'fN kfrwhichthis pamti,iss,.ed,1. . .313.,. —,—ROOF NAIL.--.-._. .._.-. ... .. ...-.
snap t coral`y my rc on i i any i be s blecno the Workers' 501 — FINAL ELECTRICAL 'ENERGY"'
man
Comrents ,ofTaLFrynu Ddwt = 502 — FINAL PLUMBING ENERGY _ " _-
APPI cam wl7sT-0 - -
NOTI E APPLTNTIf n akingthiserifcateofE iu . you should 503 — FINAL MECHANICAL''ENERGY
O pbac bj tl the Nortel Compensationp mns isof,hc Labor Code.you must
conn omplywim suchProvisions orth permit sullIn,deemed .kad. 504 —_ FINAL BUILDING ENERGY _
a,? y CONS IRUCTION LENDING AGENCY - 505 FINAL "ELECTRICAL ' ' "
I herehy affirm that there w t on lending agency for the Parc' ante 506 — GAS TEST
a.r0 of rW is work far which thpermit is issued(See 3097,Civ.C.) ," _
d sNaeY pt" — 507" — "'FINAL PLUMBING "
.7 Lend AJdrc - ,
O 508 — FINAL MECHANICAL "
1 of ih tlheed this cl dortthat esh b awsreionx
las"Ey Com:t 1 g t mply with II city and ry ordinances and state laws rcl.l ng 509 — FINAL GRADE
O V to I ing�oostrdciionandhereby authbnrerepasenedivesofthis city toenter
upon
510 — FINAL PLANNING
��+ W 'he above-mentlonee Property for inspection purposes.t••t (We)agmcrosave,indemnirymdkcephamdesnheCifyofCuMninoegainst - ^ )
3Ciliabilities,judme
gnts,costs and expenses which may in any way came aga514 — FINAL PUB IC WORKS
U ia said V 5�/
City in emmequenee of,ha timing of this permiC n '
APPLICANT,i�t DERS 4Ns DWILL COMPLY WITH ALL NT ON-POIN
SOURCE'R C�I 4Tl . 'ti' ZroL Issued by: Date
awa df Applieao omeaemr -. . Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE "'•'
Wll the applicani°r future Wilding ourapert none or handle haurrom,mmcnal Type of Roof. _
as'defined by the Cupen Municipal Code Chapter 9,12.and the Health and Safety
CM 'S 'n n75532(a) n i
D YO I... N. ':Y J-,.' f�� h' ss : ii. ' .. . se
..' S , \,, {,, All roofs shall be inspected prior-to anyroofing material being installed. ........
Will the iq licam r�nwa building occupant use equipment or devices which If a roof is installed without first obtaining an inspectio'ri','-I agree to remove
f! ",
mit haamdems air coni nas defined by me Bay Area Air Quality Management
District all new materials for inspection. Applicant understands and will comply with
' °v" : �. all non-point sou'rce regulations.. „
1 h c d'not p e d s o n en y t itis x'under si pm o 95 of the j�Le�s
Cal li Health&Safety Cud S Y 25505.25533 d 25510 1 understand shut
ho pa building does t 0 have a tenant.the t . y responsibility C ern the V
pan,o the rcgmremems which most be mit prior to asuance of a Cenifea¢of
nature of Applicant Date
S" :;a Own1,m.utho iced gen Date All roof coverings to be Class "B"or better
r
OFFICE