02080023 J
autLDF G DIIV�'ISSIIONNO CONTRACTOR INFORMATION:
PERMITING ADDRESS: PERMIT NO.
991 LONG DOWN RD 02080023
tc�,t r: SANDRA A APPuc TION SUB DAM
08/06/2002
EL:IC ti SANITARY NO. CONTROL NO.
O O ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MF.CH
L= I--1
Z O KKK LICENSED CONTRACTOR'S DECLARATION Job Description
o z=o I hereby affiroi that 1 am licensed under provisions of Chapter 9(commencing INSTALL S KYL I TE
with Section 7000)of Division J of the Busi s cad Professions Cade.and my license
a < is in fol and effect. tt�J9j
d oU Licenses Lic."F' p
S Date ,r FONA,ka�®
3 a to ARCHITECf'S> F RATI Ns
5�'=O g VI undemmnd my plans shall be used
�i repp Licemed Professiowl SEP 2 0 2002
°meq, OWNER-BUILDER DECLARATION
v I hereby affirm that 1 am exempt from,he Contmnor s License Law for the $1300
C Z a fallowro
ing son.(Section 7031.5.Business and Professions Cade:Any city or county BUILDING
S G which requires A permit to co ,tI time,improve,demolish,m repn aany structure
d 3$_.prior m its issuance,also mquues Ne.pplic uct for such permit to file.signed staamem
tQmihtifligentedparsdantto po yiaiom of Ne Commcmrs License lsw(Chepmr9 I Or ea_,y.r" ',,sVl, Valuation
(commencing with Section 7A),fDivisionJ of the Business end Professions Code)j (`11\, k 34h.��t0L2oreMgf.•.s trh.l-{l:,
or,hai'6e'i's eA6npt therefrom and Ne basis for the altegid exemptioh.Any violation.
-rol'Section 7031:5 by any Applicant for a permit subjecu the Applicant toe civil pena t, ,s.I
ofamonuremon'fiivenaMrtdd.U.. s51g0. 101APNDN691MATION I ""' Occupancy Type
°1,as owner of the properly,or my employees with wages as their sole compensation,
will B.1netheworkssrm theukam 'structureode:no isntractondedoroffcrcd'far e re1.nd apl7ols;', --- ---- - - i
'B s e f pro erty Whorls code: improves
roves Contractor's License ow does nm apply to 103 - UFER Required Inspections owner through ofpropertyhis ma Who Iveds or improve thereon,and who Anes men wank intended
or 10 4 - REBAR
or through his own employees.provided that such <is sola i not mia year or
oIJ-within'one ear of . ._._.__._. __.__- _.. ______ .__ ._
:Jffered Ton:ale lLhd a eer the will avetheimprovement r 105 - ANCHOR BOLTS "� ' ' r' '!'I.'`'
s camplm an,the owner-builder will have the Horden of proving that he did not build or '
mpmvefarpumam.1'anal. 106 - SEWER & WATER
-ni o oernC@ep pen; in aclu ly cont micting--wim-licenseuconim+onto-:.._. ....... .-.2.0.2.-'"=.....UNDERFLOOR PLUMBING "7i. t .... . .........
consbu t the pmj (Sec 7044 Business and Professions Cade)The Contractor's
Lice w does n I apply to an owner of properly who builds or improves thereon, 203 - UNDERFLOOR MECHAN'I CAL '
s _And.w .conducts.or-such.pojecn,with.a.smtnmctods)ficensed.punuant to.,he . ..__._._.2.04....__ _UNDERFLOOR_'_FR'AME__.__.
7 cont es Lice .
,Q hem. , piu D e - BePcrrtnis reason 205 - UNDERFLOOR''`''INSUL!ATION
301 - ROUGH PLUMBING
W KER SCO, LSAT C .TION 302 - TUB & OR SHOWER
Use .1 mbyeRumundttpenaltyofperjuryobeo(the following declarations; 303 - ROUGH MECHANICAL
❑ 1 hx've'vnJ`will'iwimdiii a Cibifi6aa of'Cramt 1.self-inmm for worker's 304 - ROUGH ELECTRICAL
Compensation:as provided-for-by Section 37M of the Labor Cade, for the
_ - 'performoncoortheavork.for which this permit is issued..,. 305 - FRAME
I'I°Ita e' awllm tut wake. Ci p, at 'hn n 4'md by Section 306 - HOLDOWNS '
3700 of Lan -Cod f to pbfnm, e f,h w:'rkfor hihthis pe, t.is 307 - INSULATION
ih�utmd My W k r Conpcmartian l. r n e tarrin,Add PnIkYrulaube arc
na'PohcY No. ' c,,
SHEETROCK..... if—.._ ..._.......,.
{ cenTl FICAnoN OF EXEMPTION FRO) OFUKEE s —1 ")'.'v f'.309, {i7 EXTBRIORj FL'ATH'
' COMPPNSATION INSURANCEa [ •'
-_ .- ...,. ._ ._., ,..... ._310-,--.� 'liATH.__•__......_...._,.___ --- ._ .._.. .._.,.....
fThi sec'donneea-ndtbeto irldtedinhapermit isr one hundred didt. 311, - SO'RATINTI;RIOR-CH COAT a.s•'.t..ss 1`r -~
NAIL -
y 1c n(11 m Ape i orma...of the k 'r hch the Pe iii issued 1 .t. t
sn Bnmatit loy Any -o- a a. t i,UC b3 t the Won at,! 501 - FINAL ELECTRICAIi'"ENERGY
Awan,'I Awa m` -........... -502...-.,..F.INAL_..PLUMB ING-ENERGY.... ._. .
aubj uosheWok 'sCompensatgdpetm�onsofthe ede�mdrcvakWuramt 503 - FINAL MECHANICAL'''ENERGY
OTI ETO L A after this Ceftitimc of Exemption,you should
O p ri w he ply wins npr neap 504„__,...-FINAL BUILDING._ENERGY., _.
fin” 'rn• CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
y 1 hereby ff that thereeconstructionted 378 agency f m',pent nuance +
of the akfo which thisPerrot :'issued(See 3m7C C) 506 - GAS TEST 1
GTI 0Leader's Na 'a .+ ._. ..- . - __.__ ...__ .. .. __ ._ ..._ ____..
Z Leader,o. Artily ' 507' - FINAL PLUMBING
'U O Ice';,;'hmiha 7777:7777777 sapplen n 3717.." tN<aboveinformnuonis 508 - FINAL MECHANICAL
Ise H ,'cortec 1 agree to comply with all city and county ordinances and state laws taking 509 - FINAL GRADE
t.> to Wild g nxtrua nand hereby ammo rem m ntativei of Nis city m enter upon
}'W 0
tnebo simaedpropetyfornspen prpa _- 510 - FINAL PLANNING
� gL ( ) gree to save demmify and keep h I ss th C ty f C pcnino against
w nit jdgment Coss once penile nm ynnv gainuaid 514 - FINAL UB C WORKS
C ty s quence f th iani ng of th pemy s r ��
�APPLIC UN UWILL COMMIYtV N N-P UT`
7. SOURCE IF60CATI -,, ' sto ;,,�;,t, Issued by: Dale
g,gnature to plica tlC Net Dme " ; Re-roofs
..:HAZA DOUS MATERIALg DISCLOSUR
W the pal cant r fut bJ Id c prem t o handle nazm bow ro i n I. . .Type Of Roof . ..
,as defined ythe C pemnoM mppal a Chepmr912 and th H Ithand Safety t
Cade S uon 25532(.) 3 L P'-
°Y" %r _ •_- .. All,roofs sh_all be mspec[ed pnor.to-any roofing.marenal.bemg tPstalled.,-,
t Wilt It pill t future hu gncc p t equipment or devices which jf a roof in's[alled without first obtaining an inspecti6fi I'agree to-
remove
"e t ha ad u air contaminants as reed by the Bay Am Air Quality Managemc
D amat mall new tenals fo ins Action Applicant understands an will comply with
❑re No_y all non cat source -"e Dations '-
P B q I
1 ve readthe hazardous sn to,els r quitemems under,Chap¢r6.95 0(the
CaY fomm ealth&S hyC Semione 25505 255J3a dS5J4 L ndersmnd thai
if the bol g does not cunen y haveq t nam that lib my res nil tytnufyihA' ""
p y to nc f Cm(`ifJ/¢lata bf
nature f A ]ice t ate
. ..PP,_.._ _. . g as ___ ._ ..__.
D her ass B in better'
erequ re e c t met pn
1 roof coverin s to be CI -
.OFFICE . .__._...