01030126 ITY OF
C BUILDINGDPERoNNOPE92MIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20540 MC CLELLAN RD 01030126
OWNER'S NAME: APPLICATION SUB DATE
LAN CHEN 03/22/2001
. PHONE: SANITARY NO. CONTROL NO.
t
U 0 ARCHITECT/ENGINEER
BUILDING PERMIT INFO
,L BLDG ELECT PLUMB MECHJ U
ai CI___I CI
dna
Z 5 H Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z—p 1 hemby affirm that 1 atn Ilcensed under pro sitm,of Chrpmr 9lcommenaing
re,Htw witM1section]gXllof 3oftheBusinessandProfessionsCade,andraylicenx 2972 SQ. FT. LIVING SPACE,
axE ismmnrnm=.na` C 495 SQ. FT. GARAGE.
es ce be License Clss, wsion' Lioc.a
3 n Date Can't
u clor
ARCHITECT'S DEC t TION
C 0 1 understand my plan shall be used as b is r i
a oLicensed PmPossowl
is OWNER-BUILDER DECLARATION
I hereby affirm thin I em exempt front the Contractor's License Law for the
t?< following reason.(Section 7031.5.Business and Professions Code:Any city or county
is,is, C which requites a permit to construct,alter,improve,demolish,or repair any vrvcnre
c,3 pr tot s e,al qapplicantI 1pantiO file signed a
umnicia A .
tbatlpflc6atad puli'ht+PlBe Fmisiu rthe L tnorL I�.(Chapter 9 ( $ ,I't.Flow Alegit r- aluation
Ico - g with See' ]0001 fDoL,i 3ofine B sial and PCod=) l t a� . 1-`I I ,r 11 i3 i'..1Si§ i ltf Sr.
or that he is csempr ihererrom•and the basis for the alleged exemption.Any violation
of Section 903 1.5 by any applicantfor a permit subjects the applicant to a civil onalty
of not mom than five hundred dollars($500). A N UmMr I Occupancy Type
01.as owner of the properm,Or my amployees with wages as th=is sole a......ion, i ni — I
will do she work.and Ne swctum isnot intendedoroffered for sale(SeC]Oil:
'Business end Pme ssions code:The Contractor's License Law does not apply to an 1 O 2 — PIERS Required Inspections'"
owner of property Who builds or improves thereon,and who dnes such work himself 103 - UF_
ER
or through his own employees,provided that such improvements are not intended or _ _ __ _ _ _ __ _ __
--offimid for ]Cit.n the budding pmvemem is sod wnnm one yea is 104 - REBARt.
completion,the ownc bu'Ide ill have the burden of proving that M did not build or + ' +
improve for prposcof lel 105 - ANCHOR BOLTS
,c L us awnermrihc p(Sm.7 ani exclusively contracting with licensed a Commamorstims to -- — &
---
construct t the project n Iappl TOsi,Business and property
who
ens=:)The ve ihbrro,. 2 02 - UNDERFLOOR PLUMBING
License Law does not apply m on owner of progeny who builds or improves ihumn.
projects, a comranorfs).limmoral ursuant ro.dre
-.ana wh9 comment rLaw. .p ) p 2 03 -- UNDERFLOOR-MECHANICAL-
-
Contractor's License Law.
- 0 m,e.gmpinnde,Seci' i n&PC Fortin,m...n 204 - UNDERFLOOR"'FRAME''"I '
_- owa '6.m " 205 — UNDERFLOOR INSULATION
�' �" WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
�•. 'rat• Ihereby aft under penalty orp<rja7y dt,n,nrmer rnnnwmg aecmmrm 302 _ TUB & OR SHOWER
❑ 1 nage and all hatmisin a Certificate of corim sele.im1mc for Worker's 303 ROUGH MECHANICAL
ilo e,i Compensation,-m provided for by Section 37W of the Labor Cade, for the
perforrwnce of that,work for whichrhis permit is iasued.,„+ 304 - ROUGH ELECTRICAL
❑1have and•will ma t workers Cnmpe
tinoInhuranrus msitlirsdby Se-e on 305 - FRAME
s]lyd f th Lin Code f r thepe l mi rice or the work for which N. permit is 3 0 6 - HOEDOWNS
issued.My W Lees Compensation 1 u ri c - d Policy be a
came 1
Policy N 307_..- INSULATION
JULbl ' CERTIFICATION OFEXEMPTION FROM WORKERS,i 3'OB s-'tSHEETROCKa' ItY-s•' satUj ? �
-t..
COMPENSATION,IrvSURANCE --------309- .'.EXTERIOR"liATH'
r' '(This secdon need not fe completed if the Permits for one hundred dollars .A=';s __r
CS[.Bull 1 I „ r 310 INTERIOR LATH
313" - SCRATCH COAT
loco fY tht4�, net fthc warkr"M1chrh pe„ i .sued•1 irn t pwndune stub-cot yec�rrtneworkecs 313 — ROOF NAIlitmE - .
501. -- FINAL .ELECTRICAL ..ENERGY. — ----
lbecome TOAPPL n .,r grh.Cer[finteoeLaboron.yuuumost 502 - FINAL PLUMBING ENERGY
Z � become 6imi y i,e s chip C mpcds r rip ha of e e bo Cale,you most
rnrtn m"mplywim. rip .nm x 'tnadbd Wmvuk=a. _503- FINAL.-MECHANICAL -.ENERGY---
F � "
-CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
a,> 1 h rcbY Mom that the con unci on lending agency for die performance —
'nlihe k(o, hlehthIspeon,I.issna(s 3o9] cv.c) 505 _ FINAL ELECTRICAL
y p ' Lnd ,Name '.i '--506 - GAS TEST .._ - - ---- - - - -
1,',Address
U O �,y,i er,Hr that I have mad sun application and state that fire above information is 5 0 7 - FINAL PLUMBING
w:E correct.1 agree to comps with all city and county grdinances and state laws relating, 508 - FINAL MECHANICAL
O.0 to building conaructiun.and hemny audinare repmsenrmises ofthi:city to animation 509 — FINAL GRADE
W inc shove mioncd pruPro,for inspersion purpascx,
'� p„ (W lug-e in nify and Llcp harmle,ethe City' 1C p rims riganst
F .m Ii ori as =pts .a aspera 1 n yiaany ay c =agmngsad 510 - FINAL PLANNING
U-Z ally c a e irignr ih perms - - 514 - A U WORK$ 7 /•/`
'� APFt IC I\TU )S At+d)�ILL CO\IPL\'Wil'H ALL N00.P01\T ISSned�'tZ Dale
SO'RCE'REC LAl pk.
hm�=u : . - Date Re-ro�f93 - ROOF BATTENS
dicandcamrncmro" .
HAZARDOUS MATERIALS DISCLOSURE'
INdui'ci ` utnrmw' Ca . aiMoe'«wwlea . ,
Type QAot ROOF IN-PROGRESS
as defined eCperioMunicipaldk,Chapter 9.12.and the Health andSafety
Cad SmAim
25 2(.),' ...
r ❑Y. o.,. , , . s ts .iVal r
't . Int
t.
Al 1.roofs.shall.be.inspected prior to,any. installed.. .._.._..
1 Will the applicant or future biia g occuportt use As,.snpoicat or devices which' If a roof is installed without first obtaining an inspection;'I'agree to remove
• ean it Wcandous air contaminants as defined by the Bay Area Air Quality Management
Dl,uict all new materials for inspection. Applicant understands and will comply with
r''•�”°Y°' „' No " all non-point source regulations,
''l l he' lea OROR,a memriaB rcquimmentt under Chapter 6.95 of the,
California ealth& cry Cale.Sxdons 25505.25533 and 25534.1 umlmtind that'
-iftrhebuil ingd« of tidy have a tenant that it is my responsibility to notify the
«cupenr u e which must be mer prior to issuance of a Certificate of.
Occupancy. .. • . . r 'ono pp Date
+" St-nature of Applicant
o . .
ow rcaagepr it - .Date All roof coverings to be Class "B" or better
OFFICE