01060161 f
CI em of c DIrVISPERMIT
SIION O CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20544 MC CLELLAN RD TARN' S CONSTRUCTION 01060161
OWNER'S NAME: APPLICATION SOB DATE
NG FLORA 43 STILL BEACH CT 06/27/2001
• PHONE: (916) 392-3262 SANITARY NO. CONTROL NO.
o z Z ARCHITECT/ENGINEER: BUILDING PERMIT WFO
w O O BLDG ELECT PLUMB MUCH
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y z we L-1 1_I f_J �J
zn2 LICENSED CONTRACTOR'S DECLARATION �n Job Description
O Z y o I hereby a1Erm that 1 an licensed under provisions of Ch rp d,9(coal c:ng
F v�t- with Section 7WO)of Division]afihe Budiessand Professions Code.order,license DEMO OF EXISTING HOUSE.
a F ism fr
fall force and eeot
3 da j z se License Cl Lie#cre Y'CC
od y Dae CmIImRA
ARCtI TECTS DECLARATION
; I under5wnd my plans shall be used as public records
w 25 O O Licemed Professional
OWNER-BUILDER DECLARATION
vs a m 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F Z< following reason.(Section 7031.5.Business and Professions Code:Any city or county $5000
fsp web s' 'I to en:artr Be ' I I'sh p ysn rare
tL 370 pri I. d 'III'' tl i , 'u II f d..nn. t. _._-._...
dalot sl dPdarialartl'(far-1- al f in,C t oor,Lawow Law Cellar 9I coop Valuation
au enc ngwith Seron 70000 of Di.is Jorma Basine dProfession,Core) �_ - t, 135%§10§19Or0,
or mat he is exempt therefrom and the basis for the alleged soma ioe.Any violaion
of Serion 7031.5 by any applicant for a permit subjea.s the upplicam In a civil penalty
,ofoolmom than five handreddnnaR(5500), NO AMnlilk45 INSPECT ONS ' Occupancy Type
0 Las owner of the property,or my employees with wages as their sole compcnsaion,
will do the work,and the structure is not intended or offered for sale(Sec.7044;
Bus...,,,met Professions Cade:The Contractor's License Law does not apply to an Required Inspections
damer
of property Who builds or mpm es thereon,and who does such work himscif
athrough h' Ewe y t provisional m t h' p em t r' t Jed or
'-offered Por.ale.If.howe cr the bmldin im I to sold w mieone � f
g pro em year o .
completion,fee me owner-builder will have the burden of proving that he did not build or
improve f P rp f I.).
Ll 1. of the
p LBounce,- 'exclusively contracting �withlicensed 1 1 m
cant t(Set.714 a d Pr f r . Crado:)The C t 's
Liltoon Lo t pply I fp p y b b ld, p former,
...and h coma f <hpr n'.win ovanorslkroner uem .the
CoCama Ln rS B&PCfor ChareasonOl exempt under
Q
. . ...
...._.
Owner Dale -
WORKER'S COMPENSATION DECLARATION
-.. I hereby affirm ander pe-I of perjup'one nL,the following Jedamtions:
p 1 have ad will ioainmm o CarnEcore of Consent m self-insure for Weaker
Compensation, as,provided for by Section 3700 or the Labor Code, for the
perornionce of the work for which this pcneit is inwed.
_ ❑1 ease and will minamn Weaker'e Cnmpeisation In.surancc,as required by Section
J]W of the Labor Code for the performance of the work for which this permit is
Issued My Wnrker'.i Conipensatiau losumnce carrier and Policy number are:
_... ._ .,. .. . .. -. _........._. ............._.,_.......... ... .. .. ...
Carman 1 ..- ^ Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS');'
COMPENSATION INSURANCE ' "' ' -------
IS
.... .. .. ., . .. ..
rrti s senna need not be mmplcfcd if the Permit iv far ane M1undred dalton
151 001 or less.),
t fY P rf mance of[lie k f h e m P t'. '. eJ 1
I
'sM1al t 'pl�}yhaI In 1p�jJon in anY n <y tyhe b�tflh w kers
Co pen fu� I Impi .D I L <
'N s subject
PLIC ak ng INs0.nllsum ofaerialyoushot Ist -
z Navarrah ,,reply
, cPy .In k C pcm t pa "ions of(lie Lobar Code you nun
J
Q O bath 'Ih u 1 with. M1 p .a .o 1h parent shall he dee a cd revoked.
11 .
4 °' ' '''" ' ' CONSTRUCTION LENDING AGENCY' ,"I -
a'} "I herctiy off nn alit Cheri is h wnamciion landing agency for the lidrl'ommurea "
Lc d s Nam which this P al t,_ i&j .. _ _-, .- ._. .. ... _ ..
ssmd(S' J09],Civ
Lc J.,.Add
U"0 I sorify that I have readt ppl t d ourne that theabove information's
�T+ tet ca t l c I < #PIY with II t d acarm, t d.t t law elating
O U tobuilding t t d1 bet' n v t ' of this trepan
L pVl t J pe dk ph I ' m Cry fCpn sgann
tFi V] Coya cojud eared rhev and ar, rwv wbmM1 may in any way accrue agamw sad
V.z City in ANT UNDERSTANDS
of the granting of m6 L'CO
^' APPLICANT UNDGRoNs: SAVD WILLCOMPLY WITH ALL NON PONT Issued by: Date
SOURCE REGULATIONS. y'
S,eamcof Apprc:mVCanotemr;_,. Dae Re-roofs
:HAZARDOUS MATERIALS DISCLOSURE
lie hmeppn, far yielding t now r handle hm malnaa maad,l Type of Roof
ax demand ... ..... — ..... ... .. .
y Cape f n Mu i a pa{ .Chapter 9.12,and Cha Health and safety
r.
Code:Section 25532(1, . ..; n): ...x
❑Y t
°N All.roofs shallbe.inspected prior to any roofing material being installed
Wllth pvrc r t reb ild,ng P ta:eeqturnover or device,wnch if a roirlt is installed'witIt ut first obtaining an inspection, I agree to remove
ante tl rcol t. a.define by the Bay Area Air Q fp Manag Hent
District? all ne mater orspection. Applicant understands and will comply with
1))'a, : 0No . all non- regulations:
I have r!end m bacened......donanl,oott d CI pt 695 of the
Coffee Health&S od -S lid 255p525A3and25534u
I InJr' ndthat
lithe ding due' t Cly have at at that ifi my responsibilityt Ry the
here, of t ti hmotbe ,Ricr 1.issuance of a Cen'ficme of
' Occup'ancv C _ -
�r_2�� .Signature of Applicant Date .,
�<- owner Hca agent. „ Date All roof coverings to be Class"B" or better
..;';- . ,. ... . . . I. OFFICE ....