Loading...
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 �w— 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 ....