01030170 CI TY G DIVISION
IVISI N
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7930 MC CLELLAN RD # 4 PSG FENCING INC 01030170
OWNER'S NAME. APPLICATION SUB DATE
CAMPBELL ASSOCIATES 1133 N LOTH ST 03/29/22001
ep IONS, SANITARY NO. CONTROL No.
4099953397
C s 2 ARCHITEC EINGINEER: BUILDING PERMIT INFO
Poo BLVC, ELECTPLUMP, MECH
N j LICENSED CONTRACIOWS DECLARATION lob Description'—,
p2 0 1 hereby at ire,ma,I nm Beemed under provision,art Clmpler 9(cmm�te Being
m F ei with scarab](MTU),f D"iSion J nf,bc B.,inc..an I ards"doos Cade.and my lice
ao@Ukmmnh,mtanaer - 2ND FLOOR BALCONY REPAIRS RESIDENTIA
m z 'a Liren,e __ Lic.b 1
3 LL N Dam 2 ] S DEC A
tM,G11I1 I:CI"e as Public re o d
C'=�; I unJcnam,d my Plun,.Ilett h unA u,public rca,Ns
ca a C Licensee Professional
c'c OWNER-BUILDER DECLARATION
W n 1 hereby arfirn,that 1 um escrom Iron rhe Commaor',Licence Law No the
Z
E following n, fscctin 19031,5,Homes.mW Prnfeoiunc Cn le:Any coy or county
y1 o which minfreo a'¢nail m rnn,hua,alcor,improve,dennJi%h,nr Ixpmr any'Inco nc
wtm priorto its i...ance.slsonemice,rheapplicant tin such permit,,11 lc a signed.hitvmen(
a. intheis seeoxdpunuammtheprosisionsoflocContmctorLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7H(ap of Dlvi%ion 3 ofbc Husines%and Profcsdon.Car
or,hat he is emmpt,herefrnm and the basis for the alleged eornruinn.Any violati,,n $3500
of Section 70315 by any,Tfca t for a permit object,the applicam u,o civil penalfy
of an more ma,live htmdred dollar,($500). APN Number Occupancy Type
❑Lar ownerot the portico,or my employees with wages as their.vote cmnpv.nc
will do the wad..and he strecmre is not intended art offered Ibr side(Ser.71W,
Business and Prove.%con,Code Me Contra<mr.License Law doe,not apply to an Required Inspections
owner
or prol,eny Who WIN ormprove%mcmnn,and who does such work himself
own h t ,mairded fasuch improvements are not 'ar
1.01 — FOUNDATION OUNDATION
ol throughd for sale.If, vac"...the blvar arovenanin bdwithin intended
...c cnrof
nmpleho,,cotownO-hRlarr will beae l banderol art re els nt„ e o 702 — GIERS
rrI Pamo.corsie.). 103 — UFER
OT. wthe pro,”,am esau,ively contracting will,
Eea„ed c,511NAL-
r
104 — REBAR
con ruct the project(Sec.TWO,Business and Profes%inm C(alc:)The CommeoWs
License Law doe%not apply mon owner of property who hnH 1,n an"noc, h, 1 0 Z001 105 — ANCHOR BOLTS
and whir vu f
anmmoach p
r eroyo,wish a canhaumr(,) Beamed puawaun t l� .
Comrremr,LicenseLaw, 106 — SELJER & WATER
1;an exempt ander See. .1,&P C Into,rea.on
Owner Date B ILD"4G 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARAl'ION _ 203 — UNDERFLOOR MECHANICAL_
IlnrebyleTlsn ander penalty of periaryone of the towos in,decmratioas: 204 — UNDERFLOOR FRAME
J 1 nave sad win nmh,fnln a Certificate or Consent ,,-Ioi...re for worker, 205 — UNDERFLOOR INSULATION
Compcn,miorr. as proOded liar by section 3700 of the Labor Code, far ,he
r
perfomance ofthe work for„hien this pem,it i,issued. 301 — ROUGH PLUMBING
Xhave and wdn tnim:do worker,Crn,1xmai,,it Innmmmeeimd
.:u reynby Secth,n 302 — TUB d' OR SHOWER
-,al of lbt Lunar Coda Ibr the petlar ioncx or,he wore for which,his...coin is
is.My worker'.col,Ipje�I'mnm,mm�a eflrla ata roliry burbler oyer 303 — ROUGH MECHANICRL
car lt/�01 UhryNw: QG 304 — ROUGH ELECTRICAL_
CERT ATI„NOFEXEMVI'IONFRONIWORRC S
COMPENSATION INSURANCE 305 — FRAME
rnnit ,if.....need mot lweonplOed it perch i,I.
an haneaw dollar, 306 — HOLDOWNS
rsHgparl"„ 307 — INSULATION
I scarify that in he perfnnman.or the work for which his .it is issued.1 �QLB — SI"IEETROCL
.hall not employ any Peron in any manner coo a%to become subject to the Worker 3 ,
Compensation l.aw.,n cairor,ia'O't`nne
Applicant 309 — EXTERIOR LATH
N'romesnectto the wook If,C ro,u4ingmi.c,:aincate be lady Cdc,oa-a,ould 310 — INTERIOR LATH
Immure subject u,cot worker',v o o.,cr,hi,provision.of cot Labor nvvor roe mus
p forthwith rod„rlywbn.urn,triol.aom%orad,l,ernit.nanaredeemedrx,oked. 311 — SCRATCH COAT
CONSTRUCTION LENDING ACENCY
Fd I hereby affirm corn there is a em,wraaGon lending agency Iia the prtinmancc 313 — ROOF NAIL
pi1 one workfor wl,lchmi, rtriti.:..aed(See3097,Cie.C.) 501 — FINAL ELECTRICAL ENERGY
j 7 ICl,der.ndnNa
"'. 502 — FINAL PLUMBING ENERGY
U O Icrnily that Ihave tend rhis application aadox,but the above infornationi 503 — FINAL MECHANICAL ENERGY
r+ [.n correct.I agree a,comply with all city and conn,'ordinanecs and%fare laws rela,mg
O U mhuudiageon.fraction'andl,erehyaauawreIsAwriati,e—ftni,atymmumfir,m 504 — FINAL_ BUILDING ENERGY
Fythe aboven... a or Pfulmny no ropecliun pnpa,.cs,
(lac)agar,o,me.indict,ifyand over lfmnless dcCity ofC.,nimiagaia,( 505 — FINAL ELECTRICAL
U) liabilities,judgments,cast,and caprices which may in any way acrme again.,said
U z Ciry in ctmvcyt nf,hc granting of mispem,if. C
S PPIICE RI IN DER�TANI 4ND WIL]S, ,h COMPLY/WO'li .J.NfLON1�� Issued by: 506 TEST Date �d
-I Nrl
,I —pl: Ca uva n �� IAnc Re-roofs 506 — FINAL MECHANICAL
inn HAZARDOUS MA'IERIAI S DISCLOSURE
Will the allplicant or mince building,a'cupam start rr handle hvareou.mamriul Type of Roof 509 — FINAL GRADE
as defined by the Cupcnino Municipal Code.Chapter 9.12,and fire Health and safety
Code.Section 25532(a)'1 510 — FINAL PLANNING
ElYer All roofs shall be s ectedr�'�(tr�}Q stn 1 ng installed.
Will cot a„Edam w linnrc boldin,omu,am not a ui mI<m or devices which ' Y 11VML �� � � r
1I k I If a roof is installe without fust obtaining an mspectum, agree to remove
em it hamrdom air c....o nanfsmd 9inn1 by,hc Itay Area Air Vu:Jify Mnnugcnaaa
>i.oec all new materials for inspection. Applicant understands and will comply with
0Yes ,,Na all non-point source regulations.
I have read the m.ormnu%materials moryimmenw under Chapter L 95 of,he
Cali ...ia I lcabh h Safcty fide,Secbrio.25505,25591 and 25514.1 understand mat
if he hooding Jac,bol conically have a Imam.Ihut it i.Iny re.ponsibicry ,,notify Thr -
imcup i al fl yuinvnenL which rotor are nm(prior to il,mnce art Ceraimie of
Dr nosy.
Signature of Applicant Date
,, t d daNau ✓ Dae AII'roof coverings to be Class"B" or better
OFFICE