01100101 CI TY OFNG UONPERTNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMUTING.
1105 MILKY WY, ARTISTIC KITCHEN & BATH 01100101
OWNER'S NAME: APPLICATION SUB DATE
VAN ZOEREN HAROLD R AND JANET 131 E EL CAMINO REAL 10/17/2001
j PHONE: SANITARY NO, CONTROL NO.
(650) 390-9615
BUILDING PERMIT INFO
µ+OO ARCHITECT/CNGINEER: BLDG ELECT PLUMB MECH
<i
17 y= LICENSED CONTRACTOR'S DECLARATION ofC ON Job DescriPllOn
1 tionhCTCby70 alfrm that I nn licensed under Provisions of ns Code.and(commencing L
wimSmtion]000)afDivisian3ofsheBuaincsserMPro(cssionsCodeendmyliccnu KITCHEN REMODEL & SKY IGHT.
;m2M¢ VscenuclforeeandP.—
i 3 tv y5
Comrac°
A HITECuDECLAR N F I CA O A■ C
a O understand unticrsnd my Plans shall be used as Public records C 9$ Sw 6—iw
�T
Licensed Rofcssioml
o� OWNER-exempt from he RATION 2 2 2002
r,l
= i hereby,.(Sent on I am exempt from m<Cessions o License Lew Tor me IY
H
h Z following reason.(Section t 703 1.5,Business and Professions Code:Any city a'countyIme $20000
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whichrequiresaper t, construct,is'pli reprove harems., file..ir nny esu sairm
3$ ..pn w, n,ca al rt9 the apphcuhtfw ouch Pennn so fleasignedsummem- _ _ _ -_ .--_._� ..__". --
m licensedna. aid 16dipmlisome,of,MconvacwtsLcenseLawfChapber9 Valuation
gwi Q, - _ -
or mm rc m Section n]000) f Division is J of she Business and hart. n ons Cade? �,4) g t3 TF3 ,; t..>. j'P, ,d;
or shin he is eacmp,any applicant
she basis for me ets rise ekeicarn t.Any it Penalty
en lty
ofSection a than
1.5 iv any applicant res a pert),subjects me npplieant ro a civil penalty +
.or notahnrem.nfvenummaaouars(asto). 101p`PN YlJP1P6DATIC7N S' '' ' •" Occupancy Type
Ol,as owner of the propert,or my employees with wages as their sole compensation. 109, - PIERS
will do she work.and the stratum,is not intended or offered for sale(sec.]066,1
Business and Professions Cade:The Comma;a License law does not apply to an 10 3 - UFER Required Inspections' '
or d'9 his own employees.provided that such improvements me not intended or 10.4 - REBAR _
owner of property Who builds or improves theuon,and who does such war himulf
e 7,;
.. _...
-'comrtd'fon sere.If.er-bodr,tw Il avetarurien of,molis sold at he did not year of - _.- 105 — ANCHOR BOLTS- -- - -�. '.:`;, "
improvei for the owner-builder will have me burden of,moving snot he did not build or `
improve for purpose of dela.). 106 - SEWER & WATER
--
❑I;asow-o"the 'rpeny, m `adusivdy contracting with re linsed to 202" UNDERFLOOR PLUMBING
.
construct the porch(sec.]oda,Business and Profession.CWc:)The Contractor's' 2 03 - UNDERFLOOR MECHANICAL
Licerue law docs now apply ro an owner of Property who builds or improves th=uon,
dad In eomlans Tar such projects.witn a conuchwid licensed,p mean,to me. -204 UNDERFLOOR- FRAME
ConsIDetoh License Low. ,
O L am eacnrP1 undet sec; ,,B aaPc lar raja rtaaon 205 - UNDERFLOOR�'INSUL'tATION
- ' Orncr Dale 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby arfrmcode,pe-,ayyofpe,in,oneofthe following declamtona: 303 - ROUGH MECHANICAL
❑ I have and will ans a Certificate of Conaeat to self-insure far Warker'a 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
Performance of the work for which this pnmi,is issued. 3 O 5 - FRAME
0 have'andwill,nainuin Worker's Compcnution Insulin=,as mquimJ by Section 306 - HOLDOWNS
3700 of the labor code,for the petfomuntt of ml woh for which his permi,is 3 07 - INSULATION
jiaadMy Worrier's C Pe li o lammam carne, ad Policy number one
c ,� •-=1iP l yN Is 17 8t5') O\ 3'08e;.i,�iS,$EETROCK_i
:A I CBR'1IrICAT10NOF, EMPION FROM WORKEHSI• - '' ! X309 1-f(EXTERRIOR %L'ATH
A AAA y... :..h .� r COMPPNSATION,INSURANCE;;..., .r 1 -r.i.r... .'---__. .-`310,- =-NTERTOR--LATH......._...�
(This sed
(5100) 1ss.l an need not be completed'if she permit isfar one hundred dollars 311 - SCRATCH COAT
313 - ROOF' NAIL --7.----
-
1 c nif1'Thai m pin any num tie the work for wit ch m s permit a issued;I t 'r
shall nm alim, any nom in any number lar o as m b«am subject m me wphers501 FINAL EliECTR I CAli' 'ENERGY
ComApplicant'ion Laws of California.Dam .. ". . 502-.--FINAL .PLUMBING . ENERGY__
NOTICE TO APPLICANT:IL soler making this Cenibcsm of Esempton.you should 503 - FINAL MECHANICAL ENERGY '
become subject the Worker's Compensation provisions of the Labor Code,you must:
O ZO form%imam,rplywith�uchprovi.ionsorthisPermitshanbedeemed_rescie_a. _ 504 FINAL BUfLDING ENERGY
z CONSTRUCTION LENDING AGENCY'
E+ �+ Leader's Name fGim ihn me a v a construction. nu ns agency r me are°"^'^_° 508 — FINAL MECHANICAL
. m 505 FINAL ELECTRICAL . ;.
as
'onn krr nicnm pimhi s:vea(s' 3o9]c,vc) 506 GAS TEST _
y:q
Leader's" - " ' 507 FINAL PLUMBING -
oz
U-0 , ,1 amfy that I have rtad this application and slate that the above in a L
Wt:. scmart.I ogr=e to comply with all city and county ordinances and sum laws relating' 509 — FINAL GRADE
O.0 r Iv la gconstruction:a an Rbr tum mpmu lativu arm'city em upon 510 — FINAL PLANNING
lite idswe-rounicuredr propertynde mune t poison..
le
y' IWc7 ghee io indemnify elk pharmless the CuyofC pee ai gamest
n 1 bltrs3a rs rt a x which ymay .y m against 514 - FINAL UB C WORKS
Cty c fth g , Bofmspnmt .
(CANT 'DERSTA DS ANDWILLCOM LY WITH AI.I:NONPOINT`— Is$Uedby:
Date �O
RCE RE CATIONS h 1 �t —
.. S n mrt o APPGn lar. Dam,..' Re-roofs
' RDOUS MATERIALS DISCLOSURE 1,
Willonn appl Gant or fuwre building acuPnot state cr handle hvird6us mammal Type of ROOF •'- - ""—its def,ed by the Copes, Muor Pal Cod Chu 9.12.and the Health and Safety ,s r. ��•rt -•., at aa - h _ ,L "
Code.Smuon 25532(a) c. - A, < i�+ as t \( .i r
'LiY=A"" °I"`' �•.• „ ,+ All,roofs.shall be,inspected.prior_to any.,roofing,material.being.installed—
•,:;,," Will the applicantoifuwmbuildingoccupantuse cquipmenordevices which If a roof is installed without first obtaining an inspectiori;i agree.to remove
noir haaardous air communams d.efhned byme Bay Arca Air Quality Manegcinen,
Daniel?, - - all new materials for inspection.. Applicant_understands.and will comply with
oyes No • - all non-point source regulation`s. „
1 hevetieva the nnaaous'md¢ritls requim rears carrier Chapter 6.95 of the
,Califbmie H m&Safety Code;Senium 25505.255))and 255)6.1 undcmand mat
if the buildin�Isxe nm cumeady have a mnanr.that is is my responsibility ro omify me .
"Conant of rtquiremen whichmuii be and prior to issuance of!Cc
nifca¢of
pa"`y Signature of Applicant Date
her nt tumor;: t ohm All roof coverings to be Class "B" or better
OFFICE