02080105 CI soDING DIIVIISIONNO
BUILDING CONTRACTOR INFORMATION:
'
B1L81285RMSORETTI DR. MICHAEL COLLINS PERMIT 02080105
TMML COLLINS APPLICA0 j/ UA/ 2002
PI(ONE: SANITARY N��O, CONTROL NO.
q ZO ARCHITEC UNGINEER: N BUILDING PERMIT INFO
kL" BLDG ELECT PLUMB MECH
G a'
y_ LICENSED CONTRACTOR'S DECLARATION
�S: Rion," aRw that lam ofthe B undo provisionsdPofn,Chapter Code,and
SEWER LINE Job Description
,,XMui with Section, effect.
Division Business and Professions Code,and my license ) 9—OIIV`ILt LAE-13
_x045 rscemnrlass eet. (402030027 ADDITION
M.04<
< License Class Lic.N
O Dae Contractor
s SDECLA
•�3 LL y ARCHITECT'S DECLARATION
t 1 understand my plans shall W tied as public records SEP 18 2002
�r
tis. o O Licensed Professional
is. ca OWNER-BUILDERDECLARATIONthe RATION BUILDING
^-r i I hereby affirm that 11. exempt from the Contractor's Co License Law for the
following reason(Section construct.
BusinessandProfessions Code:Any city structure
county
F F O
which req pcnn't to co swctalter pm Je r n o repair any wnure
tPs7 3 m ,pear m e, Iso ieq do Ppl caro f uch puri t t fl geed rot mens _-that sic ns'dp tta the pious s of the C tract a Lc La (Chapterv S t. FIOOhACean Valuation
(caro eg with Section 3dE0) rD'vsI 3 nn eaie, aP r:.' ewe) + ;,., ^7 .9' s 't+ ' ;5+.,,' lix.,.8lo a
or that he is compo thcufrom and the bads fnr the alleged exemption.Anyviolation
iolai on 3 7.514 0 0 3 . 0 0
of nottmore than five e any
ndred dollar,S50�0)it subjects the appOcanuoa civil pnulry APN Number Occupancy Type
°Lasowmeof the property,or my employees with wages as their sole compensation, 106 — SEWER & WATER
win do'the'wnrk:and the structure Is not intended or offeredforsale(s«.Tau, 202 - UNDERFL�@ tt@$t �'t s
Business and Professions Co :The Contractor's License Law dace not apply to an i
Cash:
owner of property Who builds or improvea rhereon.snit who dies such war,himself 301 - ROUGH PL B I NG
ar through his own employees,provided that such improvemenu are oat intended or
offered for sale.If,hmve.dd the building or improvement is.old within one year of _. __302 - TUB & OR._. H WER'::. . .
improve for theose ofbuiled,r will have the burden of proving that he did nut build or 502 - FINAL PLUMBING ENERGY
improve puryoseo
- -
- -
-- - ' - ---.._. -- _.. - - 506 GAS -TEST
..O 1,as owned of the pm •pert am exclusively connecting with licensed contractors to r. i
_ 2 construct the project(Sec.7Dan.Business and Professions Codec nc Contmcto;s 507 - FINAL PLUMBING
n
Lice se Law does not apply to an owner of property who builds or improves Merton,
_
..and who conttacm for.such.projects with a.ronoractor(s)Eomeoul pursuant m.die
vectors License Law.
_ -Ume In'oder Sec. " - B&PF for this mmnn �•'•� Ii. .,.
o e ar tp�a/ L c/Z
_ WORKER'S CORIPPSATION�ATION
r Ihcrcbyaf .underwnaloy ofperjm,oneofthe following declumilnns:
If ❑ 1 have and will maintain a Certificate of Consent to self-imuu for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
performance of the work fur which this pewit,is i...ed,
°1 have and will mirnmin Worker's Cumpensmion Insurance,as required by Section
-_ 37M of Ne tabor Cade,for the performance 6f die work for which this pemit is
issued.My Workees Comwnsation Insurance carrier and Policy number are:
rS to ('1'idr S"s .. d ;-34. s �•j. bl: ".J's xi
@ir , PalicY Nn'' (
t;.tCERTIFICATION OF L%EMPTION FROM WORKERS' - .v Ili.. . s .. .4 IA
COMPENSATION INSURANCE
(This selion'nmd not W completed if the permit is for one hundred dollars
fs 100)or less,I
....ice.e stir ub.a war
I ccnify that rn the pcifowana of the work for which this pewit is iav<J.1 '�,�1 i/iL.
Cawl t employ any a ony anngg�3 t I/eyimc subject to the Workers
pc Lbws of If +• c/ L
N E PLICANT If aft r king thl.C n fc t f E e pt ,you shaulJ '
bee blttt to the No k< .Comwnsii p ns of th tabu CMe,you must
Q 0 to lh ply sv th h , or the pew o hall bed - re oke-.
'F ^ CONSTRUCTION LENDING AGENCY. _ (,
a.7 1 hereby affirm that there is a construction lending agency for the performance
f)"
tQFs„s.QtUr,Ae oeLmfentuhdesr's k fo,which
h ch th p.it ed(Sec.JtAt,.C,
ivC.)
Lender's Name
11c nfNoIM1a< ad application nJsure
that
the Winformation
(hint on'is
agree
ommply with all city anJ county ordinances
and state laws elating
tconstruction, dhe by rho representatives ftti.city to enter upon
r- hea1m -mons :nyforinspcnipurpnus
96 (Wougeeotiose,aifyokeh the ac
liabilities,judgments,ants and capenwswhochmay in any way aacrueabin.said
U.Z Cioy in consequence of the granting of Nis pe dr. - r l
•APPCICAUNDERS'1'AN SANDw h LY WITHALL�NON
Issued I7 Date ov
'c - 'GU IONS. L y<
gn euf Applicant(Conomaor Date Re-roofs
,HAZARDOUS MATERIALS DISCLOSURE
. , Wllth pplicat ft eMlldmy«c aromarh al I,azaNaasinamrim _ Type
as defied by he Cupert MunepalC epmro and the Health and safety s s s'^.sg ---
Code Section 255J21I)' " t ) tit' 4;i ^ ' ;,"'J" •i f •"I
El Ya" �' f All roofs shall be inspected.prior.to any.roofing.material being installed._... ..
W 11thopplic pro, ii,ant use egmp t 1 rocs which If a roof is installed without firs[obtaining an ihspechon;il'agree'to retitove
imth d air cmnm ants aso ed by the Bay Area A' Quality Management
DramicC all new materials for inspection._Applicant understands and will comply with
.1111yes. No all non-point source regulations.,. ,
- I hove hazard...materials requirements under Chapter 695 of the
California Health&Safety Code.Sections 25505:35533 and 25534.1 understand that
' ifthe Willing dmsno tq Wveamna t.thntais mY rasponsibiliryto notifythe- - - -
accuPam of the req mem hich m t be, p o rssuaaae of a Ceryideate o
Occupant / /
� a / �� Signature of Applicant _. , Dale .
Owner or/tit/rood agent \ 8 Date All roof coverings to be Class "B"or better
- .. ..... . ..- OFFICE _.