01070092 CITY UoF CUDN
PERTONO
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1104 NOVEMBER DR G T BUILDERS 01r0��70092
WLAMLARRY H AND DIANNE M 18630 OVERLOOK RD 07/ 19/201
(
HONE: SANITARY NO. CONTROL NO.
(408) 354-9406
tell z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MHCH
a i m CJ L_..I r= I—I
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z LICENSED CONTRACT'OR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions°(Chapter 9(commencing INSTALL SKYLIGHT.
FoiF� with Section]000)or Division3af the Business and Rofessionz Cale,ane my licence
I x ,m roll his and erae,�
X ic<ns<Clns9 �� Lio.a FF
�, � ®
O� Dam 7/ J/ S DELLA
w 3 -•f -rr^ ARCHITECT'S DECLARATION X f fi`
O S 1 undersand o,plans shall be used as public mantes
po Licensed Probac Tonal MAY
1 U 1.1 rL7oo2
OWNER-BUILDER DECLARATION v
1 hereby M.that 1 am exempt!mm the Contractor'.License Law(or the
i following reaoi n.(section mm s,Bnoine:.and Pmtes,mni Cade:Any city on count) BUILDING $2500
which require,a petmit m construct,aha,improve,demolish,or repair any structure
as 3- .,priort is Iw W the applicants '
f ,such permit TI signed statement - - -- -
a. that he isl'censed poiscant tothe p- f the Contractor f License L (Chapter 9 , ,'36�I1�OE9Qpr00O-a „ Valuation
(core g thSc1 ]") fD 3 rd B .i dr .fysCode) . . e _ ys, 11 "'
or that he rs exempt themlrom and the basis for the alleged exempt oh.Any violation
of Section 4031:5 by any applicant for a permit subjects me applicant to a civil penalty
•ser not mom man five hundred dollars($500). 10 TARN N@IMDAT ION •• Occupancy Type
❑1,a,owner of the property,or my empmyees with wage,as their sole compensation. 10 2 - PIERS
ERS
_ _
will do the work,and the structure is not intended or offered for sale(See:]044. 10 3 - UFER Required Inspections' '
Busiries and Pmfessions Code:The Contractor's License Law docs not apply to an q p '
owner ofpmperty who builds or Improves thereon.and who does such work himself 104 - REBAR
of offered
through his own taverner,
employees.provided that suchimprovementstime far or _ _
offeree far 'IG hd 'ive the building or npro omen(is lel lam bee year of 105 - ANCHOR BOLTS
completion,theownefbulleder will have the buteen ofpmving that he did not builder 106 - SEWER & WATER '
improve purPose u 1
-202 UNDERFLOOR- PLUMBING
D 1.as r of the popeny,a exclusively d Professions
web adej Th Cma vo is
construe the projm Istt.]BU,Business and Hofcssionz coders The contrarrors 2 0 3 - UNDERFLOOR MECHANICAL '
License Law does not apply m an owner of property who builds or improves mercon.
and who go lmea fur such.projees with.a centurions)licensed purstom.m me _ 204 - UNDERFLOOR FRAME _
111..exempt`�ae« c,. '- ' .o�P C,fortm.,reason 205 - UNDERFLOOR^INSULATION
Owner ' Date ' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IherebyalfirmunderPenaltyofperjoryor�gorthefollowingdeclarations: 303 - ROUGH MECHANICAL
❑ I helve and will maintai s Cenifcam of consent to.eR.insum for Workcrs 3 04 - ROUGH ELECTRICAL
Compensation, ax provided for by Section JWO of the Labor Code. for the 305 - FRAME
perfmmancr of the work for which this permmood it is ued,
❑I have and will maintain Worker's Comporv,mivn Insurance.as retained by Section 3 06 - HOLDOWNS
37BB of the Labor Code,for the performance or the work for which this permit is 307 - INSULATION
I,,ed.My Work eri Compensation Insurance canier and Policy number arc:._„_- -,
30 SHEETROCK
-
ei. 1 1 ,:,,• t 'rwfeyNa: ? 309 EXTERIOR'.'LATH
!,.CERTIFICATIONOFEXEMPnONFROM.WOR"RS '
COMPENSATIONINSURANC"'_,
. . -------- 3-1-0-,-,--INTER30R'—LATH----f �'-- i,..� _--.- .. __.. ..
°rrni:'.etdor need not be,completed it permit it for one hundred dollar. 311 - SCRATCH COAT
(sl(wl or iena.� 313 ROOF -
'-1 cenif me Roma of the wort r which,his rmil i tide,I
�lyunbte m art rw hie. nta r to Nato h �e`r” 501 - FINAL ELECTRICAL'''ENERGY
Compel anV;Coffomi� Damon` '^ ' f+ d''° _" 502 FINAL PLUMBING ENERGY._ .
APPI cat _ _
NOTICE T vu NTBaf mak m ren asoofEempt .you should 503 - FINAL MECHANICAL ENERGY
z bac -iF et to the Wt ," m .aI pro s n'of th Irh CWe you must
pO roan m- ldywitn rnp neo p t'nallbede<me wnknd. _ 504 - FINAL BUILDING ENERGY
" 1'coes ION LENDINGAGENCY 505 - FINAL ELECTRICAL •'
1 hereby affirm that d
that is a conamei(,n lending agency for the performance 506 - GAS TEST
r of The work for which this permit iz icsucd(Sac 309],Civ.C.) .
y p Lepm
de',Nae - — : . - - ._. _ - 507 - FINAL PLUMBING.
:D:Z Lenders Address ,
d[[nir thmino,,,madmis heafonmtdamtnat
s 'he above commoners is 508 - FINAL MECHANICAL'.
��O correct.1 agree u,cumply with all city and aviary lamm nae,and state laws relating 509 - FINAL GRADE
O U tobdldfngcomdocdo..,aoil nembyaumodaereprescnativesofthiscity toenter upon 510 - FINAL PLANNING
the ab°ve.memioned property fpr inspection purposes.
F .y Welugrcebtsave.indemnifyunJkeepharmlcwtn ityinConfront agai %1 514 - FINAL PUBLIC WORKS
N liabili' .- gmm�n,case sad c s which may way accrue vSaint,said
.' U:z Ci -mmnie mace of the gra ng his permiC
PLICANT JNDERSTANUS..' .LCOA W'ITHALLNON-POINT Issued b Date
URCE RE'ULATIONS:.- Y'
SFise"lion
nlApplicant ARDO ..Dat= '- Re-roofs T7
I ZARDODS hlA'. LS DISCLOSURE
iu'.m=apvo nt or etmm Mrd occupant scone nr.nanale haavmoua mamHnl Type of Roof.
by the Caper ino Mumaipn 'tile.Chapter 9.12,and the Health and Safety
C 2553''-(a)],
ores °,o No 1, All roofs shall be inspected prior to.any roofing material.bein,installed.. .
Will theapplicantorfutum building occulsont use equipment of devices which If a roof is installed without first obtaining an inspection; I agree to'iemove
mit na emou.s air contaminants as defined by the Bay Area Air Quality Management
Docricr all new materials for inspection. Applicant understands and will comply with
10Y`s ONO ' ' - - all non-point source regulations.,,.,, ,.
t 1 have mad the intention,
materials'aquiremems under 6m,wr 695 of he
CrWomia Heahhk Safety Cade.SeSafey Cade.Se�i�05:2�it 35534:1 understand that
set,
d 25534:1 understand mat _
mg tcurrendy ,entenam ntrs responsibility to notify the
upam of the rcmems ich most must be�' rssmnw o!n cefc c ofnssmnce o!n cefc c of
`uporm Signature of Applicant Date
own •oraumntPimo Kot ate All roof coverings to be Class"B" or better
``.^ .tl ... . . . .. . .. . _
.OFFICE ...