01080093 CITY
OF GDIVISION
I PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
7712 OAK MEADOW CT C BROOK CONSTRUCTION 01080093
OWNER'S NAME: APPLICATION SUB DATE
MOHAN KINLOSKAR 189 BERNARDO 08/20/2001
i GONE: SANITARY NO. CONTROL NO.
(650) 965-8972
z ARCHITECrIENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MF.CH
Ni� C L'] Lx,
J L 7
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LICENSED CONTRACTOR'S DECLARATION
i
hereby pmrisionso p g tib Description)
1 Iaffirm that 1 am afire d under f Chapter l d Iencin / O
'�1=° x;ms<etion7dooyofDiW,mn3nrmeeusmesa Pme„mnacala� anryfiana< ADD 482 SQ. FT. & REM DEL.
-r in full force and effect
i z,��„a
License Ctnss Lic.r _
:O`a�' Date /,7—L !1_t_ Comra<mr
i is u.N t 1 `gkCHITECr'S DECLARATION
LL'O;, wtdersmnd my plam.lmll ne oars a,puhtic records
: Y.
1 z c O Licensed Professional - - - — -'
' c,ce OWNERBUILDER DECLARATION
1 hereby alfir.n that I xm exempt from the Coalmaar's License Law for the
F ZS a following,sawn.(Saban 703 1.5.Business and 11rol'e,ions Code:Any city or romp, $160000
P F C which requirts a permit to conmmct..her.improve,demolish,or repair any s0ucma
a3°O thatb ie issuance.also req applicant
perm. In,,ad
'as the. I'cam for sucM1 uo .east statamcm
that
he is,lieenseA Puisuam 1p the pmviiv on the Convenors Liccnu Lex ons ad Id R r„-T.,. Valuation
Icommcnc.ng with Seaton7(kl0yof Division3ofine Business and Professions Code)'., {;{ , tlf.'3' � IP$'. ,;,,;};;';f; .
or that he is exempt
therefrom and the husis for i'e alleged exemptitin.'Any violation
of Section 1031.5 by any applicant for a permit subjects the applicant m a civil penalty
.or not more than five hundred dollars 1x500). 1014PNI N�AT I ON Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole cmnpemrtion, 1 02 PIERS
-
will do the work,and the strvnure is not intended or offmcd for sale(Sea 7614.
Business and Professions Cale:The Contractor's License Law docs not apply to an 103 - UFER Required Inspections'
owner ofp ,cry,Who builds or improvesthd whodoe cn
' khis�
on through hemployee,Provided t. h' pintended 104 - REBAR
._.. . . , . . ._._
'offered f 'sal If now the Wilding improvement old withinye or - 105 - ANCHOR BOLTS '
completion th -b Id ll haetheburden fp gm t heddnt Wild on
iroponer r m f 1 ) 106 - SEWER & WATER
'O1.ant'oupen of lh<pmpcdy, xduidvcontraicting inowl ao�wrdoothi' 202 - UNDERFLOOR" PLUMBING
consumer the project(See 7614 Business nd Pref'smons code)The Contractor', 0
wector a 203 - UNDERFLOOR MECHANICAL
License Law does not apply m.n owner of pmpeny who halm,nr Impoves thereon,r
with a commcmr(s)rcemed.pur,uanl m the 2 04... - .UNDERFLOOR -FRAME. .. _._... . _._ .. ._ _.-
and who contracts for such Projects - .. -. . _.
Contmetunder
l
naw. ,
olam exempt nam see. ,B&Pefor this reason 205 - UNDERFLOOR"INSULATION
exempt
Owner Date 301 - ROUGH PLUMBING
_ WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby affirm under Penohy of perjury one or the following declarations:. 303 - ROUGH MECHANICAL
IJa-1 have and will,maintain.Cenificmc of Consent to self-insure for Workers 3 04 - ROUGH ELECTRICAL
Cman,rumion, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued:
305 - FRAME
❑1 have load will maintain worker:compensation Insurance.as required by Section 3 06 - HOLDOWNS
Carrie, Labor Code,for the perfomwncc of the work for which this permit is 3 07 - INSULATION
orkcr's Com�nSadon Insurance cartic and Policy num cram:
308 ;r SHEETROCK
nsu d M W
t 'CERTIFICATION OF EXEMPTION FROM WORKERS' v�iiflicy No:' 1s r`3e09' 'v'}EXTERIORr LATH
,c.. COMPENSATION INSURANCE; .. -310-INTERIOR—LATH—
(This
___
.. -
- -- 3 T0' .- .INTERIOR—liATH� "
- t (This section
neidurnrtecompleted ifthe permitisfor one hundred dollars 311 '- SCRATCH COAT
($IW)or less.)
_i<emry,that in he Performance of he walkfor«:rilon his .it is loaned:1 .. 313 -- - ROOF NAIL...
,half not employ any person in any manner so as to become sunjem to the Wnrkars' 501 - FINAL ELECTRI CAI]"ENERGY
Compensation laws of California Due ..502 - FINAL PLUMBING ENERGY-' -- - - '
Applicant _ . ._:' - -.
NOTICE TO APPLICANT:IL after making this Certificate or Exemption,you should 503 - FINAL MECHANICAL 'ENERGY
z become subject o the Worker's ComOenation provisions of the Labor Cada you must
Z2 O fanhwilh comply with such provision:or this permit shoo be deemed revoked. _ S O 4 - FINAL BUILDING ENERGY _ .. .
F4 I CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
E
7 I h reby affirm that there is a conswction lending agency for the performance -
ofinework for which thispermitisissued(Sec.3 7,Cis.c.) 506 GAS TEST
y:p
Leiradees Nam` 507 - FINAL PLUMBING
.7 .� Lenders Address.. . ,: ..• , .,.i .. `
1 .
Q O I eeniry that 1 have read this application and state that rise all information is 508 - FINAL MECHANICAL
Im E. -correct.1 agree to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
O Q the al,oing rontioned n.and pertyfcbyaummis«posentztivex of this cirymcn¢r upon 510 - FINAL PLANNING
,rise eM(We)agree to save,property for Inspectionpharmle the 61
F,tZ) (we)agra”iosn,e,inad 'ape and, hrh.rmle,aanywayseem!againtsaid 514 - FINAL PUB IC WORKS
Z) liabilities dgmenls,costs end expects 0ich may in any way accrve against said
Q z Cityi ons acnes of the n ng this unit. '
AP ICA 'UNDERST .' WR COMPLY VITH ALL NON PONT '
s RCE EGIn.Ano Issued by: Date 2 /�(�/
-da iean aurae r Dade . Re-roofs
HA]ARDo MATERIALS 1 CLOSURE -
coad.Section zss3ng o No m amm or handl<nvnmoua m.terial . Type of Roof. .. .... . -... . -...... .. -- ..
Num pPl1A r Wnaingor
as defined by the Caperton M 'pat a Chapter 9.L2,and me Health end Safety „ ,•,a ,1 a
t -
i! '
All roofs.shall be inspected prior to-any.roofing.material.being.installed. .__ ..._..
Will the o f b ildmg p t equipment a :,wmcn If a roof is installed without first obtaining an inspectiofi', I agree'to.remove
ta t naurd on t d fi by h Bay A A Q I ly Management
fame.+ all new materials for inspection. Applicant,understands and will comply with
6 oYca all non-point source regulations; .
1 has ad he harmdous materials regmremems under Chapin 6,S15,01'Ne '
Califami ea h&Safety e; tions 25505 25533 mW 25534.1 understand that
if the din note < tly ha a"non- at it ie my a=.:ibilltymnrs'y the
ant a require c s u.0 he et prior to isman<dof a C<nif�cate of
` pan of Applicant - Date
=0
<r or milli lies age Date All roof coverings to be Class"B"or better
:a
- OFFICE