01040024 CITYBUILDING DINO
VIISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO.
19211 PHIL LANE. 01040024
OWNER'S NAME: APPLICATION SUB DATE
04/06/2001
PHONE SANITARY NO. CONTROL NO.
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L=1 1=7 I_J LJ
y= LICENSED CONTRACTOR'S DECLARATION lob Description
ZO Z-, 1 hembY aRrm Jus 1 am (com
licensed male,provisions of Chapter 9(commencing Job
F_(-w wiihSenion'1000)ofnivision3oftheBuvnessandPmfessimoCn andmylkcnse ADDITION 525 SQ. FT. LIVING SPACE,
Yis in full fame and effect.
c a License Class Lia.« 151 GARAGE .
3 U Dae
ARCHRELTSDECLARATION F f IV A►LE
1 understandmy plans shall berried as public records
oLicensed Professional MAR 1 9 2003
°'K n 2 OWNER-BUILDER DECLARATION
1 hereby affirin that 1 am exempt tram she Contractor's License Law for she
It ofollowing (Section 70315 B innse d Professions Car Any city county
which re,dre,x psmumto.cor,ma,l. Ira p J nI h p y mmttrc
q _pr t 't s c q 'm .III II 'h1 lir it I 'g d. ",. e.l - ----- 4
I DIIV
II imq li I.th little just, f0 C eta ntr ,, Le onscoo 9 S FC-Floor Area at aatlO11
¢ n<,excro Sectmmour moorDiv n3 Rlteasn..aneimrxrons Cade) y 5 Areal,
.,that he is exenipnhcmfroli and ar bash for thects the exemption,Any l penalty
-
of.1 Wave
than
iv any applicant fare peemit subjects the applicant m a civil penvhy t
of Trot more roan Br<nandrw dollars lssaBl. umber Occupancy Type
01,ass ownerofthe pmpeny,no my employees with wages vs sheiraolc emn,tax,00n, 101 -
will do,he work,and the structure is not intended'or offered our sale(Sec.10.14, t`
'Business and Pmfessions Code:The Contractor's Licenm I.aw docs out apply,o an 102 - PIERS Required Inspections
caner of pmpeny Who builds or insproves themon,and who does.such work himself
of through his own bravesemployees.provided that such improvements are not intended or 103 - UFER
offered for:isle.If,howcvcn the building ._ __..._ __ _ .. .. .___....._.. ... - _.._ _ .._ ....__ _.-_..... ..- .
'cam le,ion,the owner- or improvement is till within one year of 104 - REBAR '^ "
P builder will have Nc When of pmvin8 that he tlitl not build or
improv mrparinsarate.7. 105 - ANCHOR BOLTS
1' - -
:. r .as owner ohne pmpeny.am Business and Professions
Wc:)Thmmmnmato 106 ._.— SEWER & WATERcomb _ _•__ _ _ ._. _. �.
License
cs the project(See.
appl 1044,owner o and Professions Codc:)The Cmuracimproves
common,
.,.,
License Law dos not apply to an owner of pmpeny who builds or improves ln<rean, 2 0 — UNDERFLOOR PLUMBING -
_and who contracts fur,such projects with.=.contortions) IicensN pursuant to Ibe °
Cantrntmrs LicWar Law., 203 -' UNDERFLOOR ,MECIIANTCAL _.. .... _... .........._..._...,...,
❑loraeacmpt
302 - TUB & OR SHOWER
0 I have'an8'will'moi main a Cenuic^ie af'Cument to self-inmre for Wark<r's 3 03 - ROUGH MECHANICAL
Comrmiume t, he work I.,
Tar by secnm nw or he LaWr cad<. for the 304 — ROUGH ELECTRICAL
_ peRarmance of the work for which his permit is issued.
❑I have ad will maintain Worker i Compensation Insurance,as mN.irtri by Sectio 305
- FRAME
- 37W of the'LaWr Cine:far the perfrrmvnce of tW were far which mia p<m,;t is 306 - FRAME
issued.My Workers Compensation insurance carrier and Policy number are;
carri<r,,.' -- 307,: INSULATION -
Policy
,[,CERTIFICATION,OFEKEMPTION FROM WORKERS' •3O S. SHL'-'Errl'ROCK.3
_ COMPENSATIONINSURANCE
_309-: EXTERIOR'-LATH '.- ; __-- _.._._. ..--
($100)0 lest nwnLueed not be completed if the permit is for one hundred dollars 310 - INTERIOR LATH �_. I ,m_ j
I' tris..h.aperr « rine kr nrnin minor, 31k 311 - SCRATCH 'COAT - ---'—^ -
shall not ramay any person lin any manner so ax is become sr b3ect io N<Workcri 313 - ROOF NAIL`'L
Compcnsasinn Laws ar California:Dae'
no it
501 - FbNAL -ELECTRICAL -ENERGY -- .-
,NOTICEToAPPLICANT= a ,tra liglhsCnf atomfLith n.Yom�"gold
502 - FINAL PLUMBING ENERGY
W me udo...mthe Workers Can, maim
pmvumns of the Lith
Code you must
z 0 f. ihcnmplywith tnprotaanaonn permdshmlbedttmeemsakee. ., 503- FINAL MECHANICAL--ENERGY-..-- . ....
``.' " ' CONSRUCIIONLENDINGAGENCY 504 - FINAL BUILDING ENERGY '
1 hereby aRrin that there's a construction lending agency for the performance -r;
Q in far -505 FINAL ELECTRICAL, __
Led Ad1 tied 5 c 3091 C'v c) 506 - GAS TEST -- -
l
D-Z -
V Q 1 n fy that m
I have rcaJ 's rppl. d nm
tion anathin the above infnrmatiun is 507 FINAL PLUMBING 'i
Lvr-E.: comers.l agree lin comply widsat]city and emomy ordinances and sure,lvwsiebong 508 - FINAL MECHANICAL
=:0 U toWildingcnnslmnion,andhereby,authorizerepraemadvesol'thiscitytoenterupon
the above men509 - FINAL GRADE
} fy ' cdp .pen far p rpose ..
F..-0. 04c)qW, o vast,ine fy and keep hrmlerhe City of Cupenno rganv
pj
liabilities,judgments,cass and ex,persaii which may in any way acme egmna said 510 - FINAL PLANNING
APPLV 7J- City IC se rc fin g t gof ih pe t g
e .SOURCPRF(uNI1TIDNSnDSAN ILL14 - WORKS
COMp WITH ALL ISSlledbNA C I -
y: Date
as de0ned the Cupen
c au pple meth :. ,' ,Dae Re-
roofs DOUS MATER) DISCLOSUR
Re roofs
W II a appb n future Wilding =pant state or handle harallous material p .....
Type f Roof, _..._. .
no M icipal Code Coapt 9.12.and the Health and Safety
code
°"° r All roofs shalt be inspected prior to any.roofing installed... .
ecs on _
will the.applicant or future building occupant use eq ) mm°rdavicev which If,Iroof is installed'Wlth(3ut first obtaining an inspection'}I'agree.to' emove
t
en th d us air tit is as dehned by the Bay A...A Quality Manasemeni
nntntt. .. _.. . all new materials for inspection. Applicant understands and will comply with
o"° all non-point source regulations: ,
I have read the hamNous materials rcquircments and ch purr 6.95 of she
California
Health&Safety Code.Seen...25505,25533 sad 25534,1 understand but
If the building Jucs not curtendy have atenant,that it is-my responsibility io'notify-the
accbpam of the rcyvircmenis which' st h me,prior to ieeuunae'or a cenificate of
OuapaneY.,l ► Signature of Applicant _ Date . .- .
wnerurr Hari= gen Dae. All roof coverings to be Class "B"or better
....I .. ... _. _
_ ..... . ... I
t FFCE