01110123CI nuOF UPERTNO
CONTRACTOR INFORMATION:
BUILDING ONPERMIT
�G DSDR
BUL I �i�l LACER SPRING CT
DRAEGER
CONSTRUCTION INCy
PERMIT NO.
01110123
° Ptii�A GIULIANO AND ANNA
605 COMMERCIAL ST
y
A1L1/29%2001
SANITARY NO. CONTROL NO.
PHONE:
(408)536-0420
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j
0
UJ f—s L] LJ
LICENSED CONTRACTOR '5DECLARATION
Job Description
1 by affirm tha 1 seri Ilccnscd tattier provisions of Chnpm 9lcommendng
' ere
h
I emoym)of
RE-SIDING.
' withS Divii n3ofThe Busincz. endP fc sionsC rid plAli<cnse
is in fu_cll / t v
C!m`aseuxcLie. 41
LDiae¢em__i
�Ca
{ pCT'1 DECILA R N
1 understand my plans shall be used as public mcoN.
�1740
Licensed Professional
- OP'NER-BUILDER DECLARATION
1 hereby affinn tbar 1 am exempt from the Contracmr's License Law for the
7011.5. Business Professions Code: Any city or county
team (Section and
fallowing/
i whi hoapaim, pem)it r imct llr p J al sM1 p y "rucourc
L/
-
- prima, its ewasnes'.1- reenims th ppfe . retouch Isearmitot fill aimed scilmnam
- that he li' pursuantdtth pro n of the r L C Le (Chapter9
r� pK,, ,f�r
- _ ,- 3�tH �N�r,rG�,s., { , v
Valuation
laomm uc ng with Section ]MMI) of I) vii I of rh B n rid Prof . ns Code)
exemption.
or that he is exempt thttefram aM rhe basis for be alleged Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
.of our ore the. fivehundreaaalars(SSW).
m
101AP�II'P70IMDATION
Oc upancyType
O Las owner of the propi or my employees with wages as their sole compensation.
102
- PIERS
10 3
- UFER Re uired Ins ections
Q p
-will do the work: and the swcwre'is net Imetufea or offered rot sale Iso. 7 '
does
Business and Professions Coda lac Commcmr's License Ins mm apply m an
trite r ne progeny Who build,., improves rhermr. vnd who does such work himself
104
- REBAR
or through his own employes, provided that mpr vementemcros arc not intended or
offered for sale. IL however. the building or improvement is wild within one year of
- ANCHOR BOLTS
iampler„n,the mwaer-buimerwi11 have the burden ofproving that hedid not beildor
106
- SEWER & WATER
mprove for put of sale.).
--
202
--UNDERFLOOR—PLUMBING`
o i. as mwne Pf'he pr tar. 71.nt Businxcla,ess a d professions si with licensed e C ntemm rm
construct the ro (Sm. 71W. Business and Professions Codc:) The Contractor's
203
- UNDERFLOOR MECHANICAL
License Law does not apply m an owner progeny who hilar or impmvs tl
Jean m
m the the
rn.a emmraemgsj Ecensea pursuant 10
and who commas for..wcn prm;ecrs with
2 04
- -UNDERFLOOR FRAME ' -'--- - - -
oi:me(vencp'madcr�= BA,PCfor this reason
205
- UNDERFLOOR INSULATION
301
- ROUGH PLUMBING
Owner Dare
WORKEWS COMPENSATION DECLARATION
302
- TUB & OR SHOWER
I hereby a1Btm under penalty of perjury one of the following declaration::
303
ROUGH MECHANICAL
❑ 1 have and will maintain a Cee of Cement m self-ma. tar w der.,
304
_
ROUGH ELECTRICAL
Lothar Code, for the
Compcnsatiom, as invoiced for by section 37W of the Inb
305
- FRAME
performance of the work for which this permit is ma md.
306
- HOEDOWNS
❑ 1 have and will maintain Wader's Co..... to. Immmisa as real by Section
' 37W of the labor Code, for the performance of the work for which this permit is
307
- INSULATION
issued My Workers Cv ens ton Ireur c -mer vnd Pnl cy mm�ber am:
308.
-
SHEETROCK
C Z
�'La`
c^ "
t , CERTIFlCATIO O s. EXEMPTION FROM, WORKERS
' 309
EXTERIOR'. LATH
CO PENATION INSURANCE' ;-
_ I ,s
_ 310
-INTERIOR— LATH
sirseeedmatF completed Vda, .it ismrrnehundred aouars
a(aDRn
311
SCRATCH COAT
IsIW)mleas.)
313-
- ROOF NAIL -
Icertify ihamthe p mganaardtew,tkrmrwhientmsp aisissam,i
501
- FINAL ELECTRICAL''ENERGY'~
shall ria employ vny person ill seaman( so.". become subject to the Worked
campcanatimn laws of California. DateAppli
502
503
--FINAL PLUMBING ENERGY ... _.
- FINAL MECHANICAL ENERGY
NOTICETOAPPLICA, :if. after makingthis CenificateofExemption, you should
become subject to the Workers Compensation provisions of the Labor Code. you most
mgnwit mmplywimsaenpro.isinma«wisp mit>nmlbea mearcyakea.
504
- FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
505
- FINAL ELECTRICAL -
>1'hemb,.M. bar them isaconsmnionlending agency for the perfomrnnce
506
- GAS TEST
of the work for which this permit is issued sec. 3097, C.C.)
$ tnraeraName•
507
- FINAL PLUMBING
Lender': Atldress -
�
508
- FINAL MECHANICAL
I agree toutIhave read cramthathe above informationis509
- FINAL GRADE
and county
to comply with all city and roomy ordinances and state toms relating
tea. 1g city
con
tobuildingemione npurposes
510
- FINAL PLANNING
prommyforiyspecti uposenmtivesofthiscitymemerupan
ja the above-memmaid prppeny for inspection p hmmmw .
rst
y W'e)egrceimscosts
514
- FINAL PUB IC WORKS
ndexpyeodkeephmayin my
n liabiliris, judgments, coos end expenses which they in any way ettme against said
City in consequence R the granting Df this permit.
-APPLICANTUNUERSTANDSANDWILLCOMPLYN'ITHALLNON-POINT
Issued by:
Date
SO E 7UL ISzs. I -U I
/
Re-roofs
..Type of Roof
s
..
sig t rt fAPpRaanVC r m Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the avpue t form huamgoccupant store or handle n amu. normal
asgiss dcfrted by the Cupcn o M n ci Ch pr 9 12, d th He hh and 5 fete
CagleN m nn 255321 7•
t •r v- p ,
i /
❑Yes "°-
All roofs shall
be inspected prior to any roofing material being installed.
Will the applicant or future buddi -cupamtumequipmcmor devices which
emit harardeus air contaminantsvs red by the Bay Are. Air Quality Management
If a roof is installed
all new materials
without first obtaining an inspection, It agree to remove
for inspection. Applicant understands and will comply with
District'
❑Yea "°
all non-point
source regulations.
1 have mad rhe hazardous materials requirements under Chapter 6.95 of the
California Health & Sol Code, Sections 75505, 25533 and 25536. 1 understand thio
' if the s building dommccommly have a¢tunLtbet it ismyrapm,drilhy mnotify the
occupant of rite iequirtmcnis x,hich must be mei prior to issuance of a Cenificate of
°ci'°p' r'Signature
6iil�Ot- i ai .S-O 1
of Applicant
Date _
All roof coverings to be Class `B" or better
Owncrmamhorizea agcm r Data
:... OFFICE ... .- --