01110129 OF
CI BUILD NG DIVISION
PERMIT CONTRACTOR INFORMATION:
BY'n'Y"V31,PY WY PERMIT NO. ssyy 01110129
JANE K ET AL A11C,30�2001
i�PHONE: SANITARY NO. CONTROL NO.
O ieZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
a i 1,'7
wi LICENSED CONTRACTOR'S DECLARATION Job Description
I here by affirm that)am licensed under provision of Chapter 9(commencing KITCHEN REMODEL.
t-a with Section IM)of Division 3 of the Business and Prntessions Code.and my license
a se y-
is In full force and eff 1 q
g
�
O License
all Conracto
ACHTECT' S F'N^®e
5 DECLARATION
g 1 understand my plan shall be used as public recons
JUL 1 8 2002
i o O Licen.eJ Pndcssionul
O3( UILDER DECLARATION
a = 1 ..a .sect oaf I m ,<mpt from the Contractor's is License Law for the $2 O O O O
Fffca .1hichingmnma(Section cot ,sloesand Professions Coae:Any city or county
SFO xh h ts permit t .t re Iter, p demolish, repair Y structure
.
3 m Prot its Is q ii applicant r h permit is L (Chapter
9 _._ .. _ _ .
- wine licensed pursuantt tn<pmtvon nn Contractor L La (cnapas9 136�•l�•d'�C'®C�a'„a 1 ;,.I Valuation
(commencing woh Satin 7”) f Division 3 of theBusiness nd Profe sions Cade) � (} �.i... :'l_e S :!'
or that be is exempt therefrom and the basis for the alleged eamption.Any violation
-of Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty"
of not marc than five hundred dooms(550i 101AP-N NILiJ16DAT I ON Occupancy Type
0 1.as owner of the pro,tenny,or my employees with wages as their vale cromPereadims, 102 - PIERS
will do the work:and the structure is not mended or offered for sale(sec.rBw, 103 - UFER t
Business and Proessinn,Code:Tna Canmuro,s Li,ane Law does nt)t apply to an Required Inspections-
owner of property Who builds or improves thereon,and who docs such work himself 104 - REBAR
or through his own however,t provides thin such vement mrntx are not intended m _ - _-_ .- _—
' offered for sale.If.however,the buildingmimProrcmem is mid within one year of 105" - ANCHOR" BOLTS '�" � '�.P)
completion.the owner-builder will have the human of proving that he did not build or 106 - SEWER & WATER
improve for puryase of sole.).
o1,asovmrrofineproperty.amexclusivelycontranme.;thliensdcontractorsta 202 '- ""i7NDERFli00R 'PLUMBING _
construct the project(See.7B ,Business and Professions codec The Contactors 2 03 - UNDERFLOOR MECHANICAL ,
License Law does no,apply to an owner of property who builds or improves thereon.
' ' < d who contan,fts,such projects with a contactors)licensed pursuant to the 204 -.-UNDERFLOOR FRAME-
_ Iamexcmphes ��cunderSec.ense Law..
.B@PCfar in,pnew. 205 - UNDERFLOOR11INSULATION
301 - ROUGH PLUMBING
o ser WORKER'SCOMPENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby arsrm under penalty or perjury ore of following declarations: 303 - ROUGH MECHANICAL
have dna will mimain a C<mfieate of Consent a self-imma for Wmk<h 3 04 - ROUGH ELECTRICAL
pcsuade , n provided for by section 3700 of the Labor Code. for me 305 - FRAME
rmaac of flW work for wlJch this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as taloned by Section 306 - HOEDOWNS
37W of the Labor Cade.for the performance of the work for which this permit is 307 - INSULATION
issued.My Workers Campanution Insurance canter end Policy number tic:
- --- -308 .-' :SHEETROCK
'CERTIFICATION OF EXEMPTION FROM WORKERS:' ` '369 EXTER4OR i LATH 1
COMPENSATION INSURANCE' ._. 3.1.0-.-..-'-INTERIOR- -LATH..__-
(This section need not be eomplaeed if the permit in fee one hundred dollars 311 - SCRATCH COAT '
t5i0o)anessl .._3,13 - ROOF" NAIL
1 certify that in the Performance of the work fm which this Permit is issued.I t
Coin)ottse.,16y an,humsfcabf in any mummer aatag z4mo came subject to the Workers' 5 01 - FINAL ELECT'RI CAli' ENERGY
'App=°sin _ -^ 502....-. _FINAL...PLUMBING- ENERGY. -
NOTICE TO,A 1 ANT:If.after making this CenificamofExemption,yen should 503 - FINAL MECHANICAL"ENERGY
Z become subjectt to Workers Compensation previsions of the Inbor Code,you must
p O fonhwbh wrolywt mchp.vraia.mrbi,permit>hmlbespermedrcvowa. 504 - FINAL BUILDING ENERGY .,
^z' Vi CONSTRUCTION LENDING AGENCY SOS - FINAL ELECTRICAL ,
Cs" 1 hereby M.that Ihert is a co nionnion lending aBarcY for due Perfarntattce
.>, bnhe work rqr whfoh this Pemtit is i.sued s..3097.civ.C.> 506 - GAS TEST
y..Q Lender's Nh'or "
„ . 507 - -FINAL' PLUMBING. . ..
VZ Lender's Address -
O 508 FINAL MECHANICAL"
.1«my toot I
have read this application and sate drat the above information is 509 - FINAL GRADE
W E., eorre t l g in triply In II city and county ordinancesd state laws relat ng
O U tobu'Id, g t no dherebyaom o rep . t rive r till cityt enter upon 510 - FINAL PLANNING
the bo a i d pmpcny,for inspeetionPurfrosesy (We)agree rosave.incemarify runal keep hadeadcas the wyCupnoaast 514 - FINAL PUB C WORKS
liabilities,judgments,costs d expenses
%lohmay n anyasagems eaid
U.Z City inconeegUND ofo<granting AND
I COM
' oml
APPLIC ' UNDERSTANDS AND WILLCOMPLY WITHALLIJON-POINT ISSned by:
SOURr. GULATiONS. n. 0 -01
Sr ator.o maodenntme r .. . . ; Re-roofs
HAZARDOUS MATERIALS DISCLOSURE "
• dl app lois of roma huilding aseupanumrc or handle haiutdous material 'Type of Roof
' ' t ..t„=.
as def the Cupen nq Municipal Cod chapter9.11 and the Health and safety s
-
cne”Section 2ss32f.j
ED Yes 3 r,� o, H' q.
.-All roofs shall be inspected prior to any roofing material being installed.
wnthe appimamirfuture building accuwrstuse equipment ordevices which If a roof is installed without first obtaining an inspection;I agree'to:remove
emit himmous air contaminants n defined by the,Bay Area Air Quality Management
D...el?Yes , No all new materials for inspection. Applicant understands and will comply.with
J "„; �; '.,;• all non-point source regulations,,
'I have rine a heaudous pearialn dquiremints uadrf Chopmr 6.95 of On,
Califnmia Health'&Safety Code.Sections 25505.25533 and 25534.1 undersand that
if the building dos,rim currently have a tenant.that it is my responsibility to notify the ”
occupant f oc requirements which muss b<met prim to issuance of a Cenifeate;of
cu °'' Signature of Applicant Date
r - All roof coverings to be Class"B"or better
' '_' ow r aoda<a agent - t Dine
OFFICE ... -