01100004BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10540 N PORTAL AV
OWNER'S NAME:
GUINN ORVAL C JR AND WANDA W
PHONE
t ,
O - O ARCHITEC (ENGINEER:
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t
t ¢ d
N z LICENSED CONTRACTOR'S DECLARATION
1hereby affirm the, 1r3licensed under provisionsof Chapter 9(co.1 Beene
with Senlon](NX))of Division3of the Nosiness and Rofeui Cak, atm my license
kfou rorce arta eBe"' G RO?�
a x a Lice. Class Lic.0 / r
I O O U Date /h Corer �
ARCHITECTS DECLARATION
t Ain, I undemund my pfro,holl he wad as public records
ii,i z p O Licensed Profemiowl
z OWNER BUILDERoptfrom
DECLARATION
w Z v 1 hereby .(Seth ohm 1 am exempt form the Cssions Co License Law for the
l_ Z a following neem. Permit l IDiLS Business and improve.
d Professions h.Nc: Any city or county
E � o which requires a permit m construct. aloe, impose, demolish, ar rtpau any structure
z .prior to its issuance. also rcquiros the applkam fonuch pcnniunfkasigrad nuctrcm
i 3 snit fib is licensed panuad id Inc pr'ovisimar of the Convectors License Law Whapar 9
(commencing with Section7g)0) of Division 3 of the Business and Professions Code)
or that fe is exempt theafrom and the basis fm the alkged ciemptihh. Any violation
CONTRACTOR INFORMATION:
WATER SYSTEMS PLUMBING
3844 HEPPNER LN
(408)266-8222
IRMR NO.
011gq0001 NSyy04
PPLIlOGjBDATE
01/2001
sCUTARY NO. CONTROL NO.
BUILDING PERMIT INPO
BLDG ELECT '.PLUMP
REPIPE. Job Description
O')as :-;3.158'3F2 jr&KbiGa--i. i.: — ,
: NOTICETO APPLICANT If. afar making this Cenificam of Exemption, you should t "
become sabjco to the Workers Compcns5uon provisions of the labor Calc, you most
forthwith comply with such provisions orchis permit snail No deemed avaked.
_. neka%+90 ,CONSTRUCTION LENDING' AGENCY
"1 hereby which
that Permit
,uirtronion lendings, CI five rhe pct so
o, 1.- ,
of the k f e which tM1 perms �sucJ (S '11. Civ. C 1 "'
Iknder's Name`• :. .. c ., '1 1. .. ... .�:,...': ..
Lcndefs Address
I agree
that I have read this city
and on and state thin the above inf smtixn g
erect. I agree to comply with all hereby
nu and county ordinances s athi stem laws relating
to Wilding conswction, grid hertby outhorim rcprcuntaives of this city to corer upon
_y,f W
E„s.y
- 0-W
Z
or nun more than No hundred dollars ($54)(0) - --
compcntian,
❑hazowner of the propcny, or my employees with waguazdtcir sok m
' will do the wutk,'and the suucruri is not intended or offered for sale (Sec: 7004.'
10(SAF I SEWER& WATER
202 UNDERFLOOR PL
I ' 't'' Occupancy Type
BING
s
01 ROUGH PI
-
Business' and Professions Code: The Convector's License sew does nor apply m to
- 1(
"lalGspections , "
asdefnedby Ne Cuparroo or
Owner of property Who builds W impose, Churton, and who does such work himself
3 02 - TUB & OR SHOWER'
orthroughhis own employees. provided that such improvements am not intended or
dl's ; Will the applicant ar tutu
,offered for sole. If. however, the Wilding or improvement is sold within one year of
5 02 - FINAL PLUMBING ENERGY --
emporium, the mom,lu'cds, will have he Nolen of pining that he did nil build or
5 0 6 - GAS TEST
o
mP P ons
i
OI a Owner of pmtany exclusively contracting -tnl ,wcontractors'm
-507 - FINAL' PLUMBING -,-, ---
I
consumer the project (sec 7000 Business d e f. Code:) Th C t mons
of h Wilds rh
Lice L does t t rtth
� Gf�
apply popcnY p
.ted h ca tots for such p o) ars with commuorls) licensed pursuunrm rM1e
. _.. _.. __. ..........- . ..
i ... _
��
-
O l e me e t trade Law.
❑lam exempt under sec. •" '_.'B'& P,C roe this reason
- 1
ir•:, 'J,:,'11•.gt \
am
" WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of. perjury one af,thefnllowing declarations!
01 have' and '%ill mambin it Ccnifcmc'of Consent to self -insure for Worker's
Competrarmn, as, provided far by Section 37M of the labor Code. for the
'periman
-
i:ce of the work for which this Pamir is issued. „..
1 have and will mainialn Wurkir. Comprmatioo Immouree, as required by Section
700 of the labor Confic, for the perform ce f the work' f h ch this permit is
ssu d MyW ra C open. t m I m ca}n d Pot cy n I be art:
Curer I✓IaN poi y lbs. ��7�D��\y
s:...lr C.1
+_
ERTIPTCATION ORE%EMPf10fT'ROM WORKERSd
r�:5i.�,t
`
NS
' COMPENSATION INSURANCE r,
jc.......
_ - - _ --v..- — - -
ithlitiorincc', not completed m loud if l n for ora hundred dol
P Permit
_
-- - _ ---_ -- - -- - _ - --
Lis
(51o0j or less.) , ,
..r 1'c n fY th r in th- perform tt f the oh f nick rhis'cono, is issued, 1.
r " I1•', f (, „
shall not proddy any jc , _v--anystnanncf so as id become snblect ro he Workers
: NOTICETO APPLICANT If. afar making this Cenificam of Exemption, you should t "
become sabjco to the Workers Compcns5uon provisions of the labor Calc, you most
forthwith comply with such provisions orchis permit snail No deemed avaked.
_. neka%+90 ,CONSTRUCTION LENDING' AGENCY
"1 hereby which
that Permit
,uirtronion lendings, CI five rhe pct so
o, 1.- ,
of the k f e which tM1 perms �sucJ (S '11. Civ. C 1 "'
Iknder's Name`• :. .. c ., '1 1. .. ... .�:,...': ..
Lcndefs Address
I agree
that I have read this city
and on and state thin the above inf smtixn g
erect. I agree to comply with all hereby
nu and county ordinances s athi stem laws relating
to Wilding conswction, grid hertby outhorim rcprcuntaives of this city to corer upon
_y,f W
E„s.y
- 0-W
Z
the mrse.menuoped pmpeny fn
(WI) pgree tame, holm
lixb I t rydg nts, a and
City a 0Y 2e fthe
APPLI N
SO
signomminf ApPGcanVC nuacu
HAZARDOi
-
,,. Will the applicant or furor
-
asdefnedby Ne Cuparroo or
Code, Section 255320U. 11•
❑Yes
dl's ; Will the applicant ar tutu
mit herumnus dr comamiwna
District? ,
'ores, .
(p)
— �O Ke zed grnt
in any a, rembe,t,minu said
RIMS DISCLOSURE
ng occupant store 4 harclle haramuus matmd
Code. Chapter 9.12. and the Health aM Safety
I I'I lit t e >,
F
tiding eccurym ase cquiyrocan ser dletitta.thich
fined by the Bay Area Air Quality Management
umsdi «quirementsunder ChapreA.95'of the
'.ion.4505, 25533 and 25534. 1 understand Cha
pa�LL({ant, that it is my responsibility to notify the
t be met pr'dne issuance of o cnifi<am of
�p G�6
Issued by: , n- . � � Date
Re -roofs
Type of Roof.. _....
A1Lroofs shalm
I be spected.prior to any. roofing material being installed.__
If a roof is installed without first obtaining an inspection; Pagree`.tc remove
All new materials for inspection. Applicant understands and will comply with
all non -point source regulations..
Signature of Applicant Date .
All roof coverings to be Class -13- or better
"' - ! OFFICE - -" -