00070037l.II If yr l.urnKi m'v
Hun.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWNER
PHONE: LJrlt-H,fr .1
409"572-3513
LICIINSEb Ci1N'FRAC'I OIPS DECLARATION
I hereby Mann that I airs Iiacmed under moviainua ol'Chapter 9 (conm..III
with Section 700d of Division 3 of the Business and professions, Code, and any license
is in NII force and effect.
Linen., Class Luc. M
Dale Cnntnchr
ARC] 111'FCp'S DECLARATION
I understand my plans shall he used us public record.
Licensed Profnsional
OWNER -BUILDER DECLARATION
I hereby :drfa, that I ane exempt (ruin the Conlrucmr'F Litmus Law I... the
rJlnwing reason. IScm.an 7031.5. Bowes, and i'roue lam,. Cos: Any city or county
which rc,dec a permit m am fuel, alter, impnnn, demolish, or repair any amctme
prior to its issuance, also reyuircs the applicant for such permil to file is signed statement
that he is licensed pursuant to the provisions of the Contractors License Law l Chapter
O,ourn elmµ with Section 9000H of Divl,inn 3 of the llu,ineas and PrvI1,1ions Calc)
nr that he Is asannpt Ihcrefnma and the Masi, far the alleged excnnption. Any violation
of Section 7031.5 by any applicant for a pencil subjecn the applicant to a coil penalty
of not mom than five hundred dl Wild).
❑ I, a, owner of the paopny, nr my empinpus with wage, n, man, -1c eunlva,Olon,
will do the wad, :rod it, suucuuc is .awka adlad or nfl'emd for ,ale (See. 7W4,
Inosines, and Prol'ussimu Calc: The Contmmor's Licensee law does not apply to an
ownrO of property Who Faulds or improves thereon, and who does web work himself
m tbrnuyh his own employee,. plaided that such improvements are not intended or
offered fir sale. IL however. the building or improvement is sold within one year of
mildetion, the nwnerwaiWcr will have the harden (If proving that he did nm build or
tnpm.e for purpose of at,).'
6rof the impary. am exclusively contracting with licensed contractors to
<nnam<twthe pn,jcn (Star 7044. liusineas and Professions Conic) The Contractors
Laa nse Law clue, ton apply m in loner of irnpcny who bolds or improves thereon,
send who contracts for such In lecu wilt a conuuanr(s) Iloenwd Insulin m the
Contractile, Licence law.
❑ 1 am exempt under Sec. , D & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a(Onn under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Cendi am of Consent in self -insure for Worker's
Clamparounn, av provided fur by Swann 37(1(1 of the labor Crete, for the
,dornamw of the work hr which in, ensu is'"Ined.
❑ 1 have and will maintain Worker's Compensation Insurance, as na mord by Section
37M of the Labor Curie, for the performance of the work for which this permit is
boat. My Wbdcr, Cnmpen>ation Ioumnce carrier and Ibley number me:
Carder: Percy No.:
CERI'IPICATRIN OF EXEMITION FROM WORKERS'
COMPENSATION INSURANCE
('In, section ,act not be completed it In. permit i, fair lane hundred dollars
($110) to lass.)
I utility that in the pem mtance of the work for which this permit is issued, I
shall not employ any plum in any manna so as to become subject to the Workers'
Cn Telt,adon law, of Caldoma,. Data
Appecam
Nil'ICE TQ APPLICANT:It, alter incising Of, Cenifiewu of Exmnpt]nn, you should
beconse subject m the Worker's Compnwtlun provisions of the labor Cade. You must
forthwith comply with such provisions or this fa mtit shall be deemed revoked
CON S'FRUC-HON LENDING AG 1: NCY
I hereby al'I1nn that thuya is a a Oametlon landing ngancy for the pedis -nal
it the work for which this pcnnit is issued (Set. 3097, Civ. C.)
I<nJeh Name
Lender's Address
I acuity dual I have lead Otis application and oma that the shove iilbnnaion Ix
non.1 agree to comply with all city and county ordinances and .state laws rc]ating
m building construction, and hereby authoieo representatives of this city to enter cpm
the abovementioned property fes inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupcnino against
ha bolitics, jud, as, etas amt expenses whelp flay on tiny nay aecrue against said
City in anmeyocnce of the gmnling of this Peru ,.1.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of ApplicatUContrudur Ilam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicantor l uture building ne,apant .acre ser hanmmm
dle hoed..., annl
as defined by the Careen ino Municipal Camc. Chapter 9.12, and the Health and Safety
Calc, Section 25532(x)?
El Yes (D No
Will she applicant ,, linure building occupant use evoipnunt or dmtro which
cosi, harardomin
us air contaminants as define) na
by the Hay Area Air Quality Magement
District?
oYes DNo
I hhvc read the hotain ous malcdnb Oroor nI' under Chnplar 6.95 ill' lee
Cali fnrnia Health & Safety Calc Sections 255(15.2 .)and 2553J. I underemnd than
if the huiiding Jct. of cum hereat nam,thmn yrc,pnmihilitymnrnify the
a,ecupaa, of the re e w 'c lu. t -stn is ce of a Cenificete of
ilceupancy. m
Owner
. tuffslamed ant Use
HLDG r1 -ECT PLUMB MF;CH
Job Description
ADDTN /REMODEL
Sir
APN
., t,b2t t.v3ti` R%ircd Inspections
101 —
FOUNDATION
1.02 —
PIERS
103 —
UFER
104 —
REBAR
105 —
ANCHOR BOLTS
106 —
SEWER 8 WATER
202 —
UNDERFLOOR PLUMBING
203 —
UNDERFLOOR MECHANICAL
2204 —
UNDERFLOOR FRAME
205 —
UNDERFLOOR INSULATION
301, —
ROUGH PLUMBING
302 —
TUB 8 OR -SHOWER
303 —
ROUGH MECHANICAL_
304 —
ROUGH ELECTRICAL_
305
— FRAME
306,—
HOLDOWNS
307
— INSULATION
308 —
SHEETROCK
309
— EXTERIOR LATH
310 —
INTERIOR LATH
•31.1
— SCRATCH COAT
313
— ROOF NAIL_
501
— FINAL ELECTRICAL_ ENERGY
502
— FINAL PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
504
— FINAL BUILDING ENERGY
505
— FINAL ELECTRICAL.
Issued by: 506 7"1
rlfl44t
TEST Date �— 24 -CJ C%
GTS
Re -roofs 508 — FINAL MECHAN I CAI_
Type of Root' 509 — FINAL GRADE
All roofs shall beSi�Iaa;;VV�ecte� IY7f ltI aI; femi� itirticrial being installed.
if a roof is ins[al'2�`dvitfibutbs�btairl�itnl nspQiRIIP;sagree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant
OFFICE
Date
All roof coverings to be Class "B" or better