02050050 CI et owI
e DIIVISIONNOPEKMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10615 RANDY LA A 02050050
DOWNER'S NAME: APPLICATION SUB DATE.
PATRICK & TERESA TSIM 05/08/2002
PHONE: SANITARY NO. CONTROL NO.
q ZO ARCHf1E=NGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
LICENSED CONTRACTOR'S DECLARATION
Z z n' :- ^.1 hereby o fi m[hos I am licenud under pmvixions o(Chaprcr 9(rommencing Job Description
�,=t� with Ser n7000)efD so Sof daB uanr arW Protesstonx Ceae.attd my fLenm REVISION SUBMITTED ON 05/08/2002
ems is to fllfomca, t ORIGINAL #x ' 01110057
z Licef Class L x.
LW-w o )Ct^f.„I una�rtminid'my p1Aa'Rs ehlT bECI'.5 DECubIRArec�Ms 1 y, t ',. Iy:. .• -.
yy� � :
OLicensed Professional
\
M OWNER BUILDER DECLARATION n
1 hereby.(Seco thin I amBurin from the C Professions
r s :A License Law for the V
t z G following ream n.(Session 70315.Business and Pafdemoli Code:Any tiny or county'
E.E.F G ' which its iiram a n.1so to construct.swep alcor,improve,demolish, fila
repair any institution \
3 ..,pct to[s nca els topics,the applicant forCont m ick o egad smamcm
loan hq lsl«n epursua)tom p v+x!o flheContractors L¢enu Low(Chapter 9 1 S Ft. Floor Area ff cation
(c
em with Seamo'7000). f D'v 7 fth Business and PfPf@slons Code) ,�.5�'w d.PSr�.•rq,�I p..I CS 4l'sr s,,.l h'1;gip I♦;1.4s;
or that he 14 edelnlin helefrmn and the bas for the ml6ged.j mrpuun,Any violation
.:of Sttdona031.5 br any mplicam for o permit subjects the applicant ton civil Penalty . Occupancy Type
, gar noj marc roan fee nanarca amlarp(ssdB), toe •:'.;,•:.'-
❑1,as owner of the pm«ny,or my employees with wages is their sole compensation,
-will'do the worofand Ne suumurc Contractor's
i ense La dormo 102 PIERS Required Inspections
you property
W Cade The Convenor License Law docs not apply m an _
owner f progeny co builds improves thereon, d h d h k intended
or t -
or threats h own however,
gees Imi led that such improvementsarewi not a yeir or
-dfF df- IL if hsw Ih b-Iding n rpb'm ni s. 11 ih year of
ompleimn ne
theowrbulderwillnovesheburdenof....in,thathebinmbuildor 104 - REBAR
improve for purpose of rule.). 105 - ANCHOR BOLTS
�hamither of the pm«ny,amBusiniss and Professions
Coica:licensedcontractorsno 106 - SEWER & WATERcons
_ License theoes no(Sm. tea,Business and Prty who builds Code:)Theves Intcmr's
I-:1. Low an
Litems ,cmdees.forsuy projin cr of pmpenywhonamed pmined,trcon. 2 0 - UNDERFLOOR PLUMBING
-_ Cenuacnols License L.W.
, a cemmaer(s),IiccnseJ pursuam.m Ne. ..._._.._....� -MECHANICAL----
commencer
_.._.-._
-,and' en eonve rs,f r such pro)ttrs w @
UNDERFLOOR ME RANICAL
❑la pct, Ja Sec " I B&PC,f phis reason.
I- —r--'— 204 - UNDERFLOOR''fFRAME'
° tie 205 - UNDERFLOOR INSULATION
WORKER 5 COMPENSATION DCCLARATION
Y " s 301 - ROUGH PLUMBING tt: ,--
t Iiay.F, uMerpe d(j'f«rl ryone fNe lollowin8 dal sans s
f•'t3..�' „ ,1'ws 302 - TUB &' OR :SHOWBR�. ::
❑ 1 Aa e'aad will m a'Ccn ficarc of Con¢nt'no s If x rc for Worker's
'a Compensation. as provided for by Section 37M of th Labor-Code, forthe303 - ROUGH MECHANICAL
perform5nceof ttie•work Sof which this Permit is ixsuW`I. 304 - ROUGH ELECTRICAL
❑1 n n d WitI telialtun Worke s Cin a I,on r m erne as eq a by S intim 305 - FRAME
37W of the"L M Ceti f the perform c f the work for Which this pc Itis '
fss eMyWorkers C pensau bm'sn cam ata Pol<y nu the:rc;• "' 306 - HOLDOWNS
corner l: n. s r +:Ta :Caona,bfw . 'T ,307;` INSULATION,_ .k1'
'S-, -t CERTIFIC COMPOF EN COMPENSATION INS MOM
WORKERS-f
.r ...�.__ -_»......�..... _ .�_._ ____._.....,....._..
I' r _ ,r 3 0"9 EXTERIOR-'liATH
I'( (Th s section necJ not Be compined i f the permit is for one hundred Jailors 310 - INTERIOR LATH
ISI00) I �. 1
-
Icenpl that the pinaIry Imaofr rkfor which thuperm ti'ix ed,I 1_41}: 11 i-I L
sM1 11 n n employ any«rmn n any man11 n o m to'tiecome s b)cct ro the Workers' 313 - ROOF NA I li.I`t - ' - .I.
Compens6nion laws of Caldomia:Dale, '
-AppIai - -5 0 1 -
-FINAL--ELEC-TRICAL,--ENERGY'---
O N ICETOAPPLICANT If yr dkngthn CertificateAficGaEteNof YExemption you should
0 bee of he Labor Comryou mi,it SO2 FINAL PLUMBING ENERGY
O forthwith complyywthsuch pro smthispart hall te,aeemedr ka _- __503_ --FINAL- MECHANICAL-.ENER
GY
TOGGGNSTRUC
-o' Iheby drum that th 'snionit d' gag nc
y for lhptrBn"
504 - FINAL BUILDING E
NERGY
of the Work fo h¢h shrpetmt is ss d Satt 3097 CI.C)
Cede Nn - _505_,-_-FINAL ELECTRICAL
LeAed ' , 506 GAS TEST
•
- -
' Ui0 ;vie,anify.u.,Ihave madthi.applicotiouunditnrelhaithe aboveinformation is 507 - FINAL PLUMBING
m E.
torrent I ag t mply With 411 c ty and county ordinances and tatei sal ting 508 - FINAL MECHANICAL
O V rob W gc t do dh hyo th v p t i e fthi iyt ror
pnn
y W , the eb mann' eJ'v pe tyf pe coop Iw e 509 - FINAL GRADE.,.
11-bi wfW) grcel av J fy J Which
imitators the CtiyofC perC' 'glom
ti flab t es J Jgmenfs.c [ d ,pang h h m y untiny y gam t old 510 - FINAL L NG
V City nuquenceofsh g tog WILL u - C WORKS
APpPLLIC.MT INDERSTdNDSAW WILL CObIPLY WITH ALL NbFIPOIVT " 4 r` FTN
SALRBE IfEGUfCAT1095}?.,;-,:,'!s I ! Issued Date
SigapofApp icanuco mann;a.,1 --"^'f � i Darc'r{''a, Re-r00� - ROOF BATTENS
HAZARDOUS MATERIALS DISCLOSURFt
III thepplic torture ti 'Ididgkcupnt tart tr,handle hxaaidmis mat al .Type o6.Rdof.- ROOF.-IN PROGRESS.,,...
s defined bytU Cut Mumupal,C J Ch pl 912 and theHealth and Safety i -
a 'intmo 15531.) ')'sa ,t ,YI y4)'s , ., �1,, tv"
❑Y x 1 :r I Iks(prjn ' ' ; 4,yx ,. Alj roofs shall beAAinspected prior io.any_roofing material being installed.,._,,,
•'� veli the gppI or or tutu bulding occupant use equipment or devices which If a roof is installed without first obtainin an ins ection,-I'a ree to remove
mind haivdou i m intim,as defiled by the Bay Arc A Quality Maaag mem g P g
District? P g understands and will comply with
a new materials or tnspecuon Applicant un
1 , all'non-point regulations: .:;,,
+ 1 h ve reed.the huaN i mpi<riak rcymrementi under Chapmr'6.95mfthe '
Via, I.Health Jk Safery Coee,Sections 25505;255J3 and 25534. understand
thin
-if the buildin eon nosbuaentl havea¢nmt.that it ism -
.... g„ Y yrermudiu mnotify the
ace
c upon,of heagpircm ¢- have must hems p in
ism
x n e or
a C n fare of "
bttupa r..14.. ..
' Signature of Applicant _ - _ Date
Owneror anther tied gem - '.,'; I - - , Dene All roof coverings to be Class `B"or Better -
OFFICE