04030027 CITY OF ZT-P—ERTINO
BUILDING DIVISION 'TOR INFORMATJON.-
PERNHT
BUILDING ADDRESS: WATTS CONSTRUCTION PERNIG'N0
04 0 3 0 02 7
r2n RTrART)r) Rn
R'S NAME: PERMIT ISSUE DAM
IDAYID & T.QUTqR q('�TRT -1941 RTN(-()NT A177 02 /C)-2./2QQA
E: SANITARY NO, CONTROL NO.
ARCHITrECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
mer LICENSED CONTRACTOWS DECLARATION Job Description
I humb,art that I am licensed under provisions of Chapter 9(commencing
with Section 70alkhADIvislon 3 of due Business;W Prof....Caum.wd my license is
in In I a :Eig?a
M va Lme t.
COTTAGE REMODEL (GUEST HOUSE
Dam Conirxciorjj�� A
i2 ARCHITECTS DECla,WION
IN
��dxmauxhamd my plans shall W used as Nd,to=aids
u AUG 23 2004
H
Licensed Professional OWNER-BUILDER DECLARATION
I hereby affirat that I am exempt from the Contractors License Low for the
E:20 following wason.(Section 7031.5,Business and Preaftanions Cock:Any city or county
which rapdres.permit to coustmex, Ines
improve,dauselim.ar oured,My trucatere SUILDINM
primin its na.Mcc,also requires dicapplicam fourstich pindinifile asigamseatemem,
thin he is licensed pursuant to the provisions nf ft Conexclor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7")of Division 3 of the Business and Proficani r
ENE that he is exempt therefrom and the basis for the alleged exemption.My=a.(
Section 7031.5 by any applicant for a phoundit subjects the applicant to a civil penalty of
.at na.than five hundred dollars 3 9i?bTjt"qr0 0 Occupancy Type
0 I,mowner of Mn property,or my employees with wegeaathelrale compenutlon,
will do the work and dissensions is not saturated aroffered Persian(Sec.7044.Business
and Professions Code:The Contractor's Licamse,Law dna net apply to an owner of Required Inspections
property who builds or improves therson,and who does such work himself or Through his
own employ.,provided Out such improvements sm not intended ori fiend for sude.If,
however.line building or improvement is wild within one year of completion,the owner.
builder will have due tandon of p.,let that he did not Wild or Improve for purpease of
sale.).
0 1,as owner of line propany,am exclusively contracting with licensed contursomers,to
construct the project(Sec.7044,flusincts and Professions Code:)The Connuramen's U.
cense Lov does not apply W an owner of property who Wilds or barrows therece,and
who contracts for such projects with a contreaccer(s)licensed pursuant in des Contractor's
Licamee,Law.
❑1 Ma exempt under Sec. B&P C for this Mason
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby affinte under Penalty of popery one of the following declarations:
I haw and will matrudin a Certificate of Consent to sair-imeas for Workars Compan-
attion,an provided for by Section 3700 of the Labor Cade,fer the performance of the
work for which this Futrell I.joined.
-
[D I haw and will maintain Worker's Companaration Insurance,in required by Section
3700 of the Ube,Cam,far the performance,of the work for which this permit is named.
My Worl��Mnpcnsration Insurance close and Policy number aw:
Ceti Policy No QLlq
�7 CERTI CATE OF EXFMPnDNJ310M WORKERS'
COMPENSATION INSURANCE
mus,scatimn teed ambecamplencilifthe permit is farina Weduceirmllion(SIM)
or less.)
I certify that in the pmrponowerm.of ine work for which this parent,is bound.I shall net
employ any Nixon in any mannerso in in became subject to tiro Workers'Corepcinerailon
Laws ofCalifornia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Carolina,of Exemption,you should
liccoom subject in the Worker's Conerionau,tion provisions of the,Latior Cade,you must
Z forthwith comply with such provisions or this permit shell be docerad invoked.
z 0
CONSTRUCTION LENDING AGENCY
fa I hereby.1fine that i1m.I..construction leading agency for the pe,fammuce of
tire work for which this permit is issued(Sec.3097.Ch,C.)
Lender's Name
gl�
z Lender's Md..
U 0 1 cenify that I haw mad this application and sted,that the show information is
If.Pcomm.I agree,he comply with all city and county ordinances and sum laws relating to
Wilding construction,ad hereby authorise representatives of this city to enter upon the
0 U
W above-mentioned property for impaction PUPOWL
(We)agree to save,indemnify and keep harnilcus,the City of Cars
C4 �niim U) !jpco an
is � liabilities,judgments.coati Mect
d expenses which may in any way sor,agents,said ty
in of the granting of this permit.
PLICANT NND RSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by:
S U CE
S URCE ZEGAVONS. t Date
�4 ,-1*tA Re-roofs
Foalum,of pp irstal/Conuesetar — iic
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W311 the applicant or future building occupant stow or handle hallardthel MAW621
w defined by the Calendar,Municipal Code,Chapter 9.12.and flic Health and Safety
Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes UA
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IsL haseardaus air comminninants a defined by the Bay Area Air Quality Management all new materials for inspection.
,a
DiameLl
0 yea Ly rfa�
I have
haw mad the butiondous materials requirements under Chapter 6,95 or the fuhror.
He
SgctyC�.Sec4ons255O5.25533=dZ534.lun&m=dLhaLifft Wilding
doeinjoical
to
oraincrus In,hm met Poor W teriance.f.Ccrdficiuciif _Jgcy Signature of Applicant Date
��a Milmmed agent All roof coverings to be Class"B"or better
oriv �L�arc C�/