01110128 CITY
DING DI �VISSIIONNOPERMIT CONTRACTOR INFORMATION:
eu�f.glyGPppTE ENIC BLVD BATHROOMS BY REMODELING SPEC G. 01110128
D )t"')�YRON A AND GRAHAM MARY K 1422 SARATOGA AVE APpt�796Syg�D�6i
"HONE: SANITARY
.SNO.
//L U U CONTROL N0.
(408) 328-6700
esz ARCHITECUENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MF.CH
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"�y_ LICENSED CONTRACTOR'S DECLARATION
= 1 nereby aRm,N,t 1 am neensea trwer Prowamm tar enapler 9 aammeming CHANGE BATHRM F 1 XTU 1t 5 o k TILING.
m h m wish Section]OW I of pivisi.n 3 of the Business inti Pmfeuions Cade,send on,license
t ne as� is in full Tome and a
?:z 6 a License Clavi L Lic.a G//
<O Dae Commcor��,r��(g r,
a 3
as G A CHITECT'S DECLARATION '
g 0, 1 understand my pram shidl be used as public records
�Y
i i p O Licensed Professional OWNER-
BUILDER DECLARATION
1 hereby affirm that 1 am caemp from the Contractor's License Inw for the
h z< following reemn.(Section]031.5.Business and Professions Code:Any city or county $8200
E O which requires a permit to convect.atom improve,demolish,or repair any structure
6 a poor to its isswrim.atmmr,tims Ne applies.,for such permitto file a signednemmem - - - ----- - -- -- - -
a. that heis.licensed pucsuint to the provisions of the Contusions License Law(chapter ., r ;, Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code) a!". 9'13 1� (6 '� ;� \'l;w X>t t.'-
or
or that be is exenirt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a Penni,subjects the applicant to a civil penally
of not more tea.five hundred dollars(550)1. 10 3APN 3Oi MATI ON Occupancy Type
°I,as owner of the property,or my employees with wages as their vele compensation. 102 - PIERS
will do the work:and dimstructure is not'inm,Med'or offered for ale(Sec.']BM. 10 3 - UFER Required Inspections
'
'Business and Professions Cade:The Commeton's License Law does not apply to an f3
q p
owner of property Who builds or improves thereon,and who docs such work himself . TSAR
or through his own employees.provided th 1 himprovementsa t tended _ _ _
�gffttedf ale If.however.N 6 1e.g -'mproena resold 't " , ' HOR-BOLTS - '-' -
completion,th om bu to II h N h den f vin i h Id "
improvefor Famous,.r l.) ° SE ER & WATER
-°Y es e'.f Nepmpcny am chis t ct g o t t .. . ERFL00R"PLUMBING r
Lkt law tip«i`�oi opvirgt°o 4an aw�'�ia 'r veno u,u r)Im' vea the` tO3 Ii RFL00R MECHANICAL L'�
.end who convects for.each protons w corrosion, c J tram m t - DERF-LOOK--FRAME - - -- -- -
eeyy _ _.. ... _ _. .:... .
O emeoaempivnde 8¢. .B&` Nsreawn 205 - UNDERFLOOR�) INSULATION
Owner Date ' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affi.o underpenol,y of perjury one of the fallowing declarations: 303 - ROUGH MECHANICAL
r' ° I havesad will maintain a Certificoa of Consent to self-insure for Worker's 304 - ROUGH ELECTRICAL
Compenstion, as provided I., by Section 370) of the Labor Code. for he 305 - FRAME
performance of the work for which this permit is issued.
°1 have send will maintain Wmer's Compeamion Imumnce,n required by Section 306 - HOEDOWNS
- 3700 of the Labor'Code.for the Performance of the work'fm whim this permit is 307 - INSULATION
ice.ml My Workers Compensation Insurance carver uW Policy number are. 3 0 8 . S HEETROCK -
s .,._�.. _. .. _. _,. ...
came 'S?�t✓'8>�U�/Y.POI¢y No �Y6 —oo50f�7 l?' + !3 0`9 2 -'I`EXTEI2I OR''i LATH:
CERTIFICATION OF EXEMPTION FROM WORKERS',
.._ ._-•.- , COMPENSATION INSURANCE" „
:
'(This mato.nerA not be completed if the permit is per ane handed dollen 311'1 SCRATCH COAT �t``' `•� `
(SI00)or less.)
_ . 313_- ROOF- NAIL - _. .. .. .... ... .
1 certify that in the peiformance of the work for which this pemtit is issued.I 5 O 1 - FINAL EliE CTR ICA'L"ENERGY''
shall not employ-any person in any manner m as to become subject to the Workers
Compensation lawaorcahfomio.Data. 502 - FINAL -PLUMBING- -ENERGY._
Applicant
:NOTICE TO APPLICANP.If.after making this Certificate of Exemption,you should 503 - FINAL MECHANICAL'"ENERGY
O pbecome subjem m the Workers Compensation provisions of the I�bor Code,you roan
(onhwhh compy wim such p ovixions or his p m, hall b dam d evok d. 504 - FINAL BUILDING ENERGY
CONSTRUCTION'LENDING AGENCY 505 FINAL ELECTRICAL
-'1 heathy.Brat that Ncre is o consuncliori Imding egenry fm Ne pedomuna
a_> 0(d1eWOtk(orWnlChlhl6pLIm11151S5YedI5K.3B9�f.Qiv.c, � 506 - GAS TEST '
yG Under,Name .. .. .. .�.-.. - - -- 507 - - "FINAL`PLUMBING
n7. z Lender's Address "" - -
508 - FINAL MECHANICAL `'
1 ramify Nat I have reedis thapplication and tamson at the above information is
- tL 1'oirec,.I tag.to comply with all city e,W county ordinances and nate laws rotating 509 - FINAL GRADE
-.O U 1.Wilding construction,and hereby amhonmrepresenmtive,itcity soemerupon 510 - FINAL PLANNING
(Aj
the above-memimod property for inspection purposes.
gy (We)agree1.ave.indemnify end keep harmless the City'of Capetianegansl 514 - FINAL PUB IC WORKS pO pI
(Zi hurbilhom judgments,costs and expenses which may in any way occurs against aidU City in cormspusence of the gramong of this Fourth.
LL J
APPLICANT UND (WDS AND WILL COMPLY WITH ALL N[ccljjj::: Il7"7T'' Issuedby:
Date
SOURCE'REG S.•
.. SignApplicanV
aatufofContracmr / Dam Re-roofs
- ' HAZARDOUSMATERIALS DISCLOSURE "
' Wj1Neapplic r future Wilding Kapent at=orhandle histaminic;material Type of Roof _ —, - .. .....
as defined by the Cupem.o M n a el Cade Chaplin 9 12.and the Health end Safety - "
Code,
od Senl 25532(.) J..11 f:q w s ` f s 6 t151
No All roofs.shall be inspected prior to any roofing material.being installed Will the applicant ser future building Kcapem ase squtpme.,or device,whim If a roof is installed without first obtaining an inspection';I iagrae to remove
eml haeradousaircontemin n'so
efned by the Bey Are.An Quality Management
Dt,'himq - all new materials for.inspection., Applicant understands and will comply with
0Y. all non-point source regulations. . ,t
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Sefery Cade,Sections 25505,25533 and 25534.1 understand that _
if Nebuilding does not currently have o tenant, it is my responsibility to notify the
occupant of the re Irtmeals which must be mel prior to issuance of a Certificate of
O ape
Signature of Applicant.. _ - Date
t
owner fir aamongea age., Date All roof coverings to be Class"B"or better
•;._ •.I.. _. ..OFFICE