00120144 CITY Uto ;Nup �DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: ITKNII'INO,
7610 9f7l.J:l:l:F1J0(]D lJl f LA9 F'rTNG FLUMBIISG 0011.01.44
OWNERS NAME: APPLICATION SUB DAIS
I1C iY IEfl=r21 1 RICHAIM P, AbID fall ET 1.0297 S D.F. AN7„A Ell V J.2/"?/2000
PHONE SANITARY NO. COST'ROL No
(408)283--061.8
70�-_
ARCHI'MCDENGINEER: BUILDING PERMIT INP
BLDG ELECr PLUM( MECII
- I-1
LI - .RDGGNfRAC.DR$..i6mrARACION Job Description
I, - m that I sun ofthe.B under and('ion.of Chaplce9 nd mmecensewish seri polliviion 3nf the Business xnJ l'mlc„inns Calc,and my licen.wb,rea B rsr-ITfF:/WA773 II(a7N
ver Cons, _ Lic «_ �J (_yUv c u S DECL I♦ i-7s_
ARCH;'IEC'1'S UECLAHA'Us
vCi g I undermmnd my plo:e,:hall be axed as public records
`WY
y a OO Licensed 1'rolcssinwl
OWNER BUILDER DECLARATION
I nanny Mirth that I am exempt have
the Gosnell.,' ,License Law Ibr the
following ng mason.('cation 9031.5,Bu.11.,and Praor.clanni Gdc.Airy city lir county
Z p
which nquircs a pern:il m svnspnct,altuq in.prove.Jvrnolish,lir regal,anY sWelum
ne
ii5� prior o its issuenee.aso requires the applicant for such permit)tile a signed statement _
mal he islicensed pursuant nthe pronoLlonsnf[lie Contractors LienodLow(Chapter 9 S Ft. Floor Area Valuation
R+a....areing wid.scat 170,11 of Diviaon 3 orthe Bminc,s and P..r naoa,Code) y' b`Sf000
or that he is exempt therefrom and the basis for the alleged exemption.Any violent).
of Section 7031.5 by any applicant lir a Pcnout subjects the uppl calit n.a cool Imnally -
0 1 more than the ht)mbed dodorn(S5BE. A13N Number Occupancy Type
01.asuwneroflie vo,v,ormye:n,doycexwhit wage,as dat—oleead,Na, i I, :36aQUIJ -.00
will do(he work.and due,Iraemru ix I(,,intended or olfcrtrl for,old(Sec.7614, Re aired Ins ecl1011s
Business and Professions Cole:The Cnnmctor's License Law dues not apply m an
saner or progeny who
huddler idd,dw,, hereo:I,and who does noel wink InlItself E�,2 — IJNQNiTs'Fl.-G(:Iri l.11'Q'SI n
or Ih,nuglt his awn cnoployces.provided that such Improvemmnls arc tom intended In
offered for sale.If,however,the Wilding or improvancnl is sold within one year of ♦ {
.mpletion.me owner-builder will have me burden of proving mat toe did not bund or 301 — li'G �.. .
lity,nwe r.n,apo,e of':Jc.l 5,K2 -- FINAL F4.I,MING 0,0_6Y
❑1.a, n
r of r oprnY.a...esel....ely contmrtb:g win Iiernwal eo:oramorx 1, 507 FINAL_ H4_UI'IBING
.mlmn the project(See.71,14,Boniness and Professions Cale:)The Commcm,'s
Licensc Law fres not apply m an owner of property who(wilds or improves the
and who Litt o, for such projects with a ommn.ctorfxl IioenncJ Purananl m the 1/
and
ocxlirats Law. S
❑lam ca,evo nndcr Sec. ,I1&1'C be this rea»o
Ilwnc: COMPENSATION /
WORKERSWORKERSDate DEL'LARAI'ION Q
I herehy aurin notice penally of perjury one of the following declarations:
❑ 1 baa slid will t u Ccnilicute lir Cn:ur , to S,1Ginovc fnr W..kcr's
s mgwo,alio I, as pnolded fns by Scoiun 3700 of the Labor Code, for the
per(ormantt•of the work for which this gerbil is issued. s
❑1 lane w.d will n.aimain Worker's Com,ms1liun Insurance,as recoiled by Section
37 the I,Wr Code,too, he pedinmanee of the work for which this pem.il is
,., J�Mywnrker's'1�+ICJ I,,,,; mouranee cafrier:md I'll ley numIpparUe:
I gGS g...c� ��r16N�U I!MI'No —00 /
C��rr�cr�� Bit IFK FROM WORKERS'
COMPENSAnON INSURANCE
(]his section need not by aonsplelcil it the Pennil is fnr one hundred doMe,
(S 100)u1 lcax.l
I certify that in the penbrmmove til the work Iia witch this permit is NALsed,I
.hall not cntploy wry pursed in any rumor,so ax to become ocher,toiler Wnrken'
Con.pemnlinn Law,of Califomia.Date-
Applicant
NOHCH TO APPLICANT:IL after do,kine this Canifieate of Esemptinn,you sloveld
become subject In the W'orker's Con a'alinn pmvixiom of tileti
Lan Cade you:nust
Qlonhwith comply with such pmvlot ons or Illi,permit door be Jecnmal reuoknl.
r CONSTRUCTION LENDING AGENCY
> I hereby allirm Iho thcoc is o naahtelilm lending agency tin the perro dual
nl'the work lin which(his pcnmt is teals(Sec.3097,Civ.C.) -
Q lender's Name
z Lender's Address
C.1 C) I certify thin thaw read this application and sutnhallhe aNwc informal on i,
ii E ro voic I agree to mntply with all city and umnly nnll::anays aid'title law'Mann'
O V mbuiodin,,nl,1metioo.a Iherebym: m
moriie represcabves of this city to enter upon
�. p] the above-mentioned propcny for inspection pu palles.
tiIY (Wo agree to indemnify ma le.,led diless lite City of Callevio ngao nal
N Il;milllicn.luJ n,cues:un1 expenses which may in any way accede against said
V z City m y ince :f otic graining of this permit. C
CAN IN DE STANDS ANDWILLCOMPLYWITH ALI.NON-POINT Issuedb Dille :/���'—(A
so 11 UL " [T-27'"0 r] y•
slgnalum III isirnn omrue, D.I. Re-roofs
IIA%Alt DO(IS MA TRIALS DISCLOSURE
Will the applicant Ile Comm Wilding million,sac or handle hazvdnas material 'rype of oUt
as old ;m
ncd by the C.,runto Municipal Cock,Chuplcr 9,12,and the llcath d Slo,y
Calc.Section 25532nd?
ayes 0 N All roofs shall be inspected prior to any roofing material being installed.
Wm Iad Tpraamt)rl.till,emwohngoneepant use egaiptnentordr,ices which If a roof is installed •without first obtaining an inspection, 1 agree to remove
cavil havurdous air commodious as dcbned by the Bay Area Air Quality Munam
geem
District all new materials for inspection. Applicant understands and will comply with
bYes 0 N
all non-point source regulations.
1 time ,ad the hamNous mamlu6 da,noeonrnI...noil Chapter 6,95 of the
Caoifnmin Health Soley Code.Scaio1,25514,5,25533 unit 25534.1 end cntand that
it the bulldi sn currently have a mmain,that it is ivy resprnsibility to notify the
of the scqu cnh which must be mm prior m I...mae til a G:milicum of
tic cy I'z�7 7-�dp Signature of Applicant Date
o raamal rot—g Dale All roof coverings to be Class `B•• or better
OFFICE