02050010 TY OF
CI
BUILDING DIIVPtISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22996 STANDING OAK CT 02050010
OWNER'S NAME: APPLIC4TION S B DATE
S WAW CAMERLO & ANNA SCIAND 05/ 02/2002
PHONE: SANITARY NO. CONTROL NO.
GQZO ARCHITECTMNGINEER: BUILDING PERMIT INFO
kC rin
ELECT PLUMB MECH
8',
LICENSED CONTRACTOR'S DECLARATION
'�H Z 1 hercb affum that 1 em licensed under ons of Chapter 9(commencin Job Description
E2_ y previsions p c BATHROOM REMODEL
t with Sen to n..ad effect, onJof the Business end PNfessions CMe,and my license
I,in full force end ellen. - % 'yam
i s License Clms Lic.tr C.J
3 3 DateContractor•Ve O�i ARCHITECf'S DECLARATION '+ ��
g
]understand my plans shall he used as public records
0 n p p Licensed Professional 1
o OWNER-BUILDER DECLARATION
I hereby.Sci that 1 1. exempt from the Convector's License law for the
�,Z a following aasoa(Section]construct,
Business and Professions Code:Any city or county
�O which requires a permit to conawn,alma improve,h permit t or repair any structure
$ prior toils issuance,also rcquirts the applicant for such permitmfleaaicriW turement.
me cceved pumuion 7")
Ne of Division
3 o Contractors and Pr law ons Cor) {; ,� ,a y,.as `
(commencing with Section]000)af Division Sof the Business end Professions Code 5•• 34'9• •U GCr•V'17ahv.') n'a'y,�r1: Valuation
of Set he i7 exempt thertfrom and the basis far the subjects
th d c pliant to Any violation
of Section 703 LS by any applicant for o permit subjects the applicant to a civil penalty �a��t�a�r�
-of not more than Mc hundred dollar.,($500). 10 IAPN'tl'CYl)PI'LATI ON Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation,
will do the work;and the ewnurc is not intended or offered for tale(Sea.7M103 3 - UFER Required Inspections-
Business and Professions Code:The Comments License Law does not apply to an q p
owner of property Who builds or improves thereon,and who does such work himself 10 4 _- REBAR _
or through his own employees.provided that such improvementsre am not intended
ol&rcd for ole.If,however the building or improvement is sold within ane is.of -- 105 — ANCHOR BOLTS -
completion,the owner-builder will have the burden of proving that he did not Wild m
improve for puryoae of sale.). 106 - SEWER & WATER
ml w -a - 202 = UNDERFLOOR PLUMBING -
construct
.ether (theproperty,am exclusivelycontracting with Contrmrs's
- the project(sec]to Bootees and Professions ild,or The,ex,hemrs 203 — UNDERFLOOR MECHANICAL
License
Low does not apply to en owner of properly who builds or improves therton,
and who contracts forsuch,projects with a enmmam(s)Iicamed.pmuant to the. .. 204 - UNDERFLOOR- FRAME
Contractor's License Leis.
❑lent exempt,uInder Sec. (� � �� ,B&P C fonhisrensan 205 - UNDERFLOORINSULATION
owner• me W/o 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby affirm under Penalty of Perjury date of renewing drnlaiatians: 303 — ROUGH MECHANICAL
° 1 have sod will no main a Ceaifi[aie of Consent to ulf-insure for Worker's 304 - .ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Cade, for the
_ performance of the work for whim this permit is issued. 3 0 5 — ' FRAME
°1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this permit is 307 — INSULATION
.; is d My Workers Co s pe tion Insurance carrier and Policy number are',
308 SHEETROCK..
C r• CERTIFICATION OF EXEMPTION FROM WORKERS']' " 309 Tr-atEXTERIORsLATH ;
_ COMPENSATION INSURANCE 'I i
- - 310 . ....-INTERIOR--LATH
(This section aced not he completed if the permit is horns hundred dolhrs 311 SCRATCH COAT
(3100)or less.)
I aempl that in the performance of the work for which This ct io t e issued,1
313 ' - ROOF NAIL '
shall not employ any Berson in any manner so as m become subject to the Workers' 501 — FINAL ELECTR I'CAL 'ENERGY
Cbmicant on Lows of California Date
.NOTICm 502 FINAL PLUMBING. ENERGY.... . . .
Nr.tesujE TO APPLICAorkers Cometer aims p certificate of Ube, odyou should 503 - FINAL MECHANICAL ENERGY
Z heuos4th cop comply
the Worker's Compensation provisionsofthe Labor Code,you most
,i C forthwith complywhhsuchprovisionshrtMtpermselanbedeemedrevoked. _ _ 5041 — FINAL BUILDING ENERGY _
F CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL `
EL! 1 hereby affirm that Neu is a conswction lending agency for the performance
W'„ of the work for which this pemnit is issued(Sec.309],Civ.C.) 506 — GAS TEST
P6, Lsndcr'�NameLender:Add.. 507 — FINAL PLUMBING.
v O 508 — FINAL MECHANICAL
I certify the 1 have read this application and stain ordinances
a d stat information relating
is /I
cobuildi acme to comply with all clay and county ordinances and state Iowa relating 509 - FINAL GRADE
0'V to building mnatunion,and hereby authorize representatives of this
.k�fiir',mrLat thenbaaepedpNpeidases. city to toter upon
510 - FINAL PLANNING
W (We)agree indemnify and keephathe a against es.jmts.costs and expenses which may in any way accrue against aid 514 — FINAL PJB IC W
ORKS
U City inconsequence of
the graning of this Permit,
rre
APPLICANT UNDERSTANDS ANDWILL
COMPLY WITH ALt,NON-POINT
•
Bell by: DateURC ISSREGULA121.Z
Signmareof Applicant'ContNnor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupied store or handle hurmdaus material Type of Roof. .. -.Is defined by the Cupeo no Municipal P50it.chapter 9.12,and the Health and Safety t -
Code Section 255320
❑Yes.i a t.
All roofs shall be inspected prior to any material being installed.
Will the applicant or(marc but Idm ecapant use equipment or devices which If a roof is installed without first obtaining an'inspection', I agree to remove
r77 —
All
mat hazard air mntaminantsas def bythe Bay Ama Air Quality Management
all new materials for inspection. Applicant understands andwill comply with
Ye 'all tion-point source regulations:1 have'iead the hazardous materials requirements under Chapter 6,95 of the
alifornia Health&Safety Code.Senions 25505,25533 and 25534.1 understand that
the Wilding does not curtently have etrnant.that it is myiesponsibility to notify theccupant of the requirements which must be met prior to issuance of a Certificate of
°° Signature of Applicant Date
w aatho W agepr Dae roof coverings to be Class r'B"or better
l- - OFFICE - " -