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CITY t DING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10270 S STELLING RD
01110104
OWNER'S NAME:
APPLICATION SUB DATE
CHURCH OF JESUS CHRIST OF LA TT
11/21/2001
ONE:
P
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r_t CJ L__J L=7
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lute licensed under provisions of Chapter 9 (o Boeing
Section 7(1(10) Division 3 Businessmd Code...
Job Description
,) p
with of of the Pmfessi... e
('� i AC t P & IMPROVEMENT.
is in full form and affect.
1pI ,t
Dam Convenor
ARCHITECTS DECLARATION
1 undemmnd my plain •hall he lied ex public rtcoNs
Lirenud Prole »room
DECLARATION
Oat
1 hereby I am BUILDER
.tiiw that 11. exempt from the Contractor's License Law the
resso ession Co co
, Code: Any city a county
following reason. (Section ]rainm Business and minnows.
improve,
$23000
which requites a permit in trainman, •her, darroli
demolish, or , a rig any swnure
- Pdonoiaissuance.ela inquiries be applicant ( «such permit fikasignM mtemem
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y } `E !,' 1.3 �� �, �� +,
Valuation
that he i3 licensed pue mai to the provisions of the Contractors License law Chapter 9
bionnaencipg with Section 7W) of Division 3 of the Business and Professions Code)
or out he is exempt therefrom and the basis for the alleged sib rFlum. Any violation
4, ,
- of Section 7031.5 by any applicant for a permit subjects the applicant to a civil painhy
:of natmor than ftvehundred aml. (9500).
10i4PN�DATION
" Occupancy Type
❑1. as net of the propeny, or my employees with wages as their sole compensation,
me
and
wort: anion structure is not Contractor's intended or offered Law does apply to an 4.
will Business
Business License law d «s not apply to an
Code: The Cves
10 3 - UFER Required Inspections ' `
popery Who b
hemo
owner of his Oy Who builds or improves thereon, and who does such work himself of
=his hisown employees. provided that such improvements erehin intended
1O4
.off --d'f lire. If, however, the building a impro amens . sold d- within one yce of
'co pin ,thcowncr- builder will have the Wrde fprovingthathe did nwbuildar
,__, - .. -- ",REBAR -,,." ._..._,. _, - - - - _ .. _._. ------ ..........
105 - ANCHOR BOLTS '
improve far partial sale.).
106 - SEWER & WATER
ner o(the progeny oat exduaively contracting wnhlicemedcommaonm
202 - UNDERFLOOR PLUMBING
Lconstruct the project (Sec. 7044. Business and Professors Coder) Th. Cismiutor's
icense Law doe: ne apply b, an owner of property who buildx or improves th<rtan.
2 03 - UNDERFLOOR MECHANI CAL '
and. who contracts for.such projects. with.. embra orfs) lice°aed.punmart to the
Canaanite, License Lew. ..
_.. 204 - - UNDERFLOOR' FRAME.......--- -- ...- ._- .- --- .- -._...._.._ --- ....
❑ l am exempt under see: ,B& P C, far this aoaon
205 - UNDERFLOOR INSULATION
?
eg!!' WORKERS dP °`s`oldozeT�fR 1-
301 - ROUGH PLUMBING
-
302 - TUB & OR SHOWER
I hereby affirm under Penalty of Perjury one of following declarations:
303 - ROUGH MECHANICAL
❑ 1 have and will maintain . Caniecate of Consent to self-mo a far Warker'a
3 O4 - ROUGH ELECTRICAL
Compensation, u, provided for by Section 37(10 of the labor Coda, for the
p<domain. of the work far which this Permit is leased..
3 05 - FRAME
❑ 1 have and will immusin Worker's Compensation ]as urance,.1 required by Section
3 06 - HOLDOWNS
3700 of the lane Code, for the performance of the work for which this petmiris
sand. My workers Comp nsOrion insurance came, and Policy an pm act:.
-. '.
307 - INSULATION -
Carter. J "- "tPolicy N :" •' :.
' -, . :.308,x, ;SHEETROCK_ `-- -- -'
„CERTIFICATION OF UEMPrION FROM WORKERS', •
'
309 - _ "'EXTERIOR'LATH'
COMPENSATION.INSURANCE— "
.• "' "rnis'lcih, deed
_
3 "10,;x: ',INTERIOR.. - LATH "-- _...�-�,.
an not be'completed ifthe permit is forone hundred dollars
(Slohm -la".)
311 - SCRATCH COAT -
., 1 certify tn;t in m d imaadfortn t5, mF wmah ws
x Pevnu k �sx�ea,.l
+
313... - '-"ROOF ' NAI li ' °� °'; - • ._ . .... _ - -
.. ... .., . i .. -
shall of employ any_persa in any manner so as to lzcome mb3cn to me workers'
501 - FINAL ELECTRI CAli ENERGY
C. nation laws of Caliphate. Dam '
Appbc.m r '- -_ --- _ -- •. - ..
- -- .502...- FINAL- PLUMBING ENERGY-- ..... - -- - -- - -- -- -
NOTICE TO APPLICANT. If; after meting this Camper', of Exemption, you should
beenme Subject the Warker'e Compensation provisions of the labor Cbda, you must
503 - FINAL MECHANICAL ENERGY
forth ith comply with such pro ions or this permit shall ne de m`aa " °k°'
.
.. -.
.504 =" FINAL BUILDING ENERGY __._._.
f t 'CONSTRUCTION
" Iherby dust is. cLENml4Ging St.
a conswction lending age ryfor the perfotmenm
i.'
505 - FINAL ELECTRICAL
which pe
of the work for which this pctmu is lusted Ise. 3097, Civ. CJ ,,
..
506 - GAS TEST
lather's Name -• :�__. :. -�. _- _._.... .- ............ ..
L Pagr'4Adurq x . - • "
507 - FINAL PLUMBING.,
Icenifythatlhevereedthisepplicationandneleth .nheahoveinformationis
508 - FINAL MECHANICAL
cdrrtct. Degree to comply with, ell city mid county ordiu aces and late laws slating
509 - FINAL GRADE
to Wilding conswction, and herby autbafiu rpmantetives of this city to enter upon
the aWvenmmioned propany for inspection pmpoas.,_
(we) since to save, indemnify and keep harmleu the City of cupimmo against
510 - FINAL PLANNING
liabilities, judgments, cosy and expcnus which me any way same egeimn said
514 - FINAL PUBLIC WORKS
City in c sequenke of the ing or pertni "
A Pia NT ' ERST � S N LL CO PLY W TH ALL NbN- DINT
'
O v
Issued by: Date
G
-..
igna a pP i car a - ... .. ;
Ulu MATERIALS DISCLOSURE' '
'
Re -roofs "
11 li mare busting ocsvpat tort hmtdk hasdaus materiel
Type Of Roof
$11,
ff ed by ,d, Cu me Municipal Cod Chapter 9.12. sand the Health and Safety
CiMe ._yS<h .'
t `,° f 1
(e Yea tl QN:
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....All roofs shall -be, inspected prior_to any roofing material being installed.
' will the appiiaito future W (ding cupant use equipment o devices whim
If a roof is installed without first obtaining an inspection; I agree to remove
Our haardmi eonatmn t as J fined by Ne Bay Area A Quality Manig<mem
irate(
all new materials for inspection. Applicant understands and will comply with
°Yn °rvo; ,
all non -point source regulations.,
I have read'dhe ateardoui mmndali requirements under Chapter 6.99 of the
Califdmi.' health VSafety Code, Sections 25505,25533 and 25534, 1 understand that
if the Wilding does not cusently have . tenant. that it is my responsibility to nofify the
occupant of the riquieementr which mum rior to issuance of a Cenifteam of
-
° cy'
Signature. of Applicant. Date
All roof coverings to be Class "B" or better
g � .
ner Pr awhoriu agent ' � ' ' Data
0.
OFFICE
Patricia Garcia
From: Ron Christensen [ronc @apexdg.com]
Sent: Tuesday, February 18, 2014 9:51 AM
To: Patricia Garcia 'j 0 • jl
Subject: Permit 01110104 02
Pat,
Thank you for your assistance in helping us with an open permit. Please cancel /void permit number 01110104 for work
not done. Please send me an email once it is cancelled for our records.
Thank you,
Ron Christensen, SE
APEX
DINGN GROI'P
C 435 -225 -1621
0 435- 554 -0520
ronc @apexdg.com