02030095 (2) CITY
I BUILDING pESNO
DIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11370 S STELLING RD 02030095
OWNER'S NAME: APPLICATION SUB DATE
ST. ANDREW CHURCH 03/19/2002
(*iONE: SANITARY NO. CONTROL NO.
w ac ZZ ARCHITECrIENGINEER: BUILDING PERMIT INFO
.6 BLDG ELECT PLUMB MECH
NQ.y6. -t __J L-I LJ
LICENSED CONTRACTOR'S DECLARATION
5 1 neren rfi,m Incl 1 am licenser.anger ns,Tena ter 9(rommencin Job Description
,ZED D Y a proa'inia p g
rotor wdnsection7")ofumision3ooneBusinessandprofessionsCode,andmyfanse PILASTER.
in full force and effect.
l0 I.oemeclass x
Date Contractor
i u O G ARCHITECT'S DECLARATION
{� < 1 understand my plans shall be used as public records
so
1 i 80 Licensed Professional
Irci, OWNER-BUILDER DECLARATION
R1 hereby affirm that 1 am exempt from the Contri License Law for the
h 3 a following reason.(Section 7031.5.Business and Professions Code:Any city of county $3000
Z�D which requires a permit m construct.alter.impress,demolish,or repair any.amaurc
-- pnort t also q the p[rl cam fw ouch permulofleeuglled
d3� thath-Sic av nu;n tnep ns of the Contmctnra License Luw(Chepter9 _ pe q !�{{
(mm g•'thScet 7000) fD' sion3oftheButinesrandProfessionsCode) �,{ ]Ls L «"� �+��Zr•1`+IULl.rs<I +t "S"' • Valuation
or that he Is exemltf thelafrorit and the basin for the alleged exempion.Any violationOf Section 7031-.5 by any applicant forst permit,ubjccts the applicant to a civil pe..try
'of a.,..than five hundred delta.(s5o(1). 101°kPL' NX0 *DATION .11MI1111 Occupancy Type
as owner of Ne Ti pony.Or my employ Ili age. :their sole compensation -
III do the ork'and the stmcwrc s nor ¢tided offered far'sale(Sec.701 ---- - _'_ _
'Basi ss and Pmmsslons Code The Contractor's License Law does not apply to an 104 — REBAR Required Inspections
r or Progeny who milds or Improves thereon,and.mo does such work himself
°w°` ro tintended 105 — ANCHOR BOLTS
or through nig own employees. Wilder.that such imp_.vemen n are no or
"dtTcied far 1 If'how the buildin8 o p mem is sold wnM1,n ane yew of -- - —'- - ' ----'-"'--
eomplt ner-bulderwill have the bNe fproving that hedid nor Wild or 304 — ROUGH ELECTRICAL'' -- �t�• e'1• '•t
m
improve for purpose of sale.). 505 — FINAL ELECTRICAL
oi;o.ow�erhrSe�mrenr.omdx�inai,"iy eonhmc Ge winua�.i<a contractors to "-..---- -514. FINAL; -PUBLIC -WORKS___.— ,._----------- -----.. . _.
construct the project(Sec.7044.Business and Professions Code:)The Contractors :I I t�C Pr'
Litt Ir. does of apply tog Owner ofp pent h build P thereon `
and.who cot ct.for such projects with a coonschons).liverned purriment.to.the
Cont cto s License Low, - - --_ - - _ -
❑I meemptunder Sec' _ ,B&PCf th...o ,. ,.r"r
Owccr' Use
WORKERS COMPENSATION DECLARATION
I hereby as7nn undo penalty of per) iY, opine 1011 ng declarations: Q y�
t ❑ 1 live and will maintain a'Cerificme of Consent to self-insure for Worker's
Compemmi... ...provided for by Section 3700 of the Labor Cade, for the
performance of the work fur which this permit is issued.
❑1 have and will maintain Worker's Compensationlnsurince.as iequimd by Section
37W of the later Code,for the performance of the-wdrk'for which this permit is
issued.My Whi Compensation Insurance carrier end Policy number am:
Cart r II �I I I t".iNolt<Y No syn . -s '_,:e:5't •; :fyav
a "IMPICATION OF EXEMPTION FROM WORKERS Q t _ +_ `: 1 ' t t,/1'+.c• . t.
COMPENSATION INSURANCE'I",`
. . fprssectonneed non be completed if the permit is for one hundred dollars •I,I t`. - i)s:' �.�!!is; 1j,..
($100)or less.)
I nf,ihperi, dth
e; e orka1 M_hhd: pe t's ..uedi
shall Trot " ;,Im1 n I n�•s�aneu 5[�r. e b t t th. W k I' )
Cos'ipe ssl oyssy �i j�i
Applii�rt, lJsPL"� Yl
t NGoahm subject
A to the N .Co doom p Canons of of Exemption you,you nruld •. t•
fic2,ineh inimpyrtniWbiker..Ohio, rJu,provisions,!the Labor Code, man
C) 0 fdnhwith comply'with sodh provisions or Nis permit s- _be deemed revoked.
1._.-..
t�-y rn
7 s'^�Y'.+•ICONSTRUCTION'LENDING'AGENCY,"""i .. •�.,,, • ,
• .. ,..
'> " 1 hereby aRhn that there iia construction lemim i agency for the'perfomiunce•, t• C'. f
Q Lender's k for w sd lSec.3097,Civ.C:)
kl ti pcnnt s
of the kf which this
U•Z LendersAJd
V,O ,
1 an f "Am I huse read nils a and, ad amte mat he above reformat an g
0:U corm.i`gree m romply d he all city end countyoeeineacea and Stam laws relating -
�.L) the idiove-menionedon`ridherrinspection purposes. ,ci of this citymemer upon
gl the ebo(We)h booed propany for inspection purposes.
,,.0. (Wjudgme ts.ave,and expensesy add
hi hamay in me way.a arm,against aid ^
Z liabilities,judgments,cola,and expenses which may in any wvy acerae against said ^
U:Z APPLIcANTU ace of the&iamibg of Nfs permit. " 1
'••t APPLICANTU tSTANDS'AND WILL COMPLY WITH'ALL'NON-POINT'
OUNCEREGLI. 'ONS: /1 _•Id/� Issued by: Da
�iaieofAP cva C°ntrucwr' ,nn. ,.,�„ .,,_: /,, ,,, D
Re-roofs
r
HAZARDOUS MATERIALS DISCLOSURC _ p - p y`,- g'•i
Wll the appliartt fm Wildingoeap tet orh dI by a' m aI Type of.Roof ~
area byinec p;:nn M Ip,icoa cnapl 91z em Health es Safety If a roof is installed- first obtaining an inspection; I agree C6d 5 t ]5531(`) I, y , { I s
nY _ ` "° - '1 , , All roofs shall be ms acted rior to an roofin material being Installed_ .. ..
,'I ,wBtnp.pplcat n was s p t mequp tordeiceswncn reetoremove
^Inti doasan rani 'ants m daftned by the Bay AmaAr nudity Management'
ct C&, - all new materials for inspection Applicant understands and will comply with
oY ,, —;-; all non-point source"regulations ! - -
. 4 1 have read the miaraoasmaterials requiremems under Chapter 6.95'of.the
California Health&Sam,C°de;Seciions 75505;25533 end 25534..-1 understand that
if the Wilding does not correctly have a tenant.that it is my responsibility to notify the " '- - ""_ - - ...... _.. _. .._.. .. .... .... .... . . . .. .. .... ... .
auppm of me requirements which'nall1he met prior to ismance•of a Cenilcam of
Signature of Applicant Date
re, All roof coverings to be Class "B"or better
.OFFICE . . . .. . . __ _. . . ._ . . _.. . . ._.