02070211 CI BUILDINGNDIVISIONNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
1526 S STELLING RD 02070211
OWNER'S NAME: APPLICATION SUB DATE
MIKE PEARSON 07/31/2002
PHONE: SANITARY NO. CONTROL NO.
µ�O O ARCHITECf/ENGINEER: BUILDING PERMIT INFO
CC BLDG ELECT PLUMB MECH
O U LJ U LL--J-
LICENSED
JLICENSED CONTRACTOR'S DECLARATION Job Description
Oz—O 1 hereby )of that 1 am licensed under provisions or nChapter s Cade.(commencing
p„tum with Section7”)a ect. 3 o the Baan and Proreaainna coos.and my Rcanae SPA HOOK-UP
6 Y ed 5 fiailsiult r'ellen. �(yJ�,
�rc0 n< License t<ITas's' ' - o LIE.
Date Co.—'.'
C'i ARCHITECT'S DE ATION
C -O g 1 undersand my Plans shall he used as p o records
3M-7
a S o O Licensed Professional
OWNER-BUILDER DECLARATION
6^_ 1 hereby aRrm rho 1 am exempt from the Coo anoWs License law for the
f z r following reason.(Section 703 IS.Business and Professions Code:Any city or county $2200
E Z O which requires a permit to construct,alter.improve.demolish,or repair any stru°wm
u`P18.3m...prior to its issuance.also rcquircs the applicant Four er
r such pmit to file a signed wmmem
- -
thithekhoemcdpunuantto theprovisbmofshe CombactolsLicense lnw(Chapter 9EI�YOr ea. Valuation
(nrimmedeingwphS.cann7")ofDivision3ormeey:tnes.andProfesi°nems) ( ly-:3,6 6�S3.t.
or that he is exempt thciefmm and the basis for the alleged esempibh.Any violmims I
of Section 9031.5 by any applicant for a Permit subjects the applicant to a civil penalty
of not more than five hundred dollars(SSW). 304A-PN ?4 ELECTRI L' " - Occupancy Type
01.as owner of Ne property.or my cmployecz with wages as their sole compemation, _ ECTRI 7,
--will-do the'work;and the'ntvcture isnot intended or offered for sale(Sec:7611;- ---"'- --"--'_--- "--'
-Business and Professions Code:The Contractor's License Law does not apply to an 505 — FINAL EL9eXkCTkC4IsDeCtionS
owner of property Who bullas or improves at such i and who does such work intended
of
or through his own however.employeest Wilding
that m vcmen es scuts art not intended or
..._ none.. _. -
;compleforsale:117,wner-Wildethebuildingor rmen of proven sola he did not
yearbf ..i. :s ..
eomove for the owner-W elder will have the burden of proving that he did nut build or
improve for purynx of sale.l.
' CJI as owner of the yvpeny. I lye ban B 'N lik
censed contractors to
o maur,'he project j (Sec.761i Business d Professions CW )The Contractor s
License Law does not apply to an owner of property who builds or improves thereon ar`a
..a9d.who,contracts.for such.projces weed a.ommusmrls).licensed.pumram to the _._.._.. _...... ....._...._._. ... __.......__...__ ._._ ... _...a__._____.....____.___.__. _.._.._.__...__._........
_ - Contractors License Law,
O 1 am ex:empt under Secso
: ' �B,&P C far mus rean (+ e +
Owner +.Dae ....m
WORKER'S COMPENSATION DECLARATION
1 nearby M.toodirpen Ity of pfijitiy,mrio of the following declamuons SUILMNLA
-
❑ 1 ha a md'will maintain C n richt f C rvem ti self rix re for Worker's
Compensation, as provided-for by Section 3700 of the Labor Code, for Ne
Performance of the work for which this permit is issued.) „
El 1 have and w II mant Wo ke's Comoeniaaion'bm6oancc,as ber,toodi by Section
1]00 of the Labor Code for the performance of are work fwhich,his permit is
I" d.My WokeesC pe'. t'n lnsuran caner POl Policy be „ r •,a ^,Y,�„��•,,,�,,,,•,
_ __ ........ . . ..
re k 'f}" F u. _Y. .
CERTIFICATION OF PITON FROM WORKERS S' � I 1 1• F T'^
x COMPENSATION INSURANCE s
'°'' 'fThn sect on nein nm be compleieJ if the permit is far one hondrtd dollars
'+I 'rtfYihiinthepenany manner
wo 'I It to tis issued,) 1'..• I.. ( ia1!S.:l
Com nm employ Laws any
of Cali in any manner so'm ro become subject to the Workers
Com t lawi ofC l'fo Date _... .... ._. ._.. .___ .. .. ___ .__._ ... ... ..._ ._ _.._. —_._.. _ ..
Appl ci vrt -
NOTICE TO APPLICANT IL ager making tti C nilica¢sh E e pu q You should •It
become subject the WorkcYSCompenxanon provisions of Ne labor Cmc,you must
Q O forthwith comply with such famrouam o,This permit,shall be deemed revoked.
a <CONSTRUCTION LENDING AGENCY
I h b)' R that there is a consr a lending agency f theperf rmonce
,..r of th k( which thispe,full is issued(5 309]0. Cts,C
Leader's Lead 's Name' -I ,o ... .. ., .y
....
;:).z Lenders Adaren` ,. •. .. ., .` is. ..m T" t,;l
certify that l have read this application and state that above information is
k+cts'^'4 "ivect
.l agree to
comply with all city and county,ordinances and nam laws slating
O mbuld gc wdo dh Ay authorize repmsendan4es ofths<ty to enter upon
} W Ne hove a em a ib c pcny for inspection purposes.
.. .
F y (W)agree ids a soda tiny J k p hs the City f C penmo against
(n liabilities,jdg ents,coal, d es,me h y n any y against said
U z City o seq cn2eor granting ort n
.JrArpucnvT Tkugs A PLY WITH ALL u vaiutje Issued by: r Date
Sia r none. Y
t of APPlica nlmetor:. .....�,.L.',,:... : r - " amRe-roofs
,HAZARDOUS MATERIALS DISCLOSURE will the-pplit t to.Wilding ocouperm lure handl li;1 r oa material _.Type
,. tbda'S�Y n 25)2me x1 s irimin M t(Noal '" Ch Pt 911 d rh H hh rid Safety 11? i 11 ••r e t tl 1 4 .1 s° w.ss.
. ; ATI roofs shall be inspected prior to any.roofing material being installed.,
• .Will the,applicant or ficure,building occupantuse equipment or& ceswhich If a roof is insialled!without first obtaining an inspection;'I4gree'tolremove
,.it brustromisitif col t.sidelined by the'Bay Arc Air Quality M nagement
District'? all new materials for inspection Applicant understands and_will comply with
riY°a all`non`point source regulations
I hd e' a,h h as d asr I y rcmens a de Chapter 695 of the
J
CaliformaHcodthS,S f ty Cade Sections 25505 25533 am 2553) I ndmond that
iflhe building doeznotcu III huveam iti ympomti lty to nor",rhe ,
'oe<punt of the rc rs which r c r to lean <e of a Ccnificaof of
^ a p"" Si_ a_ture cf Applicant _ _,. _ Date
thori.edage t - All roof coverings to be Class `B" or better';
OFFICE