02020033 OF
TINO
CI BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
KAN JAMES AND CELIA 2420 PRUNE AVE 02/08/2002
&HONE: SANITARY NO. CONTROL NO.
(510) 438-9000
D ARCHITECMNGINEER: BUILDING PERMIT INFO
— BLDG ELECT PL t MECH
l ML
II
11'z i LICENSED CONTRACTOR'S DECLARATION Job Description
0 z,_ I hereby affirm that I am licensed under provisions or Chapter 9(commencing p
<yr_u, with Section?")afMilitia.3oftheBusiness a Profession,Code.andmylicense CLEANOUT.
q� is in fitlfn mdc t.
r owl, Licm°- Z�0 Cio�tr F8 i�9 A L E
3 u- ARCHITECT S DEC, ON
E u.} I understand my plans shu11 he used as,ehh,scums
Y�`F
St oa3 oa< Licend Professional
OWNER-BUILDER A'T108
FEB 12 2002
1. I hereby Grin had I tun exempt from the Contractor'sLaw for the
following ria .(Section 5 Buat
siness d professions Code: city o roomy
Exwhich rqaptconst t p dIh repair any structure _
_pt 9 PPa signed Indent
11 Q O
1 ..._.._...
that h4 I n dp and to the pm of the C t t sL' s La Chapter Sq ,Ft F)oor•Areay Valuation
(commencing 'tnscq ,7000[ fDivisi 3fthe Bpnrsand rpfsxlonsCode) CX)N—lR35'9r060.1°9•$i 'fE�_bt' )
or that he n exempt thcrcfrdmLnd the basis for the alleged cxemptmn.Any violation
of Section 7011.5 by nny applicant for a permit subject, he applicant m v civil Mnalty
•ofnor lmore than five hundred dollars(5500). APNNumber 't' Occupancy Type
Ll 1.as owner of the norm employees with Wages as their sole con tion. 106 - SEWER & WATER
pipe y yemp y g pcnu
'will's t he mark,and the structure is not tr intended forsice offrcd Law
doe sale(Secapply to an' - - - - -
'Businowner of pandro Profession Cade:The Contractor the is License Law d«s not apply m an
r of his ow Who wads or improves me such iand who does sure work himself or 3 O 1 - ROUGH P
own •
or through m,own employees..pr me mat such improver sol are not intended egpr F FINAL---PLUMBING
--'Rcfd fo alb:If;however,the wildin -' mvement is suW wilhln one f� �---�--� -----507----' ._.._......_.__ _.___ ..._..._.....___.__..... . ,.__.
Icampinion.the owner-builder rill have the burden of proving that be did not build or
improve for pugwu of sale.).
O I,es owncrof the pmpenY,am<xdmivclY conwci nB witM1 1` nod convaaom no - - _- --__' _ ._.-...�_._ _ _
consumer the does
(appl7toa ownBuser
andProfessionswhCode:)The
ves tin neon,
License Law d«s not apply to an owner Ih property who builds se improves thereon,
- and whore mems fnr.auch projects with.e.contracmr(s)licensed pursuent.to.the. ... .._. _ ._.._.......—.. _ ._._.___._.____.._.
Comrcctor's Liccnu Law. ._.._ ..., .___.._ ..._.__._._.. . ...
❑I am exempt under Sec. '&PC for this rtazon _..
_
Own,, '•Date
WORKER'S COMPENSATION DECLARATION
I herchy affirm under penvlry of perjury one III the IMlowi it declarations:
l ❑ 1 have and will maintain a Certificate of Consent to self-insure for Worker's
1 Compensation, as provided for by section 3700 of the Labor Cade, for the
performance of the work for which this Firma is issued.
131 have and will maintain Worker's C6nimmaation Insurance,as required by Section
3700 of the tabor Colle,for the performance of the work for which this permit is
«dM Workers Co pesa ion ham nee - and Policy number art
aide Po1ry No,
.'1 .ACCRTIFI ATION OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE a"" - _
(Ttk se,ti6o need not he completed if the permit in for one hundred dollars •s' " \l::!; r 7 1° . . 1i.'�•tf il.'�. )nC
ISIMW,leu.),
t „ J I n fy shat in th pert rmame of the work'for whsh nh pb l't issued,l - _ _ _ --tt
shall hot employ any pn xami in any manner it'.,m become au heel m the Workers
Cam t Lo of C f D m
P
NOTICE TO APPLICANT If,
Z tOti ' Worker
ft inh Certificateof Exemption,yo ulst
Zhen it subject the W k ry C s Provisions
ov ions of LaborCode yon must
Toth th comply with such previsions or th' permit shall badeteW revolved.
'
t I "• '.
.�+ CONSTRUCTION LENDING'AGENCY
I M1ercny affil that dick is a boned rcdmi lending agency for the perfermahce
[aa7Q
of
oNf h:ch this Permits issued(See.3097 Civ C)-
r'-L'Z LcR!e,g Addfe. ,•_ v ,
1 credit,that I have read this application and state nhanhe awve infomution is
edrredt.1
agreew comply with all city and eoumy,ordmancex and sham laws relating
ro wilding conswetion,and hereby sutbodze representatives of this city to enter upon
the albve-mentioned property for inspection purposes. ,.
�a6i (We)agree m save,indemnify and keep harmlesi the City idCupcnino against
y liabilities,judgments,r t. and expenses which may,iany ay against said �7
V Z City conscq ine6 yw�pl'tIn permit
SSPPLIC NDE t NSA 16WILLCOMPLYWITHALLNON-POINT Issued by: r Date (p Uv
TIC
REGU I S. l'
sin rN<an r [ Re-roofs
B HAZARDOUS MATERIALS DISCLOSURt r
wnme ,Album r[ cwld got imin me li dichatterd' . ner l Type of,Roof_ ... _ ..
Ii dcT d by the C pen no Mun 'p 1 Code Ch pr 9 12 and th He lth and Sar ty l
Cod S t 2553200 1 f p-4F { cl <t:'�it
❑Yes - [ ; .r y All.roUS shall be_mspected poor to any roofing material being installed...
Will d applicant future building p I use equipment orate devices whim If a roof is installed'without first obtaining an inspection;I'agree'to remove
emit hariNous it,cont ants as defined by the Bay Area Air Quality Management
District? t all new materials for inspection. Applicant,understan_ds and will comply with
IS °1 all i on source'regulations.,
'c' ''1 hn"ve rcadahe hAzdrdoux�mmerials rcquikmcnts;under Chipter'6.95of the',
.California Health&S e,Se 505,25533 and 25534.1 undcrsmnd than
.e a m . [,r t it is my responsibility to notify Ne'
B th_c tibildin tot currc
«cuparithe reghiremc hich m" 'men prior te'is.. : ofe Certificate or
°"Oy t' - , t Signature of Applicant Date
- - ..
i "yf All roof coverings[o be Class "B"of better
lo Dae
r
e,._, ..
OFFICE
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