01120019 OF
CI BUILDING DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22811 STONEBRIDGE ST STARRETT & ASSOCIATES INV
ss�� 01120019
WEElv'1 "CARDNER 2395 S BASCOM AVE Al2G/A04/ 2001
PHONE: (408) 445-2040 SANITARY NO CONTROL NO.
BUILDING PERMIT INFO
a0i O OF ARCHITECfIF:NGINEER: BLDG ELECT' PLUMB MECH
<U L LJ f� IJ LJ
N4 W
?i LICENSED CONTRACTOR'S DECLARATION
° m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�ml_°_. xith Section 7(100)of Dirixion3of the Businex>and Pm'asio pee a KITCHEN REMODEL '
-t In full force and effect.
a.< Liate Glass Lica FINALE
x n U Dam Commnor
3 u 1- ARCHITECT"S DECLA q
Q; 1 understand my plans shall w used as public records awl 2�Os
an,
tt p 0 Licen.ed Professional MAR q L
es OWNER-BUILDER DECLARATION
="a I hereby a1Rno that 1 am nempl from IM1e Contractor's License lava for the
H Z< following mason.(Section 703 1 S,Business and Pttleaaionn CWe:Any city.1.onlyBUILDING
$2 3 0 0 0
F which rcquircs a permit m conswn,all,improve.demolish,or repair any structure
0.3
prior to its issuance,also requires the applicant]or suchpe oan to file a signed%nomens -
-
that he R loccincoulplovicaflathe pro%isions oftn Contractor's Lise La (chapter9 Is 334SA .,or.0C4�
a' ,' trs. Valuation
(commencing lhSmi ,7(KKI) fDivision3 of the Bpi«a.and Profession,CWc) j _ _ y1
or that he is e;empt therefrom and the basis lint the allcgca exemption.Any violation
of Sutton 7031:5 by any applicant fm a pc;it subjects the applicant to a civil penalty- 1 Q 1 1R'FTPIIPDAT I ON Occupancy IYP
of ma mme than rise nandmd dollars(ss00, APN Occu ane e
❑l.mmancrofthepr°pwy.army employees with wages asmeirsolecompensation. 102 — PIERS
will do he work.and the sirocco,1,not intended or offered for.ale(See.law, 10 3 — UFER Required Inspections
'Business end profcrsions CWe:The Conuanor's Liccnsc Law does not apply 1°an y '
owner of progeny who builds or improves thereon,and who does such work himself 104 — REBAR
or thmagh his own employees.provided thin such improvements are no,intended or
-ofiicd fim.1c.If,however.the building or improvement a sold within one year of 10 5' = ANCHOR -BOLTS -- - -- _- -" - -- -
completion,theoweo
nerrubpc' 106 SEWER & WATERrwiunavetheburdenofpravingthatWdid —
improve purpose
202-- — UNDERFLOOR PLUMBING -: --
❑h as owner of the property,not exclusively contracting with licensed contractors to
onsmtct he project(see.7044,easiness and Professions cWc:)The Contractor's 203 — UNDERFLOOR MECHANICAL .. ..
License Law docs not apply man owner h prolat,smain who builds seimproves thereon,
and men contracts ser.such pmjens wile a commno s>licensed put saant I.ma 204 -— UNDERFLOOR 'FRAME-._.... -. . . - _ .....
111 am Sec 205 — UNDERFLOOR INSULATION
❑I stn exempt under Sec. ,B&P C(.,,his reason
OwnerDale 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby alarm under penally orperjurr one ortne following declarations: 303 — ROUGH MECHANICAL
❑ 1 have and will maintain a cetiacam of Consent to self-insure for Works: 304 — ROUGH ELECTRICAL
Compensation, as provided Ibr by Section 3700 of the Labor Code, for the -
pwfmmanee of me work for which this permit is ivaed. 305 FRAME
❑1 have and will maintain Workers Compensation Insurance.as regained by Section 306 — HOEDOWNS
. 3700 of the labor code.for.the performance of me work for whim lis permit is 307 — INSULATION
' bb
sued.My We in's nu r //;
" n °; ��U 2 a/ 308 '.:7- SHEETROCK"
nro�aneeaatter n - _..
RTIFICATION OF EXEMPTION R MWORKERS',, 1 309 r=•'$XTERIOR•tLATH
COMPENSATION INSURANCE'. -. '. ,_. .._.__.__3'30:"'--:INTERIOR'- LATH
.._..-._._-...._.-,.,..,.,-..._.--................. ._ .
Mis section need not he completed if the pemtit is for one handled dollars 311 —' SCRATCH COAT
($100)mlcsa,)
I certify that to me Performaore oche work'for witch this pc.it is issued.( —3-13 — -ROOF- NAIL - - . ...
shall not employ any person in any manner so as to become subject tome Worke s 501 — FINAL EISECTRI CAL ENERGY
Compensation laws ofCarmrnia,Date 502 — FINAL PLUMBING ENERGY__ _
.Applieanr - - -
NOTICETOAPPLICANT:If.after making this Certificate°,Exemption.you Should 503 — FINAL MECHANICAL ENERGY
m '
become subject to me Workerx Compensation provisions of me labs CWe,youusl
O forthwithcomplywisesuchprovisionsorthispamntshIIIbedeemedrevoked. SO4 — FINAL BUILDING ENERGY
`m ''CONSTRUf.TIONLENDINGAGENCY 505 — FINAL ELECTRICAL '
I nercn ffirm that them is a construction lending agency for the Performance
6fmawbrkro whlmmispenoiusittdW(sda.3097.cm.c.j 506 — GAS TEST I
ZLewlNama. 507 — FINAL PLUMBING
Lcndin,Address
1.tiry that I have read this application Iod stem mat me above inrotnation is 5 0 8 — FINAL MECHANICAL
QWP: cionnt.1 agree to comply with all city and county ordinances and state laws relating 509 — FINAL GRADE
OU mbuildingconstmction,endhembywohmiectepreaemmivasofhiscitymemel-In 510 — FINAL PLANNING
the above-mentioned property for inspection parposas.
t.M. aLICA
cursive.indelnnifyandkeeQhemticsstheCityofcupcninoagainst 514 — FINAL PUB C WORKS
yants, s¢and expcnsas v�lft[n may in en y accrve against said
4,7 znc fl egmmmg of
thi p set. r
,q it NDSA' T4 i ALL NO Issued T° Issued by: Date
haanoc«tma r D Re-roofs
` HAZARDOUS MATERIALS D SCLOSURE
%I the applidant or comm wilding occupint store or handle haiardws material _Type of Roof - -- .. ... . .: . .. .•. . __ - ,
as dctined 65'.me Cupcnino Municipal CWe.Chapter 9.12.and the Health and Safety I
C1Me. cc ser 2553200? •:O No
11
• • ' All.roofs.shall-be,inspected.prior to any roofing material being installed.
will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove
19emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District] all new materials for inspection., Applicant understands and will comply with
�Y,e" all non-point source regulations.
ev ad the hazmdous hi¢dels rcquiremenB under Chapter 695 of me
omia Hca h&Safety CWe,Sections 25503,253 J and 23534.I undcrswM that _
me building « note.only horn t nt.their my msponsibility m noifythe
6ccvpant of th requi cots which met or to nee of Ceni Cate of
Occupancy.. Q/' Date -.
Signature of Applicant
— wilbon. Igen ate All roof coverings to be Class"B"or better
OFFICE