02060103 (2) CI BUILDING DIVIiSIiONV0
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10189 TANTAU AVE BATHROOMS BY REMODELING EPEC 02060103
OWNER'S NAME: APPLICATION SUB DATE
RICHARD FREEMAN 1422 SARATOGA AVE 06/17/2002
/ PHONE: SANITARY NO. CONTROL NO.
1 (408) 328-6700
9 p z0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y'^ Lm that ID CONTRACTOR'S DECLARATION Job
�' Ihcrtby vFwshaiam oftheBsinerp o(Chapter Code.
9gommccense BATHROOM REMODEL `
FHG with scnion]000)of Division lof the Business and Professions Coek.and my license
a se y is in full forte and e, G 7 ods NOV p 7 2 pp2
s o 6 u Lice nu Class /e Lic.N
3 n F Dae Commcmr
f-LL O g ARCHITECr'S DECLARA ON
1 understand my plans shall be used as public records
Ir
,cr.O Licensed Professional
OWNER-BUILDER DECLARATION
6 m 1 hereby affirm that I am exempt from the Convector's License Law for the
F z a following aeon,(Section 7031.5.Business and Professions Code:Any city or county $6 9 31
RS G which aquircs a panni,m rnnsvuct.altaolish,r,improve,demor repair any swarm,
so a 3 coo-prior to its issuance.also natures tho applicant for such permit to file a signed statement
that h8 iseliceg9vd pursuant as pov)sions of the Conwcmis License law(Chapter 9 ) Valuation
(commeng ItnSectiuni' ) fDrvisionlof,hc� mea�anaPrppras,.ioorCodo (;n�?i'>i`3'( '. `"lb•_i . SYl�l tiil'7A'.�'1.4)�+:
or that hecinis exempt themfAiinand,he basis for the.11FggL, gemp,(ot�.Any violation
of Section 7031.5 by any applicant fora pem,it subjests the applicant to a civil penalty
of out tame than five hundred doll.($500). j0jA_PNPbTftATION li of, % Occupancy Type
111.as owner of the property,or my employee with wages as their sole compensation.
s -
-'wlldothe'work.'and'me structure snot-intended or oRercd-far sale(Soc.-7044Y -. __. __.. _ ___ ._-.
'B : ss and Professions Code no Contractor's License Law does not apply m an 103 - UFER Required Inspections''�
ownerof his
embuilds or improves,hereon,andmpr whodoes such work himself
or though his own employees.provided Out such improvements arc not intended or 104 - REBAR
OR mE'foi3ale:If;however;the buildin"oP ire Fo"vnmcni is sol]within one ear of --- -'- - -"'- ANCHOR� - ��-'"--_ '- ----'-'""%;;_----� '�—'----'---'_
g p 105 - ANCHOR BOLTS
'comPle,ion,the owner-builder will have the Horden or porting that he did not build or
improve for purpose of sale.), 106 - SEWER & WATER '
of _pros PLUMB -- -
:: "C71,as owner of the propcnY,am exclusively contracting" 'thlicenseJ contractors -
y w. 202 - UNDERFLOOR- ING- ,u;_:•.e-I-r.�:,l r:r,
construct the pro,cs('eel]nu,Burins..and property
who nes cade)The contra ro , 2 0 3 - UNDERFLOOR MECHANI'CAL'-'
e a
License Law docs no,apply m on awnw of property who builds or improves thavon, �' s
.. 7 _ane what contruts.to,.mm.Proiects.with.a conuxmr(sjlkensm.prrsuanLm tale. 2'04-'--""UNDERFLOOR"'FRAME'-- - ..__.___.....L_...._.__.....____.._..__......_.
^_ - Con,ncto's License Law, A,: ^.16 s:f.x .
- � : ❑Ism enempt unJer Sed ,B&P,C for,hic mason 205 - UNDERFLOOR'•tlINSULATION
- - o ores 301 - ROUGH PLUMBING
WORKER S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
_ . Ihereby arum underpenr0ty arPely n, rime fort g dcor.raima, 303 — ROUGH MECHANICAL
7: 1-lI ❑ 1 hove end will maintain a'Cmificam of Consent to selbinsurc for worker's 304 - ROUGH ELECTRICAL
I, 1 Compensation, as provided for by Section d)(g) of the Labor Core. fathe
_ _ - Peiformancenrmeworkfarwhimthispermitisosued.,. r 305 - FRAME
1 have andivill'miinlain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
_ 3100'ofshe Tabor Code,for the Performance of Ne work for which this permit is 307 - INSULATION
isd d.My/W rkrker's Ci5rrprr, tion hosivinanci tamer and Policy - be m
carhsa " PhayNo oi'6 So �7 -,S'HEETROCK__� .r._....,.... ----,.._.._.._ ,, •
ft1HCEKTIR(;ATION OF EXEMPTION FROM'WORKERS k" 1 '�: t 3'0�'4 r f.dEX-TER-I OR 1!LATH A''• f
'
. - "':�INTERIOR—liATH-' toot. ..._ .� ._._
(1bN iI,eton,ccd ad,he co31'0?
nderal if the Permit is for one hundred dollars If U_
'
31M.,les.) 311 - SCRATCH COAT
31.3._. ROOF
Wall nit 4mpl6ynycm in person in eye( any
fmanner so as tobecome the al 501 - FINAL ELECTRICALst�ENERGY
t e bJ t, the Workers
CorrIpe...in.Law,ofCalf Dm '
OrNrrtnM1 lwdn -n ,hi"thll bd d io
ked
o
502 _ FINAL_ PLUMBING._ENERGY---
;NOTICE TO nPTTf hmaking Certificate
fE Exemption,
_
—'"_,
Z becamesuh)cm .,heWorkcrsCampcosationptt,h you 503 FINAL MECHANICAliERGY
ENERGY
Z m .504_._ ...FINAL BUILDING_
te 4CONSTRUCTIONLENDINGAGENCY _•`
505 - FINAL ELECTRICAL
a ' t I hereby affirm that Nem is a convection lending agency for the performance
„rm kl which this a _tsIssrq(s -109]CivCl : 506 GAS TEST
under�Name
p;z Lnd .Ada psi• 507 - FINAL PLUMBING.
v O 508 - FINAL MECHANICA
I c n fy th s I reply
d tall city
application my state,nm the bo laws
melon a
tat. U t 1 a mete plywth B by d o ,,r ordinances astateI ,dmmg 509 — FINAL GRADE
O..O fob Id g .,' , h do hereby smh c rep its. t (tall-city to tar upon
m hue , ter patio' ax, Pma 510 - FINAL PLANNIN
. 6i IW-)Alt-cc- is i fy andk phar 1 sth C'iy fC pen a'un't _
fa0 liabilities.judgments.cost, and espaao which in.,in any y accrue aI said 514 F I NAL UB C 79
V;.4Cry in-mommiponizi of the gram ng ii perms
AI PLIC TUNDERSTANDS AND WILL COMPLY WITH ALL'N N=POINT•r !
SGUP .<EGUCATIONS r . �;' }f�' Issued by: Date
3 g atria_,a_ r�orwctor :',i, .:., Dam...; Re-roofs
.HAZARDOUS MATERIALS DISCLOSURE,
+ ' WII th ppc m fat cbaldng x l t naso h dle baard.'tamed I .Type of Roof ,-
'" is defned Itcby Cupenn Municipal CM Chapter 913 dtheH nal andS fety t , - .�•-•.-...._ ... . ..-`... ' --------------------
I
CWe Sectn35531 a) Av ! t 4'-'•-T .,,l" T + ,T' 14 r1t""u rs
s (, rte - as + ^ - i •• ea i', .ha
I_Si rt a.iii"v:
°v ' �N 4'+ t. n - All roofs shall be Inspected prior to,any,rooftng material being,installed._
Wil I the uppi ant or.future ba Ising occupant use equipment or devices which If a roof is installed without first obtaining an inspectiori,'I-agree.to remove
:u rtnntaminenis m Jef J by,h day Arc A r Qua],y Management
o t`h, rJ � all new materials for inspection. Applicant understands and will comply with
1 " all non-pore[source regulations - t • • �h , ,
•• 1 base mad the al mrdous maanaB requirements under Chapter 695 of the
California Health&Safety Code,ScBtiens 25505,15533 and 25534.1 understand shat
if the building does not currently.have a rut that is is my responsibility to notify the -' "" _.. ...._ ... .....- _ _..._.... ..._.-. -_._._. .... -.\... . .._ _._. .. __ ..._
iiccupu I of she govements which must he met prior to issuance of a Cenifcam of '
Signature of A ]lean[ Date_
A8eg5 -6 . .- _ - .g. pp - - _ - -
own rmarrnonzeaagent Dae All roof coverings to be Class B • or better
ti ,
_. ., r .. . ..__:...,.. s..._i:.., ._, soot.. .. _ .. 1.. ......._-OFFICE----. . . .. - --- ..... . . _.. _.__.. . . _- .._._ ....._. - .