02040139I
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CITY
BUILDING DDIVISION
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
11631 UPLAND WAY
02040139
4'NER'S NAME:
APPLICATION SU DATE
04/25/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ CJ L: J t_J
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am licensed under provisions of Chapter 9 (commencing
7(00) Division 3.f Business
FENCE
with Section of the end Professions Code. and my license
is in full fora and effect.
License Class Lic. re
Data
ARCHITECTS DECLARATION
Puat
understand my plana mall W arcaed as as public rcrnMs
Licensed Profcrxional
OWNER -BUILDER DECLARATION ,
1 hertby.(Sint that I vin exempt from the Contractor's License
LiLaw for the
followingracoon.ISei7031.5. Business and Professions CWe:Ar)city or county
^V 000 QO
which rcrtapemrit msonstrn, aha improve,dnnolish,orrtpanaysiwnurt
meaPpGcant for
-'Hiortons ismsim mires
� , _,y,e., c�pptt���'I �,,� ,
its, U,J V,pgr ],37� j
Valuation
that F6porcquithe Cealwam LaW(.m¢mcm
Smereir 7000) or
(commencing wita6tiin11dlh0yfDi%insnftWCwuoaotsLicenseLew(Chapta9
the ss and Professions Code)
ofhe
:., . - y;3'tl`b .: , , ( ,
tatbes cities th basic t
and the basis for the olleged
pilled Anis violation
or Not be is eaL5
b , tip,li
ipplia or
-Of Smiom70) I:5 by any applicant for a permit subjttts tW applicanrm a civil pcvlry I
Idfam morethtin eve hundred call. ($51Y).
10�1PNt*(ANDATION
l,: s'i'f':; Occupancy Type
❑ 1. as owmcr of the progeny or my employees with wag=e m their sale compenmtion,
1 0 2 - PIERS
-will do the work:and the structure is not intarided or Offered far.to (Sec.77044:-
Business and Professions Cade: no Contractors License law does not apply to an
103 - UFER •'-i+, '
Required Inspections "
owner of uparty Who Wilds or improve, thereon, and who aces such work himself
104 - Its E BAR
or through his own whj9yees. provided that h p t o t intended r
offend for ulc If, however, tthe bis lding orimprovement-is sold th c - y -_._...._,_
_... _ _ ___ __BOLTS . _ _
105 - ANCHOR .,•r,7:.:; ,L
completion, the Owoerrbullder will have the burden of proving that head not bale or
.,.•_
improve for purpose of sale.).
106 - SEWER Sa WATER
-- - ... -- ------
cvclv�
ora licrnsheontactorsm
of the psSca.
Balance,
-..._..- - _...-._.
- -+, ;:_�.. ., I, . \ 1, ;,-,;v--_ .-..__... ..
Ii trvn ae ptajttt (stt. 71 Business ad predications
ace, he Business ana code:) The :
2 03 - UNDERFLOOR MECHANI'CAL'::
erarmtinb
too
Lions law does not Apply to an owner th a.con who builds m improves thereon,
improves
_. to the
___..___._. .204.___.�DER'F-IaOOR_-_FRAME-.__..__._.._-...-...___._....___._-....._._...__-_._
Co. ,.,x Lima Low.-.projecu.with.a.conusnw(q.Ikased.pwswm
Contractor's Uttnsc law..a, .
❑lama= tundcrScc'-" ,B&PCfmthoi-rean
205 - UNDERFLOOR,.I-NSULATION
w "' list= /o F�oZ""
301 - ROUGH PLUMBING
WOR ER'S PE... - -N. 1S -TION
302 - TUB :& OR SHOWER
I hereby aRren underpandty pr arjary One of the meowing aeclaations.--
303 - ROUGH MECHANICAL
❑ I hr;i ad will inainuin a Ceriificmc Of Consent fo self -insure for Worker's
304 - ROUGH ELECTRICAL
Compensation, as-provid=a for by Section 37W of the -Labor Code, for the
performance of the work for which this parmit is but
305 - FRAME
❑ I hromand will m5iniairi Workeri Compensnionlns... a.', as required by Section
306 - HOEDOWNS
37W of she Labor Code: far the, peirpnwaca of the work for which this Peron( is
307 - INSULATION
wurd M Worker's Com tit o In once e d Policy number My
;e .. . ,
-...
- 308:. :SHEETROCK .. _._. _.-.-
Cunu' -CERTIFICATION OF EXEMPTION MOM,WORI(F.RSsr
' ) A309 --_'',EXTERIOR'-
,EXTERIOR -LATH "l `"•'
COMPENSATION INSURANCE_'-,^�_....-..,.�
....� _-...- .. ..__. _. _..
`310, ---INTERIOR- LATH - .- __-,- - ._.
o sea on nceJ not he act. led d the garcon n for on= hundred dollen
u "" ` `•• t ; i...., �.'.
311- - SCRATCH COAT
IS!oo>a
'?l•nottnfyNatiner pernananmmOf a whfb which this permtI.eWomk t
313 -•---•ROOF•-NAIL- - ------ -
M1 nom employ anym Ona [nm = s b) t to thr Work
501 - FINAL ELECTRICAL•`ENERGY
Compeaxato Laws r,cer ha'Dalt"_.502..._-__.FINAL...PLUMBING
pp�� _,--
.ENERGY-_.___..
- -
IN ICETOAPPLICANT IT after king thisCnfca¢o rE on'yoy.nmust
503 - FINAL MECHANICAL IENERGY
r
provisions; of the Labor Code. you must
Wcotnesubject t the 'liu6 C n,
a, this
tura thcomplytniuihprosionsonhspermitshallWtlttmetlrcvokcA'
5.0,4 __ _FINAL BUILDING ENERGY
r 11 '!CONSTRUCTION LENDING AGENCY ' "
505 - FINAL ELECTRICAL
c '+r6 hereby eRmi that sere ls'a constiucuo lending ejanc, for the per io mance
f
506 - GAS TEST
anhz kr nnth p Ittxr ais[3a9rcr c)
Lender s Name - '-'— ....0 _....
Lena Aaa
.. _.._..... _. __..
507 "FINAL; PliUMBING r
508 - FINAL MECHANICAli J A
1 nfytht7hame head did, at
sapplicaton ds,amthtthcaWvcinformationis
corral 1 eg c m comply with all city and county oNtn nces and state laws alar ng
509 - FINAL GRADE
toWm g nwaton. and thereby an s
uthonpitsaatves of this city to enter upon
U
the above-mentioned bove-tioned property for inspection purpose..•,
510 - FINAL PLANNING
-
(W'=)igrca msave: indemnify and keep harmless thi Ciry`o/Cliyeiiin. against
514 FINAL PUB IC WORKS
' Iiabilt s, j Wgtnenss, emu nil expo res which may in ay why, came agents( said
-'
-
a
Cit donsequcnce of thegoon ngof Nis perm) ' "'
❑CANT UNDEA$TP\b5 A\D\\'ILL COb1PLx l\TfHALL\ \POP
mnrlD\ l y}�0
Q s, a�
n
I rS\
Issued by: Date v
Stgnatprt of prtan man .oat `p
', HA7ARDOUS'MATERIALS DISCLL OSURE - t
Re -roofs
WII ds eppll6 t o Ponta W Idl g o pant s ac o hand a ha vdous a N
Type of Roof -
as aafinad by the Capert Municipal CodeChapter 9.12. end the Health end Safety
. • s :': ! r
Cele ❑Ye 255RU1' t ,Nos. l ,t ; ls' Iji _
., ,,•
\ E '.
All roofs shall.be inspected any. roofing material being installed._-___..._..
.,,..
W ll the applicant or future building o pant Leu equipment o de tees which
-prior -to
is itisialled Without first obtaining cin'ihspectioti; I'agieeao eemove
itbaaraaas wreoniminants at defined by th Bay Aria Air Quality ManagementIfaroof
Dr;tnn7
all new materials for inspection. Applicant understands and wil] comply with
®
`'t ❑Ye, ✓tri /- NO, G - M1•, _
"
_-._. -
all non -point source iegul-a`tton,s
' Il have mad,the hazardous'smocrials requirements under Chapter 6.93 of the
California Health'&Safety Code.S=iaons 25505:15533 and 25534: 1 understand that
�ilthe'W'Iding doer nth cutrcntlj have amount: Juritia thY resPo ibl ty to notify the
-
occuppm of me raja rdrgc ¢ w h ch- tier W met p o to issuance ofis Certificate of
Oc[ppency tt•
Signature of Applicant Date
All roof coverings to be Class. B" or better' '
7.
_.'OFFICE _ .. ... _ _ __ - . ..... ..... .
_.'OFFICE _ .. ... _ _ __ - . ..... ..... .