02080039 OF
cIBUILD NO DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21353 VAI AVE R & Z DEVELOPMENT 02080039
OWN R'S ME: APPLICATION SUB DATE
R b' TS /ZANGER/FAYLOR 21771 STEVENS CRK BL #100 08/08/2002
HONE: . (408) 252-1101 SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
O O ARCHITECT/ENGINEER: I BLDG ELECT PLUMB MECH
atW
ad
z v=Ni i LICENSED CONTRACTOR'S DECLARATION Job DOSCOPhOn
I thertion 7 a)of that 1 am licensed undersines Odd Profs or ns ipley Code.add(Commencing DEMO
F-_t w wilt Sa,ion c lual of affect. on J of she Business and Professions Code,and my license
m y Jj in foil force DnJ eRcn.
E:,.6 License Class Lia.N
6 G Dale DECLARATION L' CAf
w 3 u ARCH]l=DARATION
t:°'0 g [understand my plans shall be u.ud as public records
tom++ O O Licensed Professionzl
a. e,2 OWNER-BUILDER DECLARATION
1 hereby aff
rm Nal I am exempt from she Contractors License law for the
1_z> following rowed(Scclion]03 L5,eusinesa aM Rvfcasions Codc:Any oily or<ounry $10000
3
O which requires a permit to construct.alter, p demolish, p y dracrom
p�
prior to ss murni also requires
prapplicantif chile a 11 L (Chapter
u,mem - - �',i ,��.s1 Are _ ........... ... .. ._-._lu thallic p ooh provisions of the Communes License IW (Ch ode) .s3.Cw.O�..F1�jrlArpai Z a ,. Valuation
ordeet
(commencing with Sectioneftan 0jofhe n3ofshelleged read PTpfAnyv.Cole) t- le't sN VY t!V s yI s9}j, 1"'ry
or Sec ion 7 sump,therefrom and the per for she alleged exempnttto Any l Penaun
of Section]than by any applicant difils for a permit subjects We applicant w a civil penalty
arhad mom man five hundred mgara(ssooa NO AVt4!l3RED INSPECTONSOccupancy Type
O I,as owneraf the property,or my employees with wages as their sole compensation.
will do the work,'and the araclure is nurimended or offered for sale(Sec.76 ,
'Btiiincsiand Professions Code:The Contractor i License Law does not apply ro an Required Inspections
caner of propeny Who builds or improves,hereon,and who does such work himself
or brought his own however.t building
,has such improvements ere not intendednyear or
'oRerW for sale.If.however,she buildin � - tis sold one - f
ger improof playing
Ycldo
cmprove on,me owner-Wilder will have the burden of Proving tom he did not build or r� I�p
improve for pugnu of sale.l. M
_. _.._._._ _. _. _.. _ _.. . . .._.. ed_-._._. .
❑I:as Consumer
he if the propeny,am Business a comracling wish licensed Cmdrmrs,o �� t`
License Law
project(sec.]loan Business and Professions Coaills or The Contractor's OCT License Law ones not apply loan owner with
propeny who builds nrd pubves,hereon, 1.5 9002
aM.wha conlrams'for such projects with u.cumracmr(s),IlcenseJ pursuam-,u,he L
nmrac,ora License taw. . __....-. ._..__._. ..._ .._._. ..... .. .-_. . .........__._._...._.._
= �ner ex
con under See Da 'e&PCfor this reason BUILL)HyG •-1. ::4`s.l l(st: 1P
- - _ WOR ER'S COMPEN�PbN DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
1 have and will anco min is Cenilicam of Consent to self-ina be for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for be
performance of the work fur which this pem(i(is issued.
❑1 have and will maintain Worker's Compensation Insurance,as abstained by Section
17011 of dre Labor Code,for the Performance of the work for which this Fermi,is
issued.My Worker's Control in hours a carrier and Policy number K:
C ame I . .. Ise.' sPol'cy Ni: t"Y se n.
(�CERTIFICATION OF EXEMPTION FROM WORKERS',
... COMPENSATION INSURANCE ----------
al • `.' ................._.. .... _ ....__.'a (This sec,on need not be complec ' she permit is for one It dad doll-
affil orless.
'� 'fee I he perfn once f th f - reseed;I. -
shali Dol 1 y y m n "
nit r ,p rsoilon
Applicant
•NOTIE API' IC F s rflcm�lE you should "
bje n the W k C ns p f the L C Jc,you muz(
Tom cnmpl wish h ." s n h pc t shall bed ed revoked.
FCONSTRUCT LENDING AGENCY
> - 1 hese affirm that there is a construction lending agency for the p brfomuarec
.. of the work for which this permit is issued,See.309].Civ.C.)
QLender's Name .... _. .. -. ... .. _.. _. .. __._ .. ... ._._ /1
..0 z Linder',AJJabsx
U 0I cenify shat I have read his applicminn and sum mal the Chase information is
correct.I agree to comply with all cily.and County ordinanc=e and%tate laws relating
to building ronarvc,inn.and herabyaath rtprcuma,ives df(M1isci(y so enter upon
thea mcmi"am"prate to pec o Cpu
.F g,50) t=:-n,. vvc dem if,an ke ph less the City of Captain.against a�
Ii list d ml.c u d (pen. s which ay in any way accrue against said
U ' ly in encen M1eg ni gor IsN ,i VL�
APPLI' f 'NUE, 'Td, ) A' N I . LY WITH. N-PO Issued by; Date
S P.! I 'f ONS / i
sg ( e o __ Co itDat Re-roofs
.; A US MATERIA DISCLOSUR
W me if b to buldmg pan:acme or handle hounds mrial Type of Roof
u d f by m Cupen o e Code.Cha%er 9.12.and she H W d Safety s t
codes ,an 25532( 1 . . .
Y x t '• - All roofs shall be.inspected prior to.any.roofing matenal.being installed. ....
.case the arph'aD,or for re nFding occupant use equipment of de .c<wnen If a roof is installed without first obtaining an inspection,-I agree to remove
emit Aazmdous ter Contaminants as elined by the Bay Arca Air Quality Mi' agmand
Distal all new materials for inspection. Applicant understands and will comply with
❑rea all nofi-point source regulations..
- I have mid he If Crials r quire is under Chapter 6.95 of she
Ca is Health&Saf"I e.Sec ons 23 05.255 J am1255)J.I understand teas .-_...
I Menot<u ml hav atenan.shalili my pit iboty in o fly she -
ecu , I equ mus( me,Pd to i.' nil Cate f
°" Signature of Applicant _ ., . Date, _
Of as reg I Date All roof coverings to be Class "B"or,better ,
OFFICE