01110100`-A
r
v
CI eut OFG DIV�'ISIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
19333 VALLCO PY CAC03
PERMIT NO.
01110100
56MINXI COMPUTER
(,jiO1N5UB W,
TML U U
PHONE:
SANITARY NO.. CONTROL NO.
ARCHITEC rENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed unsIer provision sof Chapter 9(commencing
ob Description
with Section 70001 Division 3 the ap:tl Professions liceme
250 KW GENERATO)G
of of ,,sand Code, and my
Asa full force end effc ////J
nu Class Lioc. X O
�®
,e I z
ARCHITECT'S DECKARATION
I undcrosmnd my plans shall be aYd w, m public recardz
1 2 2p02 Pp
Licensed Professional
OWNER -BUILDER DECLARATION
Iess hereby affirm that 1 am exempt from the Contractor's Lice seLaw for the
followingreason. (Section 7031.5, Busineand Pmtessions Code: An city or count
UN
J ���� y, � inn%O
o'o`�-
which reclines a permit to conitruct,Iter, improve demolish or repair any stmcrosv
-.prior to its, also mi,turest the applicant for such earth to file asgned sutervcnt
Hach 's licensed pursuanto the Pse l ns of the Co erectors License law (Chapter 9
(commer,cn.with Scn ]1111D�fD'aonlofthe bus sss,s and Profession, Code)
ser that be N! exempt thderrom and the bass for the alleged ak mption Any violation
f, „3 � �(',@.CFary ` 3
v.l Z`x, �I. :.♦ t. J, ,h .f.',. x711. I:!'S'..i Y,°.'
1 Va]UBIIOn
UILlD6`"
of Section -7031:5 by any applicant for a permit subjects the applicant to o civil Penalty
of not mare than five handled aau(5508).
1O1arc ARN i�0Q74P-DATION
t Ix I2 A l .: Occupancy Type
❑1.asowner of rise pmpeny, or my employees with wages a, their sole cmmpnaation.
102 -PIERS
_ .
10 3 - UFER- Required Insoections ,-
'-will do the wok - d Ne svacwre'is -not intended m offered for sale Rat: iOLI.
Bastions, and Professions Care: The Contractors L ttnse Law does not apply to an
owner of pro, c ty who buildx or improves thereon, and who does such work himself
104 - REBAR 1
or
or Nroueh his own employees.brAblprovided than such improvements are not mar
-coedi r:ale. Ir,n der, he Far
ern sold ane kin of
_ . .__.._ .T05__._ _ ANCHOR'-BOLTS'comp
will of pr v he
inapo mrfor theptu ownec-builder will have the burden of proving that he did not build or
impma,e rot pnrpaxe arxale.).
_
106 — SEWER & WATER '
of arm pit con :i:ely'at comment, with : Jconvadarsia"_...
_..._.._202 ----UNDERFLOOR'-PLUMBING- ' ,--. -
construct the Project (Sec. ]UGI. Business and Prefessions Coded The Contractor's
2 03 - UNDERFLOOR MECHAN'I CAL! : • A
License Law dines not apply man owner of property who builds or improves thermal,
.and_wno contracts. for -such p1Oims with. a. comracmrts)licensed purxnanLto.fle.
_...__. - . _..2 04... -..UNDERFLOOR --FRAME _._._..._.... ....................__ _.._.......--
CormorantsLicense Law. , .A •..
❑ I am e.m,t adder Seer 9'&P C far this reason
205 - UNDERFLOOR�I,INSULATION
9wa2r "' Date' -
301 - ROUGH PLUMBING
-" WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby arum under Penalty of perjury dneofihe following decimations:
303 — ROUGH MECHANICAL
❑ I h6Jtaad wiu'malntaln a'cedificaie'df Conant Isaeu--smarm for Worker',
3 04 - ROUGH ELECTRICAL
Compensation, asProvidedfor by Section 3700 of the labor Cede, -fn, he
305 - FRAME
affmmancemrthewalkp"which,hixpnmitisi„ued.,i ��
0 have"aid will mlimon,worimii Compehwtion lnsomiicei, as requircii by Section
306 - HOLDOWNS
37M of the Labor Code, for ,he performance of the -work for which this permit is
3 07 - INSULATION
ids d My Workers C r I mpc x ceorner Policy cnd nr arc
_ _u n. be.,
- 308,-i-SHEETROCK--- I - ............ .__..
✓✓``/�i/_./I.
CER1711111CFATION OF EXEMPTION FROM WORKERS l
,3 Q.9'' i ',;' %x%LATHi;
\ 7 EXTERIOR
' COMPENSATION P.
INSURANCE ''
_.... . _
_-,_.-----310
obis.xediav'read na,be ommpided At rhe Pcroil i, to one handled dollars
311'`k— •SCRATCH COAT -
, ..
(5100) or less.)It
-
-— _ - - -
` rl , fy that In thepe f c of,he`wark'f n whi th' pe t rs s a'I
'3half
('
501 FINAL ELECTRICAL`"'ENERGYA'
not employ' vny person navy manncrwas to becom-,ublea mthe Workcn
_ ,.� ,.,
Compensation Laws ofCalifinniaDat<, .,... ... -.
APpiacuni:
NOTICE TO APPLICANT.If. after making this Carnation, of Exemption, you should
......_.._.502 -._-..FINAL ..PLUMBING.ENERGY,--_..----.._._.-- _
503 - FINAL MECHANICAL ENERGY
bac°mei„bject to the workers Compensationprovi ions, of the Labor Cole. you Most
Itinnwithkamply with..eh pro,kbm, a, this permit hall be deaoed revoked.
- FINAL BUILDING ENERGY
' `CON STRUCr1ONLENDING AGENCY
_504
505 - FINAL ELECTRICAL
Ili by conn That thereaeon(suctionIroing ug YPor the performance
506 - GAS TEST A
of Neworkfor which dipe l issued (l ]09] C C.)
-Led .Nm- "
-—507_..___FINAli PLUMBING
Lad. AJdrc...
508 FINAL MECHANICAL'`(
1 myth,Ih rtdthtapPlctondnastate,httheabo' f tor,
earcetIagree mein,lywith aIt city and county mrgman,slid xlate law, mlatng
to building cortstrvctian:anl Immby authiiin reprasentmiks ofthis city to enter upon
509 - FINAL GRADE
510 - FINAL PLANNING
the move-m5ationed property for mxpecti°n purposes,.
r (We) agree tusave. adimmnify and keep buhjaxE he cry iY cupenindasaimt
514 - FINAL PUB C WORKS
liabilities,3 dgmentx c st and expenseh'ch. may Aa any y °ecru gains, said
C ,yconsequence of the granting or thperat
A LICANTUNDERSTANDS AND WRL, CQMI` Y WITHALL Nblo INT"'
I (/
Issued by: Date
3URrirr rc?ns.
'Dan, A.
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
,. Wllllicpplc t fl sizent material
Type of Roof__..
as call tied by. the Cupentrat MunicipalCJ Chapter 91:and the Health and Safety
Col Slalim 3553'() f
t Jr. ,
, Iix �. ,ii k1; 35s•,,. l i 1.1,1
]Yes 1 r rt 1'
No A f _ ' t
All roofs shall be,inlspected,prlor t'.any roofing material being,ms[alled.__
l'.WsBmeapplicant orfuture f,itding«yupant'use equipment orde:icexwhich
If a roof is ink;Elled'without first obtaining an�inspec[ion; I,agree'to remove
in locrandous air contaminants ix defined by the Bay Ama A (budity Management
D t ct
all new materials for inspection Applicant understands and will comply with
all non -point source regulations..,
1hve,m,d be hnNxus ma,erml<requ'remen¢'undcr Chapterfi95'of. the
'
California Health Safely 25530. I unaersmnd that
Codecurrently
, ur havSare
atenant.,hat it is mysno.a notifyrise
- t'Nebuilding dosnmmmq a to ant, that t it y responsibility
w ich
Occ pancy. rbe reyuimmen,.ti which Anuxt be con prior w is,vance of a Certificate of
°eYpagcy.
Signature of Applicant Date
_
All roof coverings to be Class "B" or better
'her or owM1orized a8cm ' m,,,u, .
.
,
OFFICE-