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CITY PERONO
UILDF
BUILDING DNPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
OWNER'S NAME:
APPLICATION SUB DATE
i P
SAN ARYN CONTROLNO.
ARCHITECT/ENGINEER:
BUILIIWG PERMIT INTO
BLDSi"." ELECT/ PLUMB'- hCCH/
LICENSI
and ofChapter
Job Description/�
hereby affirm Jm[Eam licensed r previsions 9 (commencing
with Section 71100) of Division J of she Business and Professions Codc, and my license
full force and effec
Do,.;n
L»
Qu�p,JENANT IMPROVEMENT
O -.� .
�` Jy ,.,
DaR f
(.'onVacw
ARCHITER'S DECLARA 0! •�
1 underswnd my plans shall W uud as public mcords
Licensed Professional
DECLARATION
Oat
%\
1 hereby ,(firm thin 1 lam cmI,d From
from the Cosmos(s License Law for the
L
1 S,sump[
(allowing season. (Seaton 70JIS, Business arid Professions Code: Any city
structure which
a permit m construct,lic alter id demolish. repair any
demolish.
issi ci tater
mortarss e. al, feq -res drc Pplicam for such pcmutwfle ugh dswmnvnt.
finnu fi
S. Ft. IFloor
16 OO
morn :I tlpdr. m oFhepw-aon,onneconaanar a eL, (Capmr9
(commencing 'N Section 70) Division J the Busnessand limitations Code)
of of
or that be s sonemps therefismi said she bars for the alleged nemp[ion. Any violation
,, s. .Crea
�
UUuation
l
ofSection 7031.5 by anyapplicam for apcomir subjects the application to a civil penalty
'or not more than five hundred mnar, (SSW).
pp
316 2 0� mfbeb
(� :>r•" .; Occupancy Type
Mevsolecompensation,
❑I, asothe
work,andthe structureinwithwagesas
"will Jo the work."and snc stivnuR is not Contractor c ice fortale not -apply 7B41:'
ss and Pwfcssions Code: The Com License Lew not apply w an
nlred InSpeCLIOn$ ""' ` B ^'`. i
owner theists and who dos zucM1 work himself
owner of pmpcow who Wilds or improve, the s
101 — FOUNDAT I
or slmel h his own employees. provided that such impmveiKms art not ince y e r ar
such
b(feud o(sale.If. however she b:iilJingmimF�Jementu Bold within one Ycar of
.__.._ .162_.. _._.PI -ERS- -
completion. will have the burden of proving mat he am not n,ua or
".o.. •:;
103 UFER
for
Burin
❑Lavefor porfrhieooalc'r
prpeat am exclus 1 e o ti._.m l' J r s t
--------104-.--...R1:'BAR'-__ ...---._..-.---I-1-----.; _'----:..
L'L:
c.n t.s., the project Sec 70u. Businessd Pmre inn, CWc:) Tn Contractor',
: 11
10 5 - ANCHOR BOLTS nL r L"
License lv does not apply to an owner of property W Wilds p es shermn
'
I
and. who cw
ommcs-for wch pmlecs wah a cmisaums) beep=ed punnor, so the
_. _. _ ---106. _— -SEWER--& -WATER- ---
"-
Constructor License Law... _
Olamcxcmptorder Ser: "-:B'&PCfor snisuuwn
202 — UNDERFLOOR ��PWMBING
owner }tate "' " '"'` r`
203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
204 - UNDERFLOOR FRAME
' I hereby afrm under penalty of Perjury ane of the following declaration,:
205 — UNDERFLOOR INSULATION
❑ I��vemd'wJ1'mnum,c a coo mw -Puera rook,,
Compensation. for by Section 3700 or me-IaWr Code. far she
301 - ROUGH PLUMBING
,as.Provided
perratmanp, ar me work ror wmrn mi, permit i, nmed... I
302 — TUB & OR SHOWER
❑ 1 have and will maintain worker's Co,ppensmion lnsunnce, ii O;q by Smion
-
37M of the Labor Core, for the percarmance of the work for which this pemdt is
303 - ROUGH MECHANICAL '
iss ed My Workers C hip t n Ince 'c "nJ Pul'cy b ia:_„
cc"' •�
3'04"' ROUGH ,ELECTRICAli`-'
�7- -
RAME
3O:S i FRAME
SAsTIFIC/COMPENSAEON INSURANCE ORKERS t.v
- -
306;- HOEDOWNS-----
3 -0 6-7
(Ihss union need not be comple¢d sf the permit is rot one hu,�cd dollar,
, ,
aS1W!aclaa.l _ „�
307 — INSULATION ,
_
...,.._. _. -_.3"0'8" .........
in any Workers'
become.
309 — EXTERIOR LATH
Co.cnsmwn Laws or C.hfmia D.m
Applicant-
=—
310 INTERIOR—LATH - -' � s•
NOTICE TO APPLICANT:If:a(¢r making this Certificate of Exemption, you shoulJ
become subjccuo the W.rkph Compensation provisionsof [hd CaborCWe. you mud
311 - SCRATCH COAT 1
fonhwish comply iv'nn men pmvisiom or this permit shall be tleemed invoked.
_
•' 'C6NSTRUCr10N
'' '� -
LENDING AGENCY
i ""•
I hereby mAm,matin,«I,aeon,trucsfanledamy;gencymrineperformance
501 — FINAL ELECTRICAL ENERGY'
oldie work for which Nisn. perinit is hiumd (Sec. 3097. Civ. C.1
e :
- Lender's Nam.'... _. _ ...-_..•_. --...
_ -
5'02 =--FINAL PLUMBING—.ENERGY' ---
Lender's Addmss_. "I: .-
.. ..,
503 — FINAL MECHANICAL I`ENERGY
IcenifY Ih creadthisapylicasimi ndswuthauheaboveinformationis
COR,CL I agR o 0 olY with all city and county ordinance, and store law, relating
504 — FINAL BUILDING ENS
[. builtlingc s[r'Wn:.rd hcrtby aushuriic mpresenmtives of this city to cn,rr.,o
me above. na. ed rnpeny for inspection parpa,mr., -. ., ..
,
505 — FINAL ELECTRICAL'\G\� 3
I (W agr m, tie: ind nify and keep barmlessthe Gr' of&Penino,gains
rwbdities ludg ent dna ex , which may, any (.accrue against told
506 GAS TEST ,
perml
APPL, A�rL'\DE ST carveg Sing'Drwl LCObIP \ `ALL NON -POLE
C, {�j j�T7ryryttjj�'777��TT
I$$UCdiJ `�Ijw' y"YC%7C7 L Date
U AT ,
gn wRa AppT,can �' Do
HAZARDOLS AIERIAIS DISCLOSU
-Re-roo€�s09 - FINAL GRADE
W II the applic t o fu ure Wiling c Past core or hirvdaus ma[e>il
osdf dbyth Cpn slurG J U'ps 9.1 dthe' H: hh and Safry
: TYeq _----'
Type
_ _•.
FINAL -PLANNING
cw Section ss fP,I
i ;: v
•s, ., ' L,�."
IFINA�'.PUB;,IC' WOFKSn
'
roopmed.pnor_o.any.roo Ingtrial being installed..-__
W ll sheupplcantortumreb:ilJ a<e p as<eq p toe-i«,wn<n
_All .I_ --
If a roof is installed witbout first obtaining an inspection; I agree'to remove
c rn x m us v wminans> dcfpdbYsh Bay Arc A Q is `I'".'g`m`"t
D [❑' '.
-- all new materials.for inspection.,.Applicantunderstands and wlll complywith . -
"
terC+N/
all non -point source ...
1 ha red N haramou to immentr under Chapter 6.9 of the
C 5eaions2 5; 25533and 23331.'I'under and that
C.Illomia atm S erye
.. .. _ .. ._ ... .__ _._ .. .. _.
tithe bu' n'.._.
gd c,not usr tlyhuceaunanCt t it ism, Rsponsibili[y t notify the
_ •I ., _, .
eccup [oft require e s which mutt bd m prior w isivan f nifica¢ a(
W. "`y' ' _.
_ - Signature of Applicant _ _ _ ..... _.. _Date-_
All roof coverings to be Class "B" oc.better
her or au[ ar ea age , ,e
.. _ ..:.4. OFFICE. _ . ...__. ........ ... - .. .. ._ - - -- ..._ .