02020059 TINO
CIBUILDING DIIVISSIiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
TEACHER ' S INSURANCE FREDER C 447 S . LOWELL ST. 02/15/2002
PHONE: SANITARY NO. CONTROL NO.
(626) 339-5207
ARCHITECT/F.NGINEER: BUILDING PERMIT INFO
m
mBLDG ELECT' PLUMB MECH
L S y i LICENSED CONTRACTOR'S DECLARATION Job Description
a-o I hereby affirm that 1 am licensed underro
pvision,or mr Cm 9(rommencing P
wen Scceor700Tuf Division Sore he Baa«, Pmrosion> an my rL<n,e TENANT IMPROVEMENT.
YxyS Is In full f for"
s G 1
re0 i a Limnu Clan - Li.0
�l O�
,pyf�s�. Commn I 1 NI Y
LLL a.o, Jq '-" `-� A C TECI"S D RATION / �/
- g I understand my plane eM1°II be used a,public recordsvo
n
25 o O Licensed professional
o OWNER BUILDER DECLARATION
T' 1 hereby affirm that I am exempt from the Contractor's License law for the
y
(=Z following mason.(Section 7031.5.Business and Professions Cade:Any city m county
S O which requires a pcomit to construct,alter.Improve,demolish,or repair any s,Nchum
i3et port 1 ' c L 9 tireapplicant h t itt fl g J mmmem.. . _ $120000
. ._._.. .
mplte is,licensed pursuant to the pruo isionsfreContractor's LiLa (Chapter9 ,,,_p1, Sq ,Ft: Floor-Area t n', Valuation
(commencing th Sect 70D0)of Dies J of the Business dProfessions Co t) "E f.•; Tt. ' 1[] t 1r.rE.!
or that he is eaempi themrmot and the basis for the alleged c chiptmn Any violation 316 2"0 0'6 6 . 0'0
of Section 9031.5 by any applicant for a permit subjects he a...... m to a civil penalty-
rid ofromethanfilehundredeouare(s500). APN Number .^rP•.., Occupancy Type
❑1,as owner or the progeny.or my employees with wages offered
a df arse snake
(Sec:
101 - FOUNDATION
'w'ill-ao'Ihe dark,enol mrstmaurc C now intendedLi a se La. for smart apply
1.im - "' - -- --- '-- - --------- -
ow'Birner of property Who
ilda<:The,eonsmemro,and w o d a«a now work
h m an Required Inspections
owner or property woo tineas or improves thereon,and who a«a such work mmxlr 103 - UFER
or gn o ply provided Ih I p. improvements e t intended or1-04- REBAR-
-prreaIrl � u' bJang- 'p- t'a. Ie m x rr �-� '
rr -- "-'--- .. . _.. ... . _ ..__.... . ....__.
-
compltion.ther nerbulderwllhavetheburdenofpm.ngthathedidnotbuildor 105 - ANCHOR BOLTS r -
improve for purpose of sate.).Q1;as owner of the.pm,hy.am exdasivel,cmntaztm,dim Iicensed commctors no
2 0 2 - UNDERFLOOR PLUMBING
construct me project(sec.]LKS,Business and Professions code:)The Contractor's
- F License Law d«a ma apply to an owner of pm,hy who builds or lmpmvcs poncho, 203 - UNDERFLOOR MECHANICAL_
and who,contracts for-such.pmjeco ns
with a contmctims)liceee pursuamm me
. _. _._... . ._ ..._..
Contractors License Law. 204 - UNDERFLOOR.. FRAME
❑1 am exempt under sec. ' :B h P C for whis mason si t
owner '.'Data. 205 - UNDERFLOOR INSULATION
` WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
Ihereby°frrmon&,Pdroltyofperjgryaherfinefollowing declarations: 302 - TUB & OR SHOWER
- '' 303 - ROUGH MECHANICAL
❑ 1 have and will maintain a'Cenificzre of Consent to self-insure for Worker's
CmiTer,°ron, a, provided for by Section 3700 of the Labor Code, for me 304 - ROUGH ELECTRICAL
performance of the work for which this permit is Issued.
305 - FRAME
❑I have and will maintain Worker's Compensation Insurance,as required by Smion 3 0 6 - HOEDOWNS
3100 r6 the Labor Code,for the performanie of the work for which this Permit is
C x i Tho n«La aanePo�numberam 307 INSULATION
achy P .rNoO , a 308,' 6 SHEETROCKt tr
y '
RT.)FICA ON OFF% PITON FROM OR KERS 6 - - a+• •- - a
Sq.MPENSATI Iu�cEr� _ .r, -,30.9__ EXTERIOR LATH
t E T"rfcT .�._. _—.._..- --
hr sea nn needmnt LoKiele .n ehichin «o andmddollars 310't `INTERIOR LATH
'$!"B) ' .) 3.11_ - SCRATCH .COAT,
-
".1 Icerdfythal'inthef Kormarmeofine odforwhichthdpermntoisnuW,l' 313 ROOF NAILir I •:u.,., '��� -- - -
611 or,employ any person m any manner so fis wo bicome sublcn to the Workcri '
ctimpepaalma Laws or emirrmia.Date 501 - FINAL ELECTRICAL ENERGY
Applicant. - ..
.,Nor'ice'foAPPLICANT:u,anermakimgtMecenifiLateorEaen,paaq,yry�homa � "- 502_-- FINALPLUMBING 'ENERGY
z heeomesubjecttoheworker%111mhp<nsaGon121101nsoflheLabiarCrdayoumus,' 503 - FINAL MECHANICAL ENERGY
Qforthwith comply with such provisions or this permit shall he deemed revoked.
z .O - - 504 FINAL' BUILDING ENERGY
!-
rVl 1 +CONSTRUCTION LENDING AGENCY
' I mo,by tiffirm that them nstmann lending agency for the Performance 505 - FINAL ELECTRICAL
'of tnd'work for vl hnh this Pe. t issued(Sec3097,Civ C.)
LenJeaNeme" er_ ,__, 1. :.:.. - . ._,I 506- - GAS'-TEST
D z 1<natr'aAaertaa 507 - FINAL PLUMBING'.. ...
U OIcen,fythatIhave'madthisapplication-andetatethanheabovcinformationls 508 - FINAL MECHANICAL
W [ter ihol bagree to comply with all city and county ordinances and Stam laws relating
O:U to buBemg construction:aod hereby mohadae moc,l.adve,of Ims dry m timer a eon 509' - FINAL GRADE
yt.W thgarove-mentioned property tarinspect'onpurrmes., 510 - FINAL PLANNING
A. IWe)agree io..Je,indcmnlfy endkap harmless me'City of Cupamim against
VJ li ili,ies,jgdgmepns.costs Had pens. whit may in any way.accruc egein t said 5 14 ^ NA P WORKS
U: ny t scqurncc of the gin U g of h pc ,. " ''
OP tCE 7 UNDER9T NIS ND LL ')MPLY WITH'ALL -POINT" Issued by: Date
3 �
Signature MAPplicanr/commcmr Dc Re-roofs
HaZARDORbIdoE«cprnaihand\ twllihCIuoit. nlehichad an- 1 a1. TypeofRoof _
it;definedby the pct Municipal Code.Chapter912,and th H'Im and Safety w .-......,_- -..
;cod av 2553siaiy - All I
it. roofs shall be inspected prior to any roof ng.material being installed.
the applcam qr rumor building nccupam use equipment or deuces which If a roof is installed without first obtaining an inspection;3tagree,td remove
emit harmdous air contaminants ae defined by the Bay Area Air Quality Management
Inam<t9 -. all new materials for inspection. Applicant understands and will comply with
❑Yea,. .- r all non-point source regulations,::, "
1 hit s m
read he hazardous requirinunis undo Chapter 6.95'of the
Cotonou Hcahh A SaSay Code,Sections 5505 533 ane 25531.1 undersand than
ing dace nm comently h' ate i;t t it is mY Ter,thribiloyto imury the
occupam me requnchrents h'h nus r t riot tb issuance of a Ccnificam of
7. `aP°"`y' Signature of Applicant
Date
Own r aathoracdagem, - ase All roof coverings to be Class ••B" or better
r_ OFFICE