02070152 CITY UILD NG DIIVIISVO
IONPERMIT CONTRACTOR INFORMATION:
821852 RWOODBURY DR PERMIT 16.2
BARBARA L APPLICATAVON 7�2 0 0 2
PHONE: SANITARY NO. CONTROL NO.
i
hO-Oz ARCHITEC(ENGINEER: BUILDING PERMIT NFO
& BLDG ELECT PLUMB MECH
<i U C=1 L.'I U
vi LICENSED CONTRACTOR'S DECLARATION
,z IS Ihereby ammthat Iamlicensed nnderpro.isiomofChapter 9mommencing DRYWAIL, RAbkD ft��9TCABINETS
m
t:cc with Section 7000)of Division 3 of the Business and Professions Code.and my license C.
y,3 is in full fmcamd effect. �gED-pAll
necea Liucnsc Class Lie.e
O i•`� Uma Contractor �QOrt
uARCHITECT'S DECLARATION �a L
y< 1 understand my plans shall be used as public r cords [P O 6
Y
1-00 Linnscd Profexsiowl
c� OWNEft-BUILDER m the Contractors
I hereby affirm on 1 t. emmp from me Convector's Liansc law for the DUlLD�N $2 8 0 0
t:za
following rtazoaermitt tonL5.BusinessmprProfessions Code:Anycitystcounry
IFG which iquirtsnpermit reuirstheolrar,improve,demolish,orrepairedtWnurc
a.3m ,,prm to blai.issuance,also requiree Pm,js nsof the such Contrapermit roicamele a,aw(Chtemeno _ _ _ _ _ _ ...._ _ _ _
licensed t71hepf Dionst drc Contractor License Lew..Civic Valuation
3�,'�. .Q I• 7 -_. ._- ti
(commczis th5«tion lidoofhe basisotthe Dueneaand Profnyvi Code ns' T'1 ate,. l^';: " Valuation
or Sec io is 31.5 b ani appli and the basis for the alleged a<icant t.Any violation of Section t then vc any hundred
ll for a permit subjects me applicant m a civil Penalty
of nm mme then foe mmnarm andaa tssoB). 1 U JAPN NUAbbIrUAT i ON _.. Occupancy Type
01.as owner of the property.or my employees with wages as theirsolc compensation. 102 - PIERS
-will-do the work.-and the structure isnot intended'or offeredfor sale'(Sec'tWC —
'Busincsa em'Profcssions Code:The Commnor's License Law does not apply m an Required [nspectioits •"
caner of property who builds or improves thereon,and who does such work himself 10 4 - REBAR
0
or tnmu h his own employees.provided that such improvements arc not intended or
offered or.1,.If.bnwavar,the omitting or ininwement is sold within one year of 105 --ANCHOR BOLTS
dmprovef."mowner-Wiltlar will have the burden of proving Net he Did nm Wild or 106 - SEWER & WATER
ol
tmpro f p rpn of sale) •� -
-- .__ . . _ ._202------UNDERFLOOR-PLUMBING_ --
own Cth property.am exclusively c rtwv ng with I' d t tors to p F t
on never the p I ct(sec 7614,Business and Profeacions Code)The Contractor's 203 - UNDERFLOOR MECHANICAL,.., r�.a
License law docs not apply to an owner th a,com who) Ids s proms thercnn
: c. a a.wno contracts riot n.projems wim...conma to s)licensed p m.m mti;;, _2 04-._-. UNDERFLOOR...FRAME
Contractors Licametaw.... •-�: :• ,. ,,. .._,
0 l emexampt ander Site B& Cfor his mason 205 - UNDERFLOORS:, INSULATION
ryafp�'•,. 301 - ROUGH PLUMBING
WOR SCOMPENSA EC RATf166N 302 - TUB & OR SHOWER
hereby ammmnttarPenn ltyorp'jury one ofinemnowmgdeclamations: 303 - ROUGH MECHANICAL
(t. 0 1 have'ine wiiI mainai..Cartificmeof Coium to saleimmra for Workers 3 04 - ROUGH ELECTRICAL
Compensation, a pmvidad for by Section 3700 of he Labor coda. for me 305 — FRAME '
performance of the work for which this Permit is issued. 306 - HOEDOWNS
01 have nidi will molm m Worker's Compenialion Insumnce,'as required ls,Sc;cd
3700 of ds labor Cc&.for'Ne peiformanca of the work far which this permit is 307 - INSULATION
Ceine�tk ',,g>,•ss ."eec ' 6w Po„uq numx are 30$ _ SHEETROCK —•.-. - ___._____..._
uaa My Wo kers Comper at o Insurance
policy N ".,,.n
, ,) a- CtRTIF1CAT10NOFEXEMPTION FROM WORKERS,1: '• '��' S13O9 ,'`:IrEXTER•IOR ,liATH;-
compEnsnnoryusuRnNcO"t.
r —___310 -_-_..INTERIOR.._LATH._....._..-.. .. _-..__,
iiri;:<atio�neeano�ee'dompineainhepamtirsfmonehunarcaaoB.rs 311 SCRATCH COAT - . .
`moo)Ic rtry.tnat�n inpp<riurtn • this .._.... _._3.13...r.._.ROOF_NAIL... ,.._ . ....... ._......._____ ,
. t ` th kf w;¢M1 pemtt - -a.edi 501 - FINAL ELECTRICAL,�:ENE RGY ' '-•
sou rwt p any.r IYninam CI a t oma b)em w Ne Work
pont a arcur .a k�� _ 502 FINAL_ PLUMBING ENERGY
Na ,E APP ICER r k gN c r rq t ofE mpton y should 503 - FINAL MECHANICAL• ENERGY
C) CDer nm subject theWorker's Compensation pro f me Labor Code you must
fort Ncomply� hsch provisions or this permit hall he tleemedrt kul 504 - FINAL BUILDING ENERGY
that
-
- _ 505 --'FINAL- ELELECTRICAL;
CONSTRUCTION
a fIlumbyT' thtNmsc nitmctgency or the ped s c 506 GAS TEST
ofeorrnnspims7097 c)
Lnders Nee -y'p --
,
507 FINAL--PLUMBING- --
;D z r de Ad' 508 - FINAL MECHANICAL•
V O I cenify that Ihave read this epplipeion ndstate that the eab formation is 509 - FINAL GRADE
(z Ey
correct.l agree to comply with all city ona my ordinances and state laws relating
040 m Wilding mnstmaian:and herttiynothonmrtpresentativeisofthis city toenter upon 510 - FINAL PLANNING
[i7 the altome-mentioned property for inspection purposes.
.a' (We)agree to iave;indemnify and keep harmless theCiiy of Cupeninu against 514 - FINAL PUBLIC WORKS
rn liabilities,judgments,cos.and erpcmas which may in any way accme against aid
onU
U z City in consequents of of flue granting of I.i i nit:' `
NT.UNDERS7ANSDS NDW01COhIPLY WITH'ALL NON IlT
aA O Issued by: Date
u R,o/App�icam/Con 'tor',. r•'....ry.'•... a .. /
.;HAZARDOUS MATERIALS DISCLOSUR
Re-roofs
°" Wll dm eppllcamafuwrtbuudnig occupant vorc or handle haruAous mamrial Type of Roof
ss defined by tM Cmpgmtw MunlOpal Cpd Chapmr 9 IZ and me H Ith W
Safety - Y
dale °Yes 133R(U et•1� \ It : 4y{. I .. ''' Pr -..•A-\ •. ,. '.�. . . ...� ,.. .
r; r-`,••o •w II`: .-All,roofs.shall be,inspected-priorto any roofing.material being.installed._._„_,_._,_,
„p Wi1lNeapplicentorfum b ildingmcmpentuseequip to
ex which If a roof is installed without first obtaining an'inspection; I agree.to'remove
emitbewdous air comemmet as defined b7 Ne Bey AreaA QualnyMwgemem ,
Dlsmn all new matenals for inspection Applicant understands and will comply_with
all n`on-punt source iegulationS:. r ..
Ish ve reoA tAe heavEous meiedils rtgmrtmen.'undcr Chapter 695 of Ne
Qzlifsmie HeaIN R'S.fay CotlelSeniom 23303,23373 entt]5574:1 undemand that
'if die Wilding alas na currtndY harieanent.tbact it is mY,rtspo_mibiliry io ramify the — - - - -
oceppe t of N requirtmenu wh ch mun be s poor m tauence of fcnifste of
Ons cYl
a
Signature of Applicant - Date
.tomo a.g t D u All roof coverings to be Class"B” or better ,
4
- .-- .. ---OFFICE. ._. ... ._ .