02030026 (4) OF
CI BUILDII,c DIVISION O 1PIERNHIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10395 BRET AVE . 02030026
0.NER'S NAME: APPLICATION SUB DATE
I 'C, WILLIAMS 03/07/2002
PHONE: SANITARY NO. CONTROL NO.
„FO,MW 0 O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
vUE
a s I I CJ L.--j L_J
S H Z LICENSED CONTRACTOR'S DECLARATION Job Description
z_u 1 hereby affirm,hat 1 am licence under provisions of Chapmr 9lcommencing P
yt wimsection7")ofDivislon3oftheBnslness ndProfe...on,Code,and try licensc KITCHEN REMODEL.
m a� is in tan farm, nyrrr t.
a u a License Cl. Li<. tc -
3 to D ARCHITECTS as uARATION Y• �� p
1 understand my plain shall M wsad as puhlir rtcoNs Y 17 Ymn ,
Y_
In O O Licensed Professional AUG L
O x e OWNER-BUILDER DECLARATION
w V O C rloo2
- 1 hereby affirm I am exempt from,he Commi s�oLicense law for the V
t Z a fallox'ing remon.(Section 7031.5.Business and Professions Cr-0c:Any city m county
Z=O which requires a permit m conswct,ulcer,improv,.demolish,or mpair any structure $15000
i 3 w .pno mill issuance.itionfecommltharip,lualinf npermtmn..ii,edsmommat
,bathe enc ntedwitpursuant, its p: i. of the t "a 'sl' is (Chapter s. ,f,t .ye ['+jj;,yc.:1W,pr pa,T 15L jNG
ValUanon
(common B toSection,?") fhe l ole Baja ci and Professions Code) 3- 1U V'Lt'Y:szl s_�
.,,hat he it exe:npi therefrom:td or has s Boole alleged eAeangton.Any violoi on
-of Section 703L5 by any applicam for a permit subjau the appliconuo a civil penalry
:arnmmor ill.rvehandled dollars($500) 10 APN f17T.71CrDAT I ON Occupancy Type
❑1,as owner of the progeny or my employees with wages m their sole compcnsaion,
-will do the work:and the amcmrc N not intended or offered for sale(Sec-7044, 102 PTRR-R
'Business and Professions Cock:Th,Contractor's License law does not apply to an 103 - UFER Required Inspections:f•"� "-•
owner of progeny who builds or improves thereon,and who does such work himself
or through his two employee..province mm spgh improvements arc not intendedor .... _...__. 1 O 4 - REBAR
offered for le.If h - theWilding improvement sold within one year of .....—_. .__ .-._. ...._ _..._ - .-.. _..__..-. .. ..
completion,the owner-builder will have the burden ofprovi,g that he did not build or 105 - ANCHOR BOLTS " -r 1, '
improve for purpose of llic.).
106 - SEWER & WATER
❑L as ownerofhm(Sec. y w., lycontractingi...0 licensed olaosso to
202 - UNDERFLOOR PLUMBING
_ conswct,he project(Sec loos,Bus ncss and Profess ons Code)The Comranor s � I Fs
License Law docs not to an owner of esu who builds or ins 203 - UNDERFLOOR MECHANICAli
--" PP Y I per y w proves thereon,
und.who conarels.for-such projects with ematialmol).1manced pursuant.m.Ne.. _
Cont ct apLicense Law.
20-4- _ UNDERFLOOR- FRAME_ _._ .. ..__. . __._._ .....
1 <..e da<rs 'l ;,,aper miarcas.- 205 - UNDERFLOOR" YNSULATION
wncr . - Da,e . ..r. . .
WORKER'SCOMPENSATION DECLARATION
3O1 - ROUGH PLUMBING
Ihereby affirm under Penaltyofycrju.yone arthe following aeam
declarations: 302 - TUB & OR SHOWER
❑ I have and wilt astai fain a Cert➢catc'of Consent to self-insure for Worker: 3 03 - ROUGH MECHANICAL
Complasapon. as provided for by Section 3703-of the Lather Calle, for the 304 - ROUGH ELECTRICAL
performance erthe weak tar worm mi.peon,vs i....d. . 305 - FRAME
❑1 has.Baa will mmntgln Nmk&x Ctminim aubv iesman:n,as required by.Sc;n on 306 - HOEDOWNS
3]00 f in L bor Cod f thepurf iwor6 f th 'srk'fo ti h ih':pe' i,is
isulea Mywrkar•:Co pe. -ti nI saran m- 'd Policy b,ram: - _ 307 - INSULATION
.. . ... , . tete
car, t t 1. p., -<ear<rN r::: .1 1 *r 308 cSHEI'TROCK,_.:•, - --
CCRTIFICATIONOFEKEMPrION FROM'K'ORKER \ , t
" '
COMPENSATION INSURANCE? I a'a 'T 1 3 09 ' EXTERIOR -LATH
(Th f needno,becomple,ed fthePermit sforoneh,ndreddollars 310,, . INTERIOR liATHI ,.11 - 1 i. .;
ISI W) rI.c. , 311 - SCRATCH COAT -
' 1 enf th1 nth puff
_t-ec of,h kf 'h'h,h perm, vusu dl •'__ 313 •'.RGGF--NAIL. " - - - ..•..'.'._•" _
lroe to the
501 FINAL
cam to �yw„h <nprevt eI� o ,°nnuxe«ma k 503 FINAL MECHAN
A 1 502 FINAL-ELECTRICAli' ENERGY
bw eEub lest m" k y:C mon R t fE em , n.you s - "`-" ING ENERGY
A I c tit � Z!7_���.
Z fenh Jtc ra I p nn wlrariked. h'�� - ICAL •ENERGY
I �.
you
504 — FINAL BUILDING- ENERGY-
505
NERGY 505 - FINAL ELECTRICAL,,
W,, nnnewarkmrwnirntn p ts .ad (smm3an,civc) -5.06, _ - GAS. TEST
:Z.O I:eMer's Name.'' .......--. ,. ..__-. ..0:�.�.. :
`7 Lend 'Add v .. _ ..... .. -.. ....__ ... . .. .._.. _..... _ ..
507 - FINAL PLUMBING
UO 1«ni>m„Invereoatn:.�Ppr�at oaa,ttnnn ba' 'nr - ronis 508 - FINAL MECHANICAL
w E., 5ddzmt 1 agree m<aml+ly w m all m,r dna nm,ominan<e: na state law.relating
nice upon 509 - FINAL GRADE.fJ mbutldmg<onstrtiaion Intl hembY amh'onzErcp senm,ives of mix city me
tit,abavb-nten3ng,p prov=thy Tar mtpem,lop,garpose.,,
a: We)dgrttn save:indemnifyandk ph M<ss he CityofC p ih6'aamv 510 - FINAL PLANNING
-fin ramrbes,jaastn<nta,moa and expenses which may in any way,«rues against said 514 - FINAL PUBbIC WORKS
U..Z Ci,y < nsequcni: fth g 1376 �jWxyeRll , .,.�
pPP ICAVI” R$TAN bWILLCO, TH ALL""NON OINT r \
' Sov cr T Issued by: 5d2Dale
Ul/
S.
Try or Ay�licanV - "•' -f r •',\ ;� .D c.
HAZARDOUS'MATERIALS DISCLOSORE - :' Re-rOOfs
wn,iKewrcae,or mom WlangNecmpa,nhim ornandlenarareou memm.l _. Type of Roof..
m
refined by the C pen Mu p I Cod Chapter 9 12 d the H hh d Safety - '-' '-'- - - :: --
e S❑cY 255J2( 1^es t Jk/N 1'N a �k L 1
roofs
t In - i dS pf nto'r[o any�r'o.-ofng,matenal beingI
...
Installed. _
Nw3 the applicants Phone t roadiedseraph;ymea Ai to a :cps"tacit' � If a roof Is insis]led without first obtaining an'ins ection;I'agree'toremove
mit ha adu arEnnm n t .defined 65 tM1eB yArctA Qal,y Minapemnt g p
°"'"" all new materials for ins ection. Applicant.understands and will comply with
all hon-pointsource raga axons
I h e ,&safety
h b milorials rc rcmcros und Chapt 695 ed,h
Califom a Heahh&'Safety Code.S<cfons 25505 25533 and 25534 I understand that
ifthe Wilding does not currently have a tenon,that is my responsibility to notify the
eupOccura t f, cq ircme ti 'ch mum the me m issue of C n rca -
-'' Signature of Applicant _ Date
.i weem ,a t: Vale.. All roof coverings to be Class "B"or better
OFFICE