02070175 (2) CITY ofcDVOO
DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22422 CARNOUSTIE CT NOACK ELECTRIC 02070175
OWNER'S NAME: APPLICATION SUB DATE
BRUZUS JOHN R AND JUDITH K TR 1920 LAFAYETTE ST #N 07/26/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 496-6233
O O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
<i
LICENSED CONTRACTOR'S DECLARATION
00 z y o I hereby d Emt that I am licensed under provisions or Chapter 9(commencing Job Description
<=t:; with fatin7")ofDo"lie,3ofthe Bui`iyrc;�.amProressHmrC anamyhaenae 200 AMP SERVICE UPGRADE
d p w V License C 'an. — alo u3 � a
at I S DECc>
RCHITECI"S DECLto' ION
S � I understand my plans shall be used as pub m moue s
at S Q O Licensed Pmfcssional
a. o� OWNER-BUILDER DECLARATION
1 hereby M.In.,I am exempt from be Contactors License Lai,for the
t?a following reason.(Section 7031.5.Business and Professions Code:Any city or county, $1500S
$ O wltich requires a permit m construct.thin,impmve.demolish,or repair any structure
u°ltm Poor to its issuance,dot req .theapplicantf rr
h peuuo file asgned statement.
° 3—_lyat ha h I a d pursuit n Nc Pon i.4o of N Contractors Lima Lew(CWptcr 9
- . . - Gas,, Valuation
(communistic.
core ro a iN Sec!'an
o Y600) f Div 3 of Ne Business nd Rafesswns Codd n, l?,\ ,� 3,5'f.Ug U 4 •-UTI,r„ Y, 1 s.
or Nat he is exempt lheiefmmSnd"es
e basis for sM1e alleged eaempton.Any vtolamn !
..of Secron]on:56yaaraPPhcanlfmapemlis subjecu the applicnnnoacivil penalty- Occupancy Type
IafmatmareN.nenewactedd mals5oo). APN ELECTRI AL1':-''" :
❑1.as owner of,he Property.or my employees with wages as their sole compensation, _ 'TRT
Rmppry
will do the work,-'and-the stucmre-is not intended or offered'for sale(Set.7034;' 'mr'1 J� 4lRYr
Busindss end'Professions Cade The Contractors License law dors not apply to an 505 — FINAL E Ctions
owner of property Wim Wilds or improves lhs rean,and who does such work himself
or th o gh h own employees.provided that h mem " are t. anotintended or
'--uR sed'fo sl IL lid - N Wilding-or ng provement' .old within Doty o -----------
.................. . ..._..._.._ ___,_..... __...__
'completion,be owner-Wilder will bane the WNen of Proving that he did nm Wild or
improve for purpose of sale.).
.171 -of Ne prpcny - eels IY t tngwNl he Cminct m �® —
connm t the does
(S ]to a Business ro property
ions Cade 7 The ve tact e
MINA
LicenseLa dxs not apply ro a owner of property who builds proves thereon,
and who commas formch.projccts w N a contmcmr(s)I cenud.pursuanrro,Ne
License Law2D U2
_ Contractors me reI p pt ntler See. `t B&PCT ,this reason AUU Dlfj'. lttl?fI
_ Ownei Date /J
" WORKER'S COMPENSATION DECLARATION p�
`I hereby anirmundopcnaltyofperjuryopc,ofthe following declarations: BUILDING
❑ 1 haise and will'ruimain a'Ccnificaie of Consent to self-insure for Worker's
Compensation, as pmi for by Section 3700 of the IoW, Code:for the
performance of the work far which this permit is issued,.. .
❑1 h d'will maintain Workc's Co pe u6n Insurance az rq'uimd by Secuo6
3]00 of rM1 Labor Cm f Ne perform 'f N<,work for h ch this pcnnilis
' its ed My W kerx C pe of n l '<,(a�rta Pol cy 'be ere:' ''
! s OERTfFlCAT10 QFE%EMPI'ION FROM,WORKERS t ,;e?{ r Y.!,tr;l,`7 l +. R1j' .(;
CL.I it ihsl,j s 1. -'`i'r luL fta
.
f"f°tis union neednot Wcomple¢d if the Permit is for one hundred dollars
(SI001 oIusJ
r '
Y that in the performance,ohfa,"M1t<h the Perot, a ionsaud,i
y man .to became blcct to the Wo&crs - I:.+I •I
shall t employ any person n an Il I!
Pp , um .,.,. . .,,.,
Ao'Ipc�t tion Law.k of Cahfom a D ;,,, ,. ,,„•
NOTICE TO APo the Work If afternationsg N.C Kfcate of Ea pun YOU.h Id
Z bee blecno sheW Worker's pe' s p ns ofN Lobo Cod you mut
ZQ fonhivN comply'with.such provisions or this permit shall he deemed revoked.
1P.;� '•i n t �'i'CONSTRUCTION LENDING AGENCY
a^..,' I hereby ffimt that them s a c6obaci on lending agency for the perform-ce
of thek for Permit s issued(Su309].Cr,C j
Q - NnnLe der.N -- - __ .. —..--
Q,Z li tl r.Ada ::.
„y. .I Indy ihuc 1 have turf Nrctity and
and state that the dthose sore information is s
correct.1 agree o comply with all city and c..my ade airs and sate laws enter
upon i
W th Wilding mentioned
propmy for huthoourept sentasivesof Niscity ocntr upon
}'Q. ,the W < cd sa pony for inspect put
rpo.
E.I�LL (W.)agree losd e' d nipYam kchihamain theCuy 6f wayaccm.,., said
h liabilities,judgments,cost ar i pante which may'n any y ace gains said
V 7 City c nse9 nc fN g S' fN
1Pf1 AVT WVDE'e$. I IAM1D"'1* OMPLYwITH ALL NON:POLVT
sf SLA Issued by: Date V
ig I rap maa� '.�utre.:." Re-roofs �.
` HAZARDOUS MATEftIAIS DISCL.OSU
W911 tate applicant f tare W Idiilg ictilson,stare or handl hau j.a arenor T e Of Roof..
asdefined by theC perm M ipp!Cod Chapter 912 and'he Health dSaf ty yP s
C_oee Se tion 255J3(a) t r1 } fh
❑Y ski to
I
• - 1. _I t d°- S �' B k aAll roofs shall be in•spected.pnor[o-any roofing matenal.being installed.
` wit Ne irc t ram build g p m q p tu o a n n' If a roof is msialled'without first obtaining an mS ectton' I agree'to remove -..^.
Di t h d c mail.... defined by N Bay A A Q al ly M g me t g P
°iam" all new materials for inspection Applicant understands and will comply with
. ...
all non-point source re ulatfons
I h rte mad Ne hatmdous mated Ir regmreme3ta and Chapter 6.9Y,6f i
Caldomia Hti1N&Safny Cade,Snuons 25505,2553)and 255J41.1understuM Net
if he bylitm,does nos curremlyhave a tenant..that it my resp nit ilyronotfyth - --
',ucc Pant ph egdir encs wh' - — ._...._ . ..._.._. ._.. . ..
ss W t p so is. an t o Cendicam of O -
.. Occupd :, L.. r: ..
Signature of A licant
PP. . _.. ._ . ..... Dale
raushonuda r.: Date ., - _ 11 roof coverings to be Class."B"or'better '' -
A
-OFFICE_ ----
� . IAC 1. hI'4a