00090098 (2) CITY 7
lo OF DIVISION, CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
DwrveR•s NAEeTRfE
A`p1,569 EDWARD WY - .
APPLICATION 5U11 DATE
l71
qqqq PHONE: CHEM0 BASIN SANITARY NP9 CDVTROL NO.
�0q0 ARCH)ILCT/HNGINEER• - - _ — t_ -IlU1LDING PERMIT INFO
ZwUZ l� - BLDG ELECT PLUMB MECH
y 6 a
I= CI•
IJ y= LICENSED CONTRACTOR'S DECLARATION Ib D
O Z EI O 1 hemhy aRms that I am fcensed OeSCrI (100
p under provisions of Chapter 9(commencing
.with Section 70001of Uivisinn 3ofth,Besides,and Professinns Code.and my license
m ,a ;s in full force unJ c t.
O U hieeme lass
3 ante -014 Conuneta�r�/itOP�-'j •.
�fT��� ARCHITLicr'SDCCc TrSry LIGHTING REMODEL
zn,
F 1 understand my plans shall be used as public record.
S p p Licensed Professional
w lla OWNER BUIL DI R DECLARATION
I he by ffrm that I m e pt f m theC ntmctn . Ice L for the s
C .feng (Section 7831 5 13 . es I Profir,iions CstAny filyor,cmit,
A C
which revenues il I nn;l t n.n t a It r p xl r pa y a [LL'c
C3$ priort t issuance,also require theappl'e.m for such pernw m flea etgnedstemtent
is. that ne is n[emed parental m the Pool"I'm'If he Contractor,'I'll,,Low,Cape,9 S Ft. Floor Area
(commencing with Section 7000)of Division 3 of the Business and Professions Code) rl• � Valuation
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penaltyEH
afnot mare man file hundred dollars ls500, APN Number Occupy L`y e
01, I h pmt ty, y ploy 'th yes as fit, 'pemm nn
I'll d n k ,J n t , ' not t del ,llartd a1,Ilea.7094 3561.9005
Holinessd Irl �sm. Code:The Contractor's L ense U does not apply m art 0P4 ired Inspections
owner of properly Who builds or improves thereon,and who dives such work himself
or through his awn employees.provided that such improvements arc not intended or
offered for sale.If,however,the building or improvement is sold within one year of
completion.the owner-builder will have the bul of proving but be did not build or 101 — FOUNDATION
improve far puHnw of tele), 2 — PIERS,
01.a,owner of thepropungate exclusively nmme,ing won licemed conb10
ncmrem 102 — UFER
emtpruct the police,(Sce.7044,Ravi ,and Pmt...was Cad,:)The Contmeor's -
..lseme Law tract nm apply m nn tin-ter of property who baud.01 improaes mere°"' 1.04 — REBA R
vend who contracts for such projects with a contmctons)licensed pursuant nr the
Certificates
1 am`exempt`und sc. 105 — ANCHOR BOLTS -
P .B s r c for cods reason .
Owneroma 106 — SEWER 8 WATER
WORRER's CDMrENSATIONDECI.ARADON 2202 —. UNDERFLOOR PLUMBING
I itench,.aimt Oak, mabyol niur,oneof the follawmg decloorium: 203 — UNDERFLOOR MECHANICAL
❑ 1 have and will maintain a Cmifrde of Consent to self-imum for Walker', 204 — UNDERFLOOR FRAME
Caformaceo he provided for by Section 3700 of me Labor Cl Tor me V05 — UNDERFLOOR INSULATION
Performance of the work rte winch this pectin is issued,
❑1 have and will mmnmin Worker's Compemmion Insurance,as required by Scenic 301 — ROUGH PLUMBING
3700 of the Labor Coal,fur the M`itinm:mce of the work for which this permit Is '
�ued.MyWasker'aCampvma,ijr,mmaeratrf,,and Glyt"ub�3'03� ?02 _ TUB H OR SHOWER
ruler: N rou[yNr.: / 303 ROUGH MECHANICAL
Cr: TIPICATION OF COAPENf TIIOINI.N.SURANCE I-1"IN PROM LINKERS' 304, — ROUGH ELECTRICAL_
("itw0ionneed antberadmitted; 'he In, it is future hundred dollars 305 — FRAME
0 flat or less.).
306 - .HOI_DOWNS
1«nploteat m me persona ma n me work for which ants perms;s;.toed,1 � 307 — INSULATION
shall not ation L any person in any manner so m to become subject hr the Workers'
Applicant n ,nfcal;ramia.Date 308 — SHEETROCK
NMICETOAPPLICA :lr,artermakmgtmseemnratennL.mnpian,ynr.ha ld 309 — EXTERIOR LATH
Z become suhjmno the Workels Compcnmtinn provisionsafthe l.ahar Code,....ant _
O O forhwithcomply with inch provisions orthis permit shall edeemedrevoked. 310 — INTERIOR LATH
za
a CONSTRUCIIONLENDINGAGENCY '�11 — SCRATCH COAT
1 hereby affirm that there;.a issued
(Sic. lending agency fur rhe perinmtana
If he work vr.m[nmi.pentad i.;ssaed(Sec. r�.c'1 313 — ROOF NAIL
y Q Lender's Name
Under',Address
U zo501 — FINAL ELECTRICAL ENERGY
1[ed;fy that nmve mad this application and nine that the above information is ,`-,-)022 — FINAL_ PLUMBING ENERGY
Fa rest.1 agree at comply with all city and county ordinances and shite laws relating
O U mho;Id;ng,omtncda itmI hereby atnhar;tt reprcsbntatill tis city mentef open 503 — FINAL .MECHANICAL ENERGY.
'the abom n'tooned Poll lir io"'Ifion purposes.
0. (We)agree 1.asa,,indemnity mal keep harmless'he Corot coperdnaagainst 504 FINAL BUILDING ENERGY
vZ) liabilities.judgment..[oats and expenses which may in any way accrue against.said
z CityinconsequenceannegromingofthisMa 505 — FINAL ELECTRICAL
APPI C NT UNDERSTANDS AND WILL COMPLY Won AL.NON-POINT
S ILATIONS. `� de sue by: 9nF. — GAS TEST Date — _O
pp rmm'n [tor I- Dme Re-roofs 507 — FI NAL—PLUFUT FIG
IIAl.AR000fi MN'IHUALS DISCLOSURE
W,nme."Itcaut or future building cainfant stem or handl,hazardous mecrial .Type of Roof 508 — FINAL MECHANICAL
m defned by the Capetim 255blanicipal Cudc,Chapter9.12,and the health and Safety 509 — FINAL GRADE
Code,Section J2(al'
❑Y`s "° All roofs shall be lfll�cted FriBP•kZ1lan)FIb6 t1�1�1�4�et'ial being installed.
Will thcopplicard or fumrcbmlding Weariful use equipremor devices which Ifa roof is installt�..�1 ii�� thou[
e;t hazanlous themom;nans as defned by the Bay Area Air Quafry Management "91'.''4 PrIlly14lairift3U-ihG'�et6tli��i lisgree to remove
PIs'"mo yes Nu all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the hazardous materials requirements under Chapter 6.95 of the
Caffomia Health&Safety Code.Sections 25505,M533 and 25531.1 understand that
Occupau;ldi gJrvesnot currtndy hareetenant.that it is my msrymrihilinymnotify the
ecupam o rcquircme which mint he met prior m issuance of a CeniErme of
�Occupan +
•. iPC� Signature of Applicant Date
ow Ilk Date All roof coverings to be Class sB" or better
al OFFICE