01070066 (2)CITYILDING
DR7SIONNO PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
1103 ELMSFORD DR
PERMIT NO.
01070066
OWNER'S NAME:
SILVERMAN RICHARD
APPLI ATION UB DATE
07%162001
' PHONE:
SANITARY NO. CONTROL NO.
za ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
E`l
I I I__._I I= LJ
Z LICENSED CONTRACTOR'S DECLARATION
0 I hereby affirm that 1 am licensed under provisions of Chaprer 9 -commencing
Job DDSCpptlOn
m wimSemion]000)ofDivisian3aftheBusinessendpmfessimeCode.and m license
y
CHANGE ELECT. SERVICE.
i is in full force and effect.
License Class Lia #
[- Dam Contractor
se ARCHITECT'S DECLARATION
-t I understand my plans shall be used as public recurs
O LicanseJ Professiaul
i OWNER-BUILDER DECLARATION
1 hereby affirm that I am exentp' from the Contractor's License Law far the
2 f0110wmg reason (Section 7U315, Norio', tend Protctdnns Code: Any, city ormnm)
which requirm a permit w muctmct, alio,, ini'm". demolish,
$2000❑
at m,r rsty xmewre
n ... prior to its issuance, also requires the applicant for such Permit o file a signed statement.
-
thatmmen wit pursuant to theProvisionsavi sof theIn, Business
(commencing g m Section ]m0) 3 f In, Business lid
Cad La (ChapterCot
ons Cale)
, '+ `'., l 3 6'$iI) ��.F)I@4S(TOe?'
` Valuation
or t h s exempt therefrom and the bas for the
'he basis imn.
ekmpt on. Any violation
" ' - ` '- - • -
S subjects
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
the
'
of act mare than five hundred amara (SSW).
3 04 APNELECTRI Ali - Occupancy Type
C1 1, as owner of the property.ar my employees with wages as their sale campcnsatmn.
01 — FINAL ELECT RI AL ENERGY
will and t, is no[ intended offered for ante (sec. ]044,"
toand
ne Pro Code:
Business and Professions Code: Th< Contractor's License Law Jas not apply ro an
Lice
5 O S - FINAL ELI�k"q Wa(1 ctions '' -
Who builds or improves thereon, and who rices such work himself
owner ofpropertyhis
ow
or through cc's own employees. provided that such improvements ..t it dad or
I
offeredfo sl If, 'h - th building ni mim-verman Ii s.hf`ivithioYan,of-
co pl th a b'Id llh th hod of pr gth th ❑'d tbu'IJo
imp
- _� - -
F p ryas f le 1
a ...
is
poperty n 1 IY main, thl rose,
tactors to
project
consb n the prof t 7044 B 'lie d Pr f ons Cad ) TT C
:)n i s
LicenseLo do apply t lie f property b bu Id. r' p Iranian,
(�/Q•/
_
with.1')I alp ant to the
Contractors
❑1 B&P,C[ his reaxon
MMSAILATION
f,.j-1
owCARATION
- ��
1 hereby affirm under penalty of perjury one of the following declarations:
/
ID I have and will'manoun a Certificate of Concent in self-insure for Worker's
Compensation, as provided for by Session 37W of the Labor Code, for the
performance of the work for which this permit is issued.
111 have and will maintain Worker's Compensation Insurance, as required by Section
37W of the Labor Cole, for the performance of the work For which this permit is
issued. My Wodatrs Compensation Immance carie,-ad Policy numbererc:
tint fi s :.'.dor No.
r
y
CERTIFICATION OF EXEMPTION FROM WORKERS
:
s t . 11., l
I e t s
COMPENSATION INSURANCE -
ITh s section neeJ not be completed if the is for hundred
permit one Dollars
(SIM) or leas.)
'
It"erf rm hh r
e o us k f rich
notcertify that III the m in Wcarke.'I
P Y Y m man to becom subjecti WorkerK
- - --
-'
o the
Compen.caiion Laws pf Cali
f a. Date
'
APPI
- - - " " ' " "-
+ Nsxoc,TOAPPLICANT 11 ft r k rleart ng th Cert f r E Exemption, Yushould
bec'masuhjemmthcWorkersCom �Either
penaat n Proclaims ons of the Code, you must
forthwith comply th such
p y wi provisions or this permit shall be deemed revoked.
a tided
.� CONSTRUCTION LENDING AGENCY
1 h by fT m t th - '. t i 1age cy for the perfonuance
me work for whmh th s perm t is dmeJ (Sec. 3099],7, C Civ. C.)
I -"
reader's Name.. -, ... _. ..'.
... _....
Lender's Addrecs
.. ..._ ._: -� -
I cenify that I have read 'his studleatien and sm'e d at the above information is
correct I agoic to comply thall cityand countyordinances and state laws relamg
to buildingcmr,amiciml,and hereby authorize representatives of this city to enter upon
the above-mentioned property fo pe fi p tp
(W i s t nJ y J Ice, h I, the City of C pet against
liabilities judgments, M1 h in
Jti
nsec any y against said
Caysequence,,gof thl Pr t: 1 '
e r i!
PPL ANT UNDF, TA D6'AND WILL CO PLY WITHAL ON-0150 CE RE IONS. Vii!, - /
Issued by: Date
'goal APphe. matter., - " 'Date -
Re-roofs
.' HAZARDOUS MATERIALS DISCLOSURE
III m a applica t future Wilda- occupant wore or handle hazardous material
def d
Type Of ROOF
as by h Cupert Municipal Code.Chapter 9.1 and the Health and Safety
. -: .• _
-
Code 9 coo 25320 l
WY as °
r t
tP i -• ,
N
p,-.
All roofs shall be ms ected rior to.an _roofin material.being insralled.--
y g
'line Pplc a t r t rc told fin g < p t use ea i ant a e
emit hazardous lit n N ac definedb) the Bay Area A Quality A1nwgem
If a roof is installed Without first obtaining an inspection, Fagree to'reinove
em lit t
s n -
°i _
❑o N
e
_ all new materials for ins ection. Applicant understands and will.co 1 with
"' r P PP 4_ rp
'
all no n-point source regulations:
Ithavereadthe hmandurs materials requirements under Chapter 695 of the
cm r H n& o a- ty COJ t m 25505 5531 d 25534 I dcomml that
oc rare
cupa { 6f the req mev h mon be n p nor to sn ce a Ceri fca¢ of
t
cc lir. r /
✓1-C ,' f •% �� �i
Si nature of A hcan[
g __PP._. _ _. _. Date
All roof coverings to be Class "B" or better
wner or outhnrized agent pate
" _..... _
;� -OFFICE- .. ._ _ .. _...