02090153 (3) CITY DISIONO
VIINPERMIT CONTRACTOR INFORMATION:
IIIRLDIp1GA�WOOD AV PERMIbN�p90153
19I'1/-11ftf RAYMOND M AND BARBARA APPLI(MYSI)A7L002
qqq• PHONE: SANITARY NO.L J CONTROL NO.
OO ARCHTTECT`ENGINEER: BUILDING PERMIT INFO
F BLDG ELECT PLUMB MECH
��t�bl
ZO=� LICENSED CONTRACTOR'S DECLARATION t REPAIR. MS BATHR1vtJ/1?ASE to c®
OZ� IhereM1y uffm uu,lati licensed under provisions of Chapter 9(commencin
r-yt� with Section 700D.f Divisimrlafthe Business and Professions Cade,and my license
,.h.full force and d t. DEC200
o License Glue 1 e Lie.« 3 1 2
Date Convector
0.5 ARCHITECT'S DECLARATION'.'
m S 1 understand my plans shall be used as public records
p O L tensed Professional
OWNER-BUILDER DECLARATION ����D��■C;
�
1 hereby affirm that I am exempt from,he Contractor's License law for,he $20000
t Z Gfallowing mason.(Section 7031.5,Business and Pncasinos Crate:Any city or county
which requires o M t t construct,alter,improve,demolish,or repair any awcmm -
e 3$ •Port.its issmoroe.itiotivesthapplicros fur such permit m file asitnwxatemem --- _ ........
A. A .... .,.._... .._.
M the is learned pub t,Blk piavisronsofthe Contractors License,Law Chapter 71 `i i O .QCean aFi'T•{{\f'. r Valuation
(cum 'ng with Sec 7000)of Division 3 of me Qusmessmal Pmfessmna Cak) �,�,y (aL r,i„ ei.rit ?'.hl :r1lJ+'s:
of that he is Agmpnhcofrom and me basis for the alleged eAemp,inv.Any violation t
-of Section 7031.5 6y my epplicah,(...penrv,subjme the applicant to.601 penalty, P y�P
of not mace than five hundred e.garsfs5oo). AP roc'.;.",o Occu ane e
01,aa.wnarodum n 102 - PIERS
pope y,ormy with intended
wagamed their ale(Sens7r.
will do,'m work:'and'ihc ode:TItruchie Contractor's
en a Law
snot apply
to an .. Required Inspectionsl:a f.:
' rBusihesi vnd Piofessinm Code:The Commct.r's License law d«s no,apply,.an 3• -
owner.fp penyWh h Id nmprov th naid hodnessuchworkh'm If 104 - REBAR
orflaomgh Micron employee,.providedthattinch imporwmero arc no,imemlexim i
105- - ANCHOR-BOLTS - ._ -_ _...._ _..
`nlf red forsl .'If.hive e,,he M1u,IJing cop bemem rssadwnhm rob year of F
'cdmpletin,the owner-builder will haw the burden of proving that he did not Wild or 106 - SEWER & WATER r
improve for purpose of sale.).
- ------ - - -- -- - - .._._...—._... - ----202-----UNDERFLOOR....PLUMBING----- --- - --- ---- -
ElLia,gwnerohhe property,am exclusively comnning with licensed conuamosam -
- co,.iwn me project fSro.7044.Business and Professions Cwea The Comment's 203 — UNDERFLOOR MECHANICAL ELU : ".1 NM ,,, ,
License law does not apply to an owner of propcny who builds or imposes,hereon.
-- _.and-who.contracts for-such.p cls.withacomnc,or(t).lieaused us,..."t..me- __.__.-..__.204_.=...UNDERF.LOOR_FRAME S _----_. _-
c m,rL
le 205 - UNDERFLOOR�,,IN(S'ULATION
t d ' < I' `B&P for arc an
d': 301 - ROUGH PLUMBING r
"WORKERS COM SATION DECLAR ON 302 - TUB & OR SHOWER
hercbran. ngrprnneyorpr)y .ntgnher.u.wmgdealnvam- 303 - ROUGH MECHANICAL
=
01 heveeod will'maintainacceeiecdie'of'Conmem`ht self-mmarc for Walser's 304 — ROUGH ELECTRICAL
Campgmmain;as provided for by Section non of the-Lahr Code, for the 305 — FRAME
perfow f he workf rwhich,hi pawn is issued., 306 — HOEDOWNS
n.rCIy'Pn.n,wCeIr.C"scOMnc'JAIaNCllf�S1Oi 11T0tM,RhNnN�aePUOEa,TNPimepS�EIeOpAf_yPXcalTvNek�E.1 otrIwnMOn`aN P nnm TIe ipNlt S.cNfUp-Kk,eR.FhtriRA-iOrNewiuMCdr�srE AWfoe1 lfIO.r°ErforRdrd'n.iie"
fp
hhaP"o¢ub h$n°dFmrtr`-ni
t.
.:lI
'3330-.3 70 4_:..:...,.-... INSULATION
ElIh c ndwillmwc
sdetl 308, .. .,SHEETROCK
30itkTERIQRiI LA
A'TT
HHi_as/',_
,
dt 311 Y ,1,SCRATCH COAT
ush' s - FINAL ELECTRICAL_--_.;f._`f_.E-._'N., ER...
G._
Q,Yt.,'J
�-C,r
have
Weiser
501
Pi502 - FINAL PLUMBING ENERGY
c
NDTICpushoudd 5 0 3. FINAL MECHANI CAL . ENERGY
h c meh
fo voe uv
rtcomplywlhsmhp�Positions 504 FINAL BUILDING ENERGY
C _ -505 = -FINAL-ELECTRICAL'
.,....-_..-.._...._._
_
a,> he by Piwihvuh answmo 1nd,ng g yf ,fiepAomn 506 — GAS TEST
b(the kf
which,h pe ua,ssued(Se 3097.Ci C) " ,
50-7-'�--FINAL-PLUMBING- - --- '_ --
D-Z Lcna4 Aearca._ ' Y I ,.,.I 508 - FINAL MECHANTCAD'i,
VO leen fy thmlM1 cad m's appl car and atom,he the hove mformmon is
QkTa''Qr[ny- jAI hPehPLibtIo Ge(WAeN'77edgWf menDeA,uEdTRpIcO5NTpAt StNntgi.ay:DlfiePd5fm`eAn1x}'igNf'ysOj�paesW;n;nd'NIt Lkr:nepL hr`P pC.'Ohh(rp Y.."ImP;ljLeYsfe,
lNi,hYrT♦CHi,XyLolfCNuOpeNm_'-naoat �''
a — GRADE NAL[. sNatnt
.V nor spn 510 NAL P NI ING
51 NAL
said
C -` ,
POIIRKS
DateSOUCGLLISSUedby
-
.Srtpot F.f lC , c. rRe-roofs
HAZARDQUS MATERIALS DISCLOSURE t ID ,
^ Wll,h opphcam (wren ldtag occpantmm or handle hdzwdo
uus ertenal Type Of ROOF --
�adfncdbythe Cuq.ninn Municipal Code Chnpmr912 enJ,he Health andSftyp1; iii
;code Ov�v553O lr 'r, t ¢ '" f a
�4 All roofs shall be inspected prior.to any,roofing material being installed
• ; if]the pphcanto artyrebuihing <ui,flay eArQnto deuces h n If a roof is installed without first obtaining an inspection I'agree`to remove
cion hamrd 'air com m non¢as defnw by the Bay Arta A1r Quality Menagemenl
'D tactall new materials for inspection Applicant understands and will comply with
`all non- oint source re Mations
1 ha a read the h i-aus mann Is- gmrcn rRs undo Chap r 6.95 of the, '
C hfa&.Health&safety Coda,Sectio 05,25533 and 25534 I, ndersand that I
„if,he build ogd yrcspo sbh,yt - ufY m< _. __.... . . . . ._ ... .. - _.-_,... - _...._.__..
Oce Pfitof,h re , re m: 1, m m, n ni m ce of CemE t f'
esn cu niy mea, ,rot t sat
p p
Signature of Applicant_,_-
'Owner a,mcnu as All roof coverings to be Class "B” or better
v
u. OFFICE....