01080147 (2) NO
CITY BILDFING DIVISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22588 LAZY OAK CT 01080147
OWNER'S NAME: APPLICATION SUB DAIS
YOUNG RICHARD A 08/30/2001
PHONE: SANITARY NO. CONTROL NO.
Critic ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w 'BL ELECT PLUMB MECH
,cub
8?Z LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Desert mill
'HELLwirhSenionl(g0lorDivi,inn3oftheBu.ainersandPmfessionsCode,andmylianse REPI� � rALLL & WINDOWS .
is to hill lima vrdeBc
e . f WA
s w a LicenseClasx Lic,a
:O V Date Commit.,
i3 v. ARCHI'TECT'S DECLARATION DEC 0 4 2001
o; 1 understand my plans shall he used as public records
ink
m e C Licensed Professional OWNER-BUILDER DECLARATION BUILDING
ca 1 Hereby off rat that I R-exempt from the RATION License Law for the
t_i a following mason.(Section 7031.5.Business and Professions Code:Any city or county $6500
f S C whin q Permit t construct. Iter improve,demolish. p' r structure
ca 3C_c. .prise t t '. Lw q thef hper tt fl :'g dstatement.
is. tnatM sltt dp .0 tt men n of the C tractor.License L. (Chpmr9 I Valuation
(commcrcngwth Section 111!10)of Division 3 of the Businessd Professions Code) ., a ,34sntc�d .Oua•
or that he is exempi thcrefrum'and the basis for the alleged esemption.Any violation
-of Section 1031:5 by any applicant for a permit subjects the applicant to v civil Penalty-
or muncre roam me hundred dollars($500). 101AP-NVOOMATION Occupancy Type
❑I,es mvner of the property,or my employees with wagea.e mei,sole eompcn alum, 102 - PIERS
will dn'thi'work:and do,simemrc is not intended or oRaed for sale(Sec.7014;
Business and Professions Code:The Contractor's License Law does not apply to an 103 - UFER Required lnspections7 ^-
owner of property Who builds or improves thereon.and who does such work himself through 104 - REBAR _
or ugh his own cmPluyecs.pncomi d dint such imprm
uvecm,are not inrendeJ or .. ._ .. .—.. _ -. ... ... ._ . . _.-. .. . ..._ ...
ro105
fremd for sale.H,nnweser•the budding or impmone roweent is sold within-orear of 10 5 - ANCHOR BOLTS i ..., V•.
iamplction,the owner,buimer will have the burden or proving thin he did not build or 1'
mprove fpr.pnmazenfzalc.). 106 - SEWER & WATER
s of sivelY naing with licensedconrvos 'UNDERFLOOR"PLUMBINGxnwnegothepopery,am eu_u202 - -� . '---"
- - -
_ ...tram she project(Sec.7!111,Business and Professions C(ee:)The Contractors 2 03 - UNDERFLOOR MECHANI CAL '`s`
License Law does not apply to an owner of property who builds cur impm,<s thereon.
anawho contracts For such prn;eets.with a auntmcmr(.e)licensed pursuant to the _.. . .. 2 04 UNDERFLOOR -FRAME- - - — - —
Commamrs Licenslaw,t
❑Iain ex1 �,to' £r see, - .B&P,C for this mason 205 - UNDERFLOOR`tINSULtATION
ovine P'30'j'po/ 301 - ROUGH PLUMBING
WORKB COMP FJ ATION DECLARATION 302 - TUB & OR SHOWER
Ihercbr M.on er penul!y ofper;ory,6ne of the rmuuwing denamtlom>:' 303 _ ROUGH MECHANICAL
{ ❑ I have and will maintain a Centrcme of Coni.eta!to self-unsure far Workers 304 ROUGH ELECTRICAL
\,-1 Compensation, as provided for by Section 3700 of the Labor Code, for the
o performance mfmu work for which mis permit is 1...ea. 305 - FRAME
❑1 have and will maipmin Worker's Compcnsvtibn luminance,as required by Section 3 06 - HOLDOWNS
- _ 37M of the Labor Cede,for the performance of the work for which this pettnit,i` 3 07 - INSULATION
iszuetl'My W k ri C pc sato Iuobrantt d Policy mbar arc:
308 _
ySHEETROCK---- :
Cnot t I CERTIFICATION DF EXEMPTION FROM WORKERS'._-' 309
iEXTERIOR LATH"
_ COMPENSATION INSURANCE:'. . .. '• _ -_.-._.._ ._._ __ _._.._._.__ _ _..__...____-._..
(Thi:ueiiannttdnmtlsecmmvmtea'ianepem,nisrmrmnenunareaamnar: 310.__--INTERIOR LATH- __ ._ ..
311 SCRATCH COAT „' ars"c C. ;.
6I00p or less.),t, :
Itgnifythatinthe performance onnework for which this pentrou`Gissund,I. .. ... .-.'..313,..._ -ROOF'.NAIL....._..........r_......,_.......,_..,...__,.. _._.. ._...,._. . .
.hail amt employ any pre..nn m miry moo me,so as to nurse subject m me Wmkcre' 5 01 - FINAL ELECTRI CAL�tkERGY'
Compensation Lows of California.Date
Applicant.. - .. .._- - 502 -- -FINAL PLUMBING ENERGY--- _. .
NOTICETOAPPLICANn If.aftermakinggaisceniicatenf Exemption.you should 503 - FINAL MECHANICAL ENERGY
Worst
1.the workers Compensation provisions of the Latin,Cade,you must'
C O hornwith complywith such provisions or this a�it shall W deemed mocked. .. ,., 504- -...FINAL BUILDING _ENERGY. ._...
F m cONsIRucIIONLENDING AGENCY" 505 - FINAL ELECTRICAL ,.
"P hereby uffitm that there is a r.rumcimn lending apem6y for the performance
W ?
of the wbd for which this mad- peisissued(Sc,.3W7.CIv.C.) ' _ 506_ - GAS TEST
yap LetolName - 507 FINAL PLUMBING
� z Ldndets nddrczs � .. - ., .•. .. ,•: ,• I
U0 I certify mat l have read this application and state that me above information is 508 - FINAL MECHANICAL
�•: F.,
correct,I agree to comply with all city and counay ordinances and state laws relating 509 - FINAL GRADE
O U the cho,c-ore timed lunfndy(or toueclimn rtprtsemativcs infants airy to corer upon 510 - FINAL LrWNING
>,.� me anmve.mennnmea plyperr(or mspcnmq qumnse,. ._ �P.
y L
(we)agree on sive.irdemniry and keep harmless the City or Cupeninoupamol 514 — FINAL PUBLIC WORKS
-V] hii1AIiues,ju nu.costs artd expenses which may in any way aacme against said
f..).z City in cot quencc of t c grunting of min permit.
'APPLIC ' UNDO 'ANDS AND WI :OMPL),WITH ALL NON:POINT' Issued by:
I _ DateOUR GO \S - - _�6_0/
Sip t e ofAppbcan winos - - Dam •. Re-roofs
/ HAZARDOUS id=df DI OSURE
r
Wjil;hc applaqjii futureWilding occupantstore rhandle hLodmismmeral 'lype.ofRoof —..'..... ..-._. - - - .
v def d by the Cupcnmo Municipal Code.Chapter 9.12.and the Health and Safety
C .Benton 25532(a)' ../1(�-.t ••.; N ,.r —t
r ❑Yes':...• . . O'No ,..I 1 . r n ,
._ . -_All roofs shall.be inspected prioctaany roofing material.being.installed. ._..__ .. _.
.widithe apnlicamorfummbuildingmcopartuse equipment ordevices which If a roof is installed without first obtaining an inspection] agree to remove
emit h yu.ny.os air contaminants as defined by the Bay Arca Air Quality Management
Domic, all new materials for inspection. Applicant understands and_will comply with. .
DYes CNm" all non-point source reglations._. , •i,q
have rcud the h rNous'matcnal us,inommunsi under Chapter 6.95 of the
California Heahh'&Safety Code.Sections 25505.25533 and 25534.bunderuand but
`ifilii b6ilding dms not cu=ntly,hace.inn nh Nat it is ury nespo utility to notify the
" am i, the,:qui emu wh'h m s met pFinhn issuance of a CenifcSte of
" - Signature of Applicant Date
x-30—e All roof coverings to be Class 'B" or better
xneror.mhoaaed agent• " Date
OFFICE