03080057 (2) CI'T'Y OF CUPEWFINO �
BUILDING DIVISION PERMIT WONTRACT(�R IINFI,QRMATION ° '
BUILDI
NO ADDRESS: CLAIBORNE CONSTRUCTION PERMIT NO 03080057
1691 LOMITA AV
ERS NAME: 4638 HEDGEWICK AVE PERMIT ISSUE DAM
STEVE & JENNY YHEW 03
NEI (510) 651-1820 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;Op LICENSED CONTRACTOR'S DECLARATION ]Ob Description
miW p 1 hereby affirm that 1 am focused under provisions of Chapter (commencing p
lwith Section7M))af Division 3 ofthc Business and Professions Code,an liecirmis
a« in full force and effect, REVISION--IN HOUSE USE ONLY
ir'A? clava Loc.»
Dam ContractorNO NEW PERMIT ISSUED/ ORIG. 303050155
r Detc
ARCHITECTS DECL DECLARATION
I Is s shall he recd n publica. records
mV
Vi Ivens 0
'03
OWNER-] ER DECLARATION _
<i 1 h chy affirm that I am a empt from the Contractors License Low for the
a 0 follnwtng js^n.(Section 713 I.S.Business and Pmfeuintts Code:Any city or eoumy
e 2 which men as a Permit Os ennstmct,alter,improw,demolish,or repair any structure
a!` prior o its issuance.also inquires the applicant for uch minor to file a aignedsotement 0
a< that he isliccnseJ Punuammthepmvisionaof the ComrncmriLicenac lsw(Clnpter9 q.Ft. Floor Area Valuation
`'a (commencing with Section 7W)of Division 3 ofthe Business and Pmfessiona Clvk)ser
— Not he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant o a civil penalty of TWiTiBer00 Occupancy Type
not mom than rive hundred della.(S50().
❑ 1,as owner of the property,or my employees with wages as their sole compensation,
Will do the work.and Ne strumure is not intended ar.ffe.it fonale(sec.7044.Business dins eCt1O0$
and Pmfeasions Code:The Contractors License Law does not apply to an owner of _ p
property who builds or improves thereon,and who does such work himself or through his 1001 OUNDAI ,
.we employees,provided that such improvement ate nut intended orofO.d for tile.IL 1002 — ERS
however,the building or improvement is sold within one YOU of completion.Ne owner'
builder will have the burden of proving that be did not build or improve for purpose of 103 — U F�SR
sic) 104 - REB�AR
❑I,as Owner of the property,am exclusively contracting with licensed contractors to 1 O 5 — ANCH R BOLTS
conatmct the Projctt(SOc.7W,Business and Prnfassions Cnal Conmctor,Li�
e.as'hw doe,not apply to an owner of progeny who builds orimproves,themon,and, 1006 — SEWER & WATER
who comractsfar such projects with oconwctor(,)licensed purauanno the Com ca tors 202 - UNDERF OOR PLUMBING
Lkcnse Lew.
❑ l can exempt under Sec. .B&P C for reason 203 - UNDERFL6R MECHANICAL
I Data 204 - UNDERFLOa� FRAME
Wm underSCOM COMy of PENSATION DECLARATION 205 - UNDERFLOO NSULATION
lnercbyalmai under penfficateof jmyorcofthe(nsumor oCc 301 — ROUGH PLUM NG
1307W
haw and will maintain Section
37 o of Consent mCode.sum for arrommWorkers ce of be
,as provided for by Section P W Of the labor Code,for the performance of nM 302 — TUB & OR 9H E R
for which thio peran is issued. 303 - ROUGH MECHANI AL
have and will maintain Workers Compensation Insurance,as mquimd by Scnian 3 00 4 — ROUGH ELECTRIC
of the labor Code,for the erformance of the work for which this permit is Issued.orke(,Compcnaation Insurance catsiv end Polley number am: 305 — FRAME
r; Pal icy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(Thlauctirm need not Mcomplmcdlfthe Kornitlsforonehunlmd datars(SIW) 308 - SHEETROCK
i11ess.) 309 - EXTERIOR LATH
1 certify that in the perfmmanec of the work for which this permit 0 nmcd,1 shall not 310 - INTERIOR LATH
employ any permn in any manner so u m become subject to the Workeri Compematian
Laws of California.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT.B,after making this Certificate of of Laborodyoushould 313 - ROOF NAIL
become suhjcn to the Worker's Campcnmtion previsions of the labor Cndc,you must
p ,2' mnhwithcomply with such pmnsirateorthis Permit matibedeemeduvoked. 501 - FINAL ELECTRICAL ENERGY
z� CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
�.. r. l hereby affirm that there its construction lending agency for the performanceof 503 - FINAL MECHANICAL ENERGY
a > Ncwnrkforwhichthis prtitisissd(Scc.J(N7,Civ.C.) 504 - FINAL BUILDING ENERGY
W Q Lcndcrk Namc
Z UndZsAdduas 505 - FINAL ELECTRICAL
U O 1 certify that I have read this application and sone that the above information is 506 - GAS TEST
W correct.I ague to comply with all city and county un inanms and sum laws relating to
O U building construction,and hembyauthorize representatives ofthis city toenter upon the G
ahoy mentioned property for infection purposes
Fr^ W (We)'Sam I.save.indemnify and mcp harmless the City of Capt
against R08 "1'F1'PIIN _. LItabilitiasjudgments,costsandexpcasaswhichmayinanywayaecmcagainstMidCity 5U z APPLICANTOUNor D granANDSting of tAND his rWILL COMPLY WITH AL NON OINT Issued by:5NG Date
SO RCE REG _
Re-roofs
1,1313EIC WORKS
Sin p, OV —11 Odic
ARDOUS MATERIALS DISCLOSURE Type of Roof
HI the applicant ar future building Occupant tore or rd
handle hamous material
defn d by the Catania unicipal Code.Chapter 9.11,and the Health and Safety
ction 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant o atom ending ocenpant nsc'goipmem nr dericca whim If a roof is installed without first obtaining an inspection,I agree to remove
It hanrdnus air conom an JCOncd by the Bay Area Air Quality Management all new materials for inspection.
Disnin7
C Yes
I hove read the ha Nous materials requirements under Chapter 6.95 of the Cali for.
tie Hcahh&Sufery Cod Sections 25505,25533 and 25534.1 order aonJth If the uiWino
does
w nartly have a remain,Nm it is my reapomibiluy no nodly the cup of te
hve cn whic most be ren prianu iamenccaf a Color= c . / Sig nature of Applicant Date .
0wn' atnaria em Dam All roof coverings to be Class "B"or better