02080111 (4) CIBUDIGoONO
BUILDING VIISSINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
20651 MC CLELLAN RD ARMSTRONG INSTALLATION 02080111
WNAME: APPLICATION SUB DATE
g$A LANG 774 HARRISON ST 08/20/2002
PHONE: (415) 777-1234 SANITARY NO. CONTROL NO.
G oiZ ARCHITEC(ENGINEER: BUILDING PERMIT INFO
a BLDG ELECT PLUMB MECH
F iV
Z 5 H i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm mat l am licensed under provisions of Chapter 9 fcamnncine REPLACE WINDOWS (4)
with Section 7")of Division 3 of the Dust..and Poresums Code.andmy license
ate x at; is in fuHtoafse end eIf �d 2L �'Yi G
zso Lice GGtriun Lim♦ (-�j PINALED
w 3 ou y Dme S cont
ARCUITELTas n
z0 1 understand my plans shall be used as public tecwil OCT 1 8 2002
N
w a—.p re Licensed Professiowl
.reOWNER BUILDER DECLARATION
¢t=u. 1 hereby affirm mat 11. exempt from the Conon Cod :Any c ty o for me
follC Boxiness and demolish.
e Professions Code:Any ciryorcaunry SUR��G.
ad D which ts res a Permit to recn t t alma improve dPermit,orerepair any swnurc
a 3 m Poo a b issuance,also req to ishims o for mon Permit mice s stead statement - - - ----- -- ---Valuation
-
conna —wdySectiotmtb Pio Division f me
andPrfawrnsCaer9 .f ' +355911 O��r�lgaav y R Valuation
foomn g rhSeerefro had
iasisoofine Business and nyviol We) + I•, 1,1"�" 4i ti;
or that io is 31,5 bt therefrom and the boar for me allege)ueicant t.Any violation
of Sectinm]fU LS iv any hundred
applicant for a prmiit subjects the applicant to a civil penalty
ronnaa marc man Eve nararca aogars lasoBl. 101APNtge*fDATION Occupancy Type
OL as owner of me property,or my employees with wages as their sole compensation. 102 — PIERO
-will'do'she work,and the structure is not intended or offered for sale(Sec:7g44, 103 - UFER Required Inspections,
-
Bdain&s'and e Professions Cam:The Contractor's License Law does not apply to an Q
owner of property Who builds or improves thereon,and who dues such work himself 104 - REBAR
or through his own employees.provided that such Improvemetns are not intended or _
',bffrrtd nuICh
' w
sr1e. oevrr,the hiiilding ur improvement a sold wnbin one year of 105 — ANCHOR BOLTS
t completion,the owner-builder will have the burden of proving that he did not build or
improve for pshimaeafstde). 106 — SEWER & WATER
0].as owner of prop ny.:mrxiu:iJelr=omridtiugwiiniih :eeaawaetosid 202 UNDERFLOOR PLUMBING_.__.,..__.....:-- ...- ---..._.. _ .
_.
construct the project(Sec.7044.Business and Pm easimas Cama The Cannata¢ 2 03 - UNDERFLOOR MECHANICAL .'
License Law does not apply to an owner or proprnr who huilds or improves thereon,
_.and.who.contracts for.sueh projects with a.cortacturi).Beamed pursuant.to.the ----..__...-- 2 04 --- UNDERFLOOR- FRAME --- - - — _.
- ' olomexempt`unerSc. B&I'Crmwsmarm 205 - UNDERFLOORWINSULATION
her Data 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby afrrmunder penalty ofperjury one of be followingdalamdon.: 303 - ROUGH MECHANICAL
❑ I have and will maintain a eenh3ome of Camara m,elf.inmre Can worker'¢ 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the 305 - FRAME
'performance of the work for which this permit is issued
❑I have and will maintain Wwkrr s Compensation Imaumnce,as required by Section 3 06 - HOLDOWNS
3700 of the Labor Code,for the prrformance of the work or which this prrmit is 307 - INSULATION
issued.MY Work rs Compensation marine c and Pol cy number srr:. - ' "3 0 6 SHEETROOK
- ..
. . - r� / i _..� _. ._ ..
G eri .,•�(al c ��O .. _. ..
V�.: ,- CERTIFICATION OFEXEmPX10NFROMWORKERS" '-?�l 11309' ��%+EXTER.IOR�liATH=t
COMPENSATION INSURANCE•s' -", -.-_ .—_ —----------------"-------...
_ . . ---3-10 :-.:-INTERIOR--L-ATH---_
roti:section need not be<omplcted if she prrmit is for one hundred dollars 311 SCRATCH COAT i I `
(sloB)ar laaa.l ..313 _ "ROOF NAIL,
_.
X5., ,1 certify,that tallhe performance,of the work for which this rmit is issued,1
hall not employ any Person in any manner as as m heron subject to the Workers 501 FINAL EILECTRI CAf:'ENERGY
Comer a im,Laws oPCalifornia Dat ' 502 — FINAL PLUMBING ENERGY- ...-
-
' ca
NanCETOAPPucANflr.after mlpigth crffamorExemption.you should 503 - FINAL MECHANICAL ENERGY '
bac bden to the Worker C npe sm p of the LaborCada:you must
ODforthwith'comply with suchp sins anthis pemashall beJrrdresulted. _ 5.04 ,-._FINAL BUILDING ENERGY ,,. . . ..._.. --
u'r'n " f CONSTRUCTION CTRICAL
C 505 - FINAL ELE '
a C
1 hereby alpha that thect indin eyf th xrorm nce
of the work hichthe issued(Sea se)
- GAS TEST 506
Lena N
507 - FINAL 'PLUMBING L
r7 Z Lend Addren. v —
'UO Iamrrmualnavercvdmsappliat �utd.aatethaun mweitfwmammis 50 FINAL MECHANICAL
W F 'correct.I agree to comply with all city and county ordlances and state laws relating 5 9 — INAL G DE
'O,V ,tobuilding consourcuira.andb by sualunite mptaiivesfthiic"y, ta.,.. 5 kO - INAL N NG
•the M t „Ip Pnyl impar npiq .
E"-p, IW) lire t do-'ly (keep harmless ror Cly rCupen toga rot 51 - INAL RKS /
:n liabilities1 dgn<m. costs d is se, h h may t any y.,me g ou said L v
_U- City incuse,...r eft he limning of this Mrmt
APPLICANT UNDERSTANDS AND WILL COM•. 1TH ALL NON-POINT ' Is$nedSO
b Date
�. Date
Re-roofs
HAZARDOUS MATERIALS DISCLO R ,
Will the applica t or future Wilding occupant awewhandle haraNteral. . Typeas d f n d by the Cupen p M c pal Cale.Chapter 9.12.and lie Health d Safety -
Code,Scto 255320)?.r .y '. T- - { j1• (';; �� ' t :iP;• '•i '. '
o a All roofs shall be inspected.prior to any roofing matenal.being installed. . ._. .
Will the applicant or future building occupant use equipment or device.which If a roof is installed without first obtaining an inspection, I agree to remove
emit harardoun air contaminants as i rfincd by the Bay Area Air Quality Management
Distrito all new materials for inspection. Applicant understands and will comply with,
❑Yes Na all non-point source regulations.
'1 have read ane limitations materials requirements under Chapter 6.95 of me
Cdifamia Health&Safety Code.Seaton 25505.25513 end 25514.1 undersmndthttlithe Wilding does not currently have a mount,that it is my responsibility to notify the -
becupa d of the rcquhvments which most be in.prior to issuance of a Certificate of
'- °rap' ® Signature of Applicant _ Date -
:..
Ow ream = LDate, All roof coverings to be Class "B"or better
OFFICE . . ..