01030167 (2) V OF
crBUILDING �P DIVISION
o PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7904 MC CLELLAN RD # 2 PSG FENCING INC 01030167
OWNER'S NAME APPLICATION SUB DATE
CAMPBELL ASSOCIATF_S 11.33 N 10TH ST 03/09/2001
IONS: SANITARY NO. CONTROL NO.
4089953397
D C Z ANCIII I'ECT/IiNCINIiIi R'. BUILDING I'ERMIIINFO
w 0 14,I)f ELECT PLUMB NIECII
a i w I_ 1=] LJ I-1
�ad
nlhICINSLD CONTRACTOR'S DECLARATION Job Descriptio
HC hcrcny rnnncn
O
�uttlu Wim Sffllnn 71X101o1D um3nf lbc It Cif'.an my li'tow
acs "'°°r°"""acfr - t0 � '� 2ND FLOOR BALCONY REPAIRS
z s a I"ifcnw Clu..�/�.r'G`J� Llf.x_
6 V Ddlf i�,�y Gal ECTAr
d a� r A I(r[Cr'Slonew ATIO. —xl[T—
t� I undfnaund nIY pions Shull tw tocd as public racor
M`
� Limawd Professional
caEo
OWNER-RUILDGR DECLARATION
I+�1H I hereby ulfm,that I an,exempt from License the Contractor's law for the
C�< following remtn.(Seatinn 7031.5.Bu.ines:md Pn,fe,iars Code:Any fit,or county
5 F❑ wl icl.requi a Pf ,'ll ,,cour
rmcl,ultfr,Inr)rom.JfrnnIN I. ,r rcpmr any nlownre -
a3w pnor In it,i...anm,alsoc,ire,t he applicant for wrlilt
luh permit to a,igned smtcrneta
mat lot ialicensed pur,u,nuathe pmvi..,°n.afthe eon°an°ra.mcnrelaw(Chapter 9 Sy. Ft. Floor Area Valuation
laanmencing o int sedan 70001 of Division J of the Au.iness and Professions Cote) $3500
or Ihtt he i,exempt themfmm and the baa,for the alleged exemption.Any violation
of Sectio,7031,5 by any applicant Its a pam,it suhjccks the applicnnl In a civil penalty
oro„lI aman f,e Io"ndrf,]dollar,Ishan. APN Number Occupancy Type
❑I.0 nd,be propeny.a my anni with wagas.f.thei—ole campfnsalion. 36212001. 00
will do the work,and the structure in not intended 0r offered div sale(Sm.71W.
Murines and Protissions Cale:The Contractor's I.imnw law dtm%not apply it,an Required Inspections
m properly WI build, Ithaproves hereon,tad who don,inch work hhnxdr 101 - -FOUNDATION
v 1Lrougn his luployces.pct vidnl In..,ucn llnIT flit,are n t i",fndfd o
or 1,,e]to,,Ole It,however,the h"Ilding or lmpnwennn,i,Hold within ore Ycar(,1,
utmplclion,the 0wncrlwiWfr will hmx the burden of proving Lha he did Hol build n, 1.02 — PIERS
rPracc mrpmpo,e nr,we.). a 103 — UFER
J
❑L:o,uwne rojmpmp,.fly.nnlra,io,v�r "octingwith dc:twdcC an""m 104 — REBAR
OnNmt,(rerpmjfnl fappl or a.Ben lid Pmrnv s ild,or rhe Ct, I...a1,,
ttohocont,w.m„tmuch ajects ith. ourrw...h,) Eceried prmustatit)the - 105 — ANCHOR BOLTS
and who eanvau Ito men projects with a nmtmemds)Iieenw,l pursuant 1,o the
c0mmemr,LicunderSte 106 — SEWER R WATER
❑into faftnpt under sec. ,Bd,tic monis reason
onion Dal, 002 — UNDERFLOOR PLUMBING
WOR KER'SCOM PI!NSAT[ON DFcLAW\l'ION 203 — UNDERFLOOR MECHANICAL
Ihereby alrmlunder penalty ofperjury one athe following declar.tion.: - 204 — UNDERFLOOR FRAME
, 1 ha.c ;rad w;B °nialain tt Cerdrean, at Caa.cat to seB:inone for worker, 005 — UNDERFLOOR INSULATION
CnllEmneaion, us pravidW for by Section 3700 of he Libor Code, tin the
rrann
peaor,of me work far wmfh hi,ti,i.,tnal 301 — ROUGH PLUMBING
Acl have and will lnaimain Worker:Campemztion Insurance.as"dred by Section 302 — TUB & OR SHOWER
1701 of the Luton Cale,for the Mrli rroarm of he work for which thio permit is
it.trod,'MyFwarjk)crSCmn(/lw,�n+s,a,ti�onlrtwora"cecarricrandpolicyu,tmnfran; 303 — ROUGH MECHANICAL_
Catri,rVq , >J_y (IlRohpNn:/���'! 304 — ROUGH ELECTRICAL
'1 NIt 9:ACOMCPINIS`AI IONIIN.SURAINCE ORLL b 305 — FRAME
rnd„enin"ace,1 nm lie cor"ph ed inns pconit is no ora h,lndred dollar, 306 — HOI_DOWNS
rSEX))mlena.l 307 — INSULATION
I
modify that in the perforn:lne of be work for Is huff his permit is i.sucad,l ,08 — SHEE T ROCK
,hull not employ any person in any munner a,a to becom3e,.hjml to he Workers'
cm,tpar,.nian La”nfcaldi,mia.Date 309 — EXTERIOR LATH
Appbnuu
Noonew oto the N"CIf.C... rnakmglms Cciorur 1 OfGwN,Cod rnu,nould
.,, 310 — INTERIOR LATH
O Gtxnnnehcompu,the Wnalt campers r this pmrrou shoot the t LIN,,wvuk you roust
rannwilnc0mpywhn,trcbpmci.ion,armispfm,il.naBnf,decmearenakm. 311 — SCRATCH 'COAT
VJ CONSTRUCTION LENDING AGENCY
F t linen,alar,,that there i,it con,,ractia"modiag agency not ma perftm;,ac 313 — ROOF NAIL_
s
'If the work ifor wlacl,do,N itI,i...ad(Sm.3an.Civ.C' 501 — FINAL ELECTRICAL ENERGY
Under
der,nd
5 z de,,
502 — FINAL PLUMBING ENERGY
vO 1certifymarIha'treadIrkappd"tdont11W.mtethat'henNeeInfornradnr1' 503 — FINAL MECHANICAL ENERGY
entre”.I a"m Ia"anPly with all any and aounry on in...a,ted arta law,rclaring
mntmingcan.wmca„r,.ataracnya°m°deemprf,mAfi,c,orhi locanno or 504 — FINAL BUILDING ENERGY
the aNweanennoned Praps",for inspection puEanm.
a (We)agreeln,"ve.irlmarlyandkcephannle,stheCiry9fCupeninnuguin.0 505 — FINAL ELECTRICAL
to liabilities.judgmcm,,casts and c.perwe which mar in any way:wemf against.aid
U 7. c'�Iy'�@41,1uh
1w rmmng„fmi,panai. GAS TEST
AI'1'ISTANDS WILLCOMPLYWITII .I.N)N POIN” Issued Dille
Sol )NS � t Y NG
Sig nort =Date Re-roofs 508 — FINAL MECHANICAL
ZARDOU. N1ArERU1•S DISCLOSURE
Willt or fulttrc ntmding 0ccopanl store or handle ha,ardat,nancrial Type of Roof 509 — FINAL G RADE
a,aflin"In,mectspanin,,MuniviPw Ca In.Colon tprar 9.12.oIna Health and SalOy 510 — FINAL F'LANNTNG
Gude.Section 255J200'r
0Y°, ^° All roots shall be Wj%cted fiyWoEttyFy V nnat� fg installed.
Wil l the applicant or future fuiding oacupant tow eyuipm naor dcvifes which It'a roof is installe without first o taming an inspection, I agree to remove
mdI htv:udom w1,cnntruninanI m laf ted by he]toy Area no Qnuli y Mcna"cmm�l
niadcn " all new materials for inspection. Applicant understands and will comply with
❑Ya, Na all non-point source regulations.
I have rent the h o,allom mataial,reyulmmmo¢an&,Chapter 695 of the
Calilbr"in Ileallh.k s:dtty CnJe.Sections 25505,25533 and 25530. understand that
i(Ibe building Mew not ca,,cntly hate it.,air 1,h n it is my nspomibl lby m not Iy,hc
,aupanl of do,reyuimnmrts.1rch rnuM he ,,a,prior m iss°mac al'"Carl lir
Ue "''' �_ 2 Signature of Applicant Date
c -rnraan,m .J�gf 5—), ^- Izaw'— All roof coverings to be Class "B•'or better
OFFICE