02040023 (4)ram
CITY
I BUILDIN DIVISION CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT N0.
1075 MILKY WY 02040023
OWNER'S NAME: APPLICATION 5 B DATE
'ZAMLICH JAMES G AND GWENDOLY 04/04/2002
"HONE: SANITARY NO. CONTROL NO.
ARCHITEC ffiNGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
I� r_I C._I 1_._)
LICENSED CONTRACTOR' S DECLARATION Job Description
1 hereby O)of Division
1 nm of
licensed vines provisions of ns Codex (commencing
mmccense r a �..a �p,y s�z.a,.�an
with S herbyoffoerthatIoamm(InunerandPlonsofCsaptera(cmmencing FIR+{Y�B�tl.Ij�CI!'Nl��+t1YbLaQ1161.'�.a��iMENT.
full �rryc a flea. �.
an
Lie�nse Cell. _ =. sec I • �/ 3
1 mwerxtana mr vlo� �n�li he o ee s a'manomdd rcI°aa APR 0 8 2002
Licensed Professional
OWNER -BUILDER DECLARATION BUILDING
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county $3000
which requires a permit to construct. alter, improve, demolish, or repair any structure
..prior to its issuance, also requires the applicant for such permit 10 file a signed statement
that he licensed pmmbal to the PC mouser he Corinctolx License LswChapin9 ` 3Aq,.FfS,plasasI:F Valuation
(commencing with Sect ion 7WO)of Division 3 of the Bupinexa and Professions Codd (;f4 x1
or that he is cxcmpl therefrom :and the basis for the allege) cat minIbd. Any violation -
- of Secure 703IS by any applicant for a permit cubjcers the applicant to a civil penalty
•mfrmmorethan fivehundred dolLtn(5501)). 10IAPNPfll f(1DATION Occupancy Type
01, as mricrof the propcny, or my employees with wages as their sole compensation, PIERS
-
-wlu do thfwmrk. and the stmotom N net intended or offered"mrsole Sec: 7ou:- 1 O3 - LIFER Required Inspections
•Busimus'm l Professions Coal The Contractor's License Law does not apply m an q p '
owner f property Wim Wilds or improves theater, and who does such work himself 104 — REBAR
ore ggh s: win employees e mJN that such improvements 1 intended or _
o@rcdf' l lC Aow the bildmg' 'p fix IJ 'ih ywr of .. ._.. .. ..____ ..-BOLT
completion, the owenobmlder will have the burden ofproving thin he did not Wild or 105 — ANCHOR BOLTS
improve fm,mpxxaofxale.). 106 — SEWER & WATER
__----- -- -_li-ccs.__.._.. .._.__._..-_.202'. _UNDERFLOOR"PLUMBING.
❑Lasowner ofthepnpenPam Btoinis,; and mnerngns Cocc:) The onnorslo
icelmetthe does
(sec.7toanowner o ceraerty%hie builds cine:)Thevemn neon, 203 - UNDERFLOOR MECHANICAL' ."T '.1.:.Le er,a
Claim law does nml apply m an owner of property who halide tu improves thereon,
_cera wnm.xmrgaax.rmr.xaanvroiecu.with.a=mttnenrfx).B=emud.pmsu,mt.wme _ ._. --2'04----UNDERFLOOR FRAME--------- —_ ._...._---._.._--_—.
Conmanols License Law.
❑lam eaetppt mrger secs'' ';';"I""' ".'Br&;PC for this max°° 205 - UNDERFLOOR'" INSULATION
ower' Dare 301 - ROUGH PLUMBING
'
WORKER'S COMPENS1.ATION DECLARATION _ 302 — TUB & OR SHOWER
Ihereby afnrmunder venahyorperjury,oakrfther°Bowingdecimations: -303 - ROUGH MECHANICAL
❑ 1 have Edd' wiil mai ntaid'a'ccnmcale of CdnserPto sall-irare for workers 304 - ROUGH ELECTRICAL
Compcnaeticr,-ax-provided for by section 37W of the Labor Code, for the
'perfmmmce mfm� work mr wnicn thix pmmit is itiona, , 305 - FRAME
❑1have 'una`will maintain Worker?Coinpensmionlnsumnce,as"eired by Section 306 - HOLDOWNS
31W or the Labor Coder thePerform c of to work for which his wm+i 3 07 — INSULATION
mitt rc '
issued.MyWorkers Compenwt do In�,rane e an
,qlPoIiry 3 -308*:—,'-,SHEETROCK' „ • _ .. ..__ ._. _ _ _ .__._�... _..:. .a. _,.
m �t�CC CAT10 OF EifemY N FROM wokKERs � -0,it• 3 0 9 � - `xEXTE12IOR� � LtATH'• amu, •
��. COMPENSATION INSURANCE
310,-:--INTERIOR--L-ATH---' --- - —
"o obs' timnndearmbacompleted one Permit is for one hundred dollars .I _ , ,,,
alW3mrlexx.) 311 SCRATCH COAT
.313--' ROOF=NAIL-
I nfyd 1"n the perfom eof lM1 ok'f "Arch the pernft. .aJ1 t
shall net employ any Teri In any ma are, so as, in W6me ;mblect on the Workers 501 - FINAL ELECTRICAE ENERGY
Certification.
„bv 1 mlawxmrcmr al= _ - .. 502 FINAL_ ENERGY...._..._.
NOTICE
TOvolhCANM If.
after Com along this no __.-. o_,... _.. ._. .._._
PP
ficmf the mpr ori you should 503 - FINAL MECHANICAli"ENERGY " '
wear mar m<Labm erode amu 'n
rnnnwimrcoiplywnnsuchprovisionsorthispermitshanxdeemedrevoked. _504. _-. FINAL -,BUILDING ENERGY'...._..._._..._._.._
its: "'' • `CONS RUCrIONLENDINGAGENCY - •” '• 505 - FINAL ELECTRICAL
' 1 hereby ulRnn That there is'a cdnstmciion lending agency funhe performance
of the' kf which his pciml is issued is 3097. Civ. 506_ - GAS TEST _
Leede N 507 - FINAL PLUMBING•.. .,.__----
Lere er s Addresx'
'I cenily that l have mad this application' and steta that Be above inrorraamn is 508 - FINAL MECHANICAL
coved. I agree to comply with all city am county ordinances and state laws relating 509 - FINAL GRADE
orienting conm9ction, and hereby autheiriu«presenndvu ofthe city to enter upon 510 - FINAL PLANNING
the above-mcnliomed pe,pcn, for inspection puryouv.,,.
(We)egme to...c:indcnmI`y and keep hamlesi Bit, 6iy of ClwniriAiamet 514 - FINAL PUB IC WORKS
liahilitiex.judgmenea costs and uwrsu,which may in any way accrue ugalnsl said
City in cams,uence ofthe 'grnntrig of thix pcimit;, ' "•'• 11 .
AP NDERyTANDSANDWILLCOMPLY'Wfm'ALLNON-POINT' Issued r Date
( RCE kEG ONS., , . ,. �e „i...•... ^l�.D y'
Srgn, t of Appliban✓Conl ctor •' -, ', Re -roofs
HA]ARDOUS MATF.RIAt S DISCLQ SUITE(
"1' L Wlldc ppl'cantm f tw<W IJmgoe w rr' drhandlehiaard wnal Type Roof -,. _...
yp .. ,. ,.
as Crdc( dbYthC N) Municipal "Cod Ch pl 912 and the Health and Safety t. Si. [ 1 fa ...i vas• •. IPI:-. .
Cod 'S t 255J2(e), : v tt'
❑Y e -': < v. "° ;y t 1 ...... ' 'i _ All roofs shall be inspected prior to any roofing material,being.installed.- _.
wpm applicant r 1 n ilmgg p t ,seequipment or devices If a roof is installed' without first obtaining an inspection;'Iiagree'to"remove
ithnrdos irimnte - 1 sdeffned by the Bay Arca Air Qualdy Management
Diair<t all new materials for inspection Applicant understands and will comply with
7 Y<x 611 non -point source regulations,"_.,-,
I" I tin a cad the hmuNovi maledals regal mxmis and Chapmr 6.95 of me
C6lifomio HeabK& Safety Code: Sections 25505;25533 and 23534. I understand that _
if di FIN, Itling dots not currentlyhave a krait, that it is 'bilis to notify the
my Y Y ..
• q Ira LexaerC[ of a CNlficele of
`
Ocupari of me re airtmenls which must be met prior ,
r _ • s,r_aL Signature of Applicant Date
Ih camed agrnt to
OFFICE - -._ .. .. .. .._.....
All roof coverings to be Class "B" or better
..
ram
CITY
I BUILDIN DIVISION CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT N0.
1075 MILKY WY 02040023
OWNER'S NAME: APPLICATION 5 B DATE
'ZAMLICH JAMES G AND GWENDOLY 04/04/2002
"HONE: SANITARY NO. CONTROL NO.
ARCHITEC ffiNGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
I� r_I C._I 1_._)
LICENSED CONTRACTOR' S DECLARATION Job Description
1 hereby O)of Division
1 nm of
licensed vines provisions of ns Codex (commencing
mmccense r a �..a �p,y s�z.a,.�an
with S herbyoffoerthatIoamm(InunerandPlonsofCsaptera(cmmencing FIR+{Y�B�tl.Ij�CI!'Nl��+t1YbLaQ1161.'�.a��iMENT.
full �rryc a flea. �.
an
Lie�nse Cell. _ =. sec I • �/ 3
1 mwerxtana mr vlo� �n�li he o ee s a'manomdd rcI°aa APR 0 8 2002
Licensed Professional
OWNER -BUILDER DECLARATION BUILDING
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county $3000
which requires a permit to construct. alter, improve, demolish, or repair any structure
..prior to its issuance, also requires the applicant for such permit 10 file a signed statement
that he licensed pmmbal to the PC mouser he Corinctolx License LswChapin9 ` 3Aq,.FfS,plasasI:F Valuation
(commencing with Sect ion 7WO)of Division 3 of the Bupinexa and Professions Codd (;f4 x1
or that he is cxcmpl therefrom :and the basis for the allege) cat minIbd. Any violation -
- of Secure 703IS by any applicant for a permit cubjcers the applicant to a civil penalty
•mfrmmorethan fivehundred dolLtn(5501)). 10IAPNPfll f(1DATION Occupancy Type
01, as mricrof the propcny, or my employees with wages as their sole compensation, PIERS
-
-wlu do thfwmrk. and the stmotom N net intended or offered"mrsole Sec: 7ou:- 1 O3 - LIFER Required Inspections
•Busimus'm l Professions Coal The Contractor's License Law does not apply m an q p '
owner f property Wim Wilds or improves theater, and who does such work himself 104 — REBAR
ore ggh s: win employees e mJN that such improvements 1 intended or _
o@rcdf' l lC Aow the bildmg' 'p fix IJ 'ih ywr of .. ._.. .. ..____ ..-BOLT
completion, the owenobmlder will have the burden ofproving thin he did not Wild or 105 — ANCHOR BOLTS
improve fm,mpxxaofxale.). 106 — SEWER & WATER
__----- -- -_li-ccs.__.._.. .._.__._..-_.202'. _UNDERFLOOR"PLUMBING.
❑Lasowner ofthepnpenPam Btoinis,; and mnerngns Cocc:) The onnorslo
icelmetthe does
(sec.7toanowner o ceraerty%hie builds cine:)Thevemn neon, 203 - UNDERFLOOR MECHANICAL' ."T '.1.:.Le er,a
Claim law does nml apply m an owner of property who halide tu improves thereon,
_cera wnm.xmrgaax.rmr.xaanvroiecu.with.a=mttnenrfx).B=emud.pmsu,mt.wme _ ._. --2'04----UNDERFLOOR FRAME--------- —_ ._...._---._.._--_—.
Conmanols License Law.
❑lam eaetppt mrger secs'' ';';"I""' ".'Br&;PC for this max°° 205 - UNDERFLOOR'" INSULATION
ower' Dare 301 - ROUGH PLUMBING
'
WORKER'S COMPENS1.ATION DECLARATION _ 302 — TUB & OR SHOWER
Ihereby afnrmunder venahyorperjury,oakrfther°Bowingdecimations: -303 - ROUGH MECHANICAL
❑ 1 have Edd' wiil mai ntaid'a'ccnmcale of CdnserPto sall-irare for workers 304 - ROUGH ELECTRICAL
Compcnaeticr,-ax-provided for by section 37W of the Labor Code, for the
'perfmmmce mfm� work mr wnicn thix pmmit is itiona, , 305 - FRAME
❑1have 'una`will maintain Worker?Coinpensmionlnsumnce,as"eired by Section 306 - HOLDOWNS
31W or the Labor Coder thePerform c of to work for which his wm+i 3 07 — INSULATION
mitt rc '
issued.MyWorkers Compenwt do In�,rane e an
,qlPoIiry 3 -308*:—,'-,SHEETROCK' „ • _ .. ..__ ._. _ _ _ .__._�... _..:. .a. _,.
m �t�CC CAT10 OF EifemY N FROM wokKERs � -0,it• 3 0 9 � - `xEXTE12IOR� � LtATH'• amu, •
��. COMPENSATION INSURANCE
310,-:--INTERIOR--L-ATH---' --- - —
"o obs' timnndearmbacompleted one Permit is for one hundred dollars .I _ , ,,,
alW3mrlexx.) 311 SCRATCH COAT
.313--' ROOF=NAIL-
I nfyd 1"n the perfom eof lM1 ok'f "Arch the pernft. .aJ1 t
shall net employ any Teri In any ma are, so as, in W6me ;mblect on the Workers 501 - FINAL ELECTRICAE ENERGY
Certification.
„bv 1 mlawxmrcmr al= _ - .. 502 FINAL_ ENERGY...._..._.
NOTICE
TOvolhCANM If.
after Com along this no __.-. o_,... _.. ._. .._._
PP
ficmf the mpr ori you should 503 - FINAL MECHANICAli"ENERGY " '
wear mar m<Labm erode amu 'n
rnnnwimrcoiplywnnsuchprovisionsorthispermitshanxdeemedrevoked. _504. _-. FINAL -,BUILDING ENERGY'...._..._._..._._.._
its: "'' • `CONS RUCrIONLENDINGAGENCY - •” '• 505 - FINAL ELECTRICAL
' 1 hereby ulRnn That there is'a cdnstmciion lending agency funhe performance
of the' kf which his pciml is issued is 3097. Civ. 506_ - GAS TEST _
Leede N 507 - FINAL PLUMBING•.. .,.__----
Lere er s Addresx'
'I cenily that l have mad this application' and steta that Be above inrorraamn is 508 - FINAL MECHANICAL
coved. I agree to comply with all city am county ordinances and state laws relating 509 - FINAL GRADE
orienting conm9ction, and hereby autheiriu«presenndvu ofthe city to enter upon 510 - FINAL PLANNING
the above-mcnliomed pe,pcn, for inspection puryouv.,,.
(We)egme to...c:indcnmI`y and keep hamlesi Bit, 6iy of ClwniriAiamet 514 - FINAL PUB IC WORKS
liahilitiex.judgmenea costs and uwrsu,which may in any way accrue ugalnsl said
City in cams,uence ofthe 'grnntrig of thix pcimit;, ' "•'• 11 .
AP NDERyTANDSANDWILLCOMPLY'Wfm'ALLNON-POINT' Issued r Date
( RCE kEG ONS., , . ,. �e „i...•... ^l�.D y'
Srgn, t of Appliban✓Conl ctor •' -, ', Re -roofs
HA]ARDOUS MATF.RIAt S DISCLQ SUITE(
"1' L Wlldc ppl'cantm f tw<W IJmgoe w rr' drhandlehiaard wnal Type Roof -,. _...
yp .. ,. ,.
as Crdc( dbYthC N) Municipal "Cod Ch pl 912 and the Health and Safety t. Si. [ 1 fa ...i vas• •. IPI:-. .
Cod 'S t 255J2(e), : v tt'
❑Y e -': < v. "° ;y t 1 ...... ' 'i _ All roofs shall be inspected prior to any roofing material,being.installed.- _.
wpm applicant r 1 n ilmgg p t ,seequipment or devices If a roof is installed' without first obtaining an inspection;'Iiagree'to"remove
ithnrdos irimnte - 1 sdeffned by the Bay Arca Air Qualdy Management
Diair<t all new materials for inspection Applicant understands and will comply with
7 Y<x 611 non -point source regulations,"_.,-,
I" I tin a cad the hmuNovi maledals regal mxmis and Chapmr 6.95 of me
C6lifomio HeabK& Safety Code: Sections 25505;25533 and 23534. I understand that _
if di FIN, Itling dots not currentlyhave a krait, that it is 'bilis to notify the
my Y Y ..
• q Ira LexaerC[ of a CNlficele of
`
Ocupari of me re airtmenls which must be met prior ,
r _ • s,r_aL Signature of Applicant Date
Ih camed agrnt to
OFFICE - -._ .. .. .. .._.....