01070122 (2) CI BUI DING DIIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10959 NORTHSHORE SQ THE BATH ROOM INC 01070122
OWNER'S NAME: APPLICATION SUB DATE
ROSEN MAY TRUSTEE 1910 W EL CAMINO REAL 07/25/2001
• PHONE: (650) 968-7666 SANITARY NO. CONTROL NO.
Mai ARCHITECTIENGINEF,R: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
Z 5 v=Ni i LICENSED CONTRACTOR'S DECLARATION lob DeSCIIpIIOn
O Z-O I hemby affirm that 1 am licensed under provisions of Chapter 9(commencing
fn w with scctum7001oTuivibd3ofthe Bu:lie„andprof,.,+e:C .,ammencing SHOWER REPLACEMENT.
a y; n in fall force and eff �L
_,-_ Date 1 Lie.« FINALED
F,6,
O i O Date Commctor
OO 3 w'. ARCHGECfS DECLARA
1-.='O S 1 mulcound my plans shall be used as public recent,
C�Q�
d�oo ueenvedPrefe„ienal JUL 3 1 2001
a' OWNER-BUILDER DECLARATION
1 hcreh, M.that 1 am sxcmpt from the Commemf's License Law for the
`Z9 following reason.(section 7031.5.Business and Profession,ends:Any city or county $3000
E which requires a permit to construct.alter,improve,demolish,or repair any swcture
Of, prior to its lewaace,also mquires she applicant fm such permit to file a signed statement R11 i nimr.a. -- -_---
Thathe:u,licensed pumuanl rd din provisions of,he Con,mctorS License law,(Chapter 9 Ca,.G(OC'j q0• ,p sip
(commencing with Section A000J of Division 3 dithe Business aM Professions Code) 1=°:in., 3,1. S55T1 LL oo 11rUUVVa4.;t.til �1 ,°,, Valuation
or that he is esmupt hand,, nand the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a Permit subjects the applicant W a civil penalty
of not more than five hundred dollar:(s500). 10 6APN§E,R1LwK & WATER Occupancy Type
111,as Owner of the PrOKRY,or my employees with wages as their sole compensation, RTMr
1
will do the work,'and the structure is not imended or offered for sale(Sec]Bu. -
+Business and War..tons Code:Tim Contractor',License Law,does a.,apply W an 301 - ROUGH PI.RR46W(Ilispeetions '
r of property Who Wil&sir impmve:thereon,and who does such work himxlf
°w”` t iterated or 302 - TUB & OR SHOWER,:--
-
or through his own employees.provided that such improvements art no
'dlleied for fe:Ifaiuwsver.the building ,Is mid within ane 'f -.
eburden of pro year 502 - FINAL PLUMBING EERGY- �
completion,the owner-Wilder will have the burden of proving that he did not build or t
ENERGY-
improve for pa,pox of sale.). 506 - GAS TEST ,
- - . . ._ . .
.. 1D1i..,in m:nnhe properly.un e.naavei.... iraciin with incensed comoc, W ._. _..._ -----FINAL*
_.. ....-'—'_...__._.........._._..__.. . ,__...__-.—"--'
en gwi 507— -FINAL PLUMBING r \I : .°;tr.
construct'he
oesn rasp.]toa Business and Pmwhlo b Cod,)rTheContractorstheron.
-L '_..—'---- ------------- ----
License Law does not apply to an owner of prnpeny who builtls or improves thereon.
end.wctor's License
fLa wch.prolccs.with u.contmctonsl licensed pursmnt.m the
Olarnsc License Law.
- � Olam exempt under gee: :9"ffi PCfor this mann
Owner •. Dam •.
'WORKER S COMPENSATION DECLARATION
I hereby affml under penalty,of pc jury line of the following declarninns:
❑ 1 have-"and'svill manifold a Csdifcais oI'Conum to self-insure for Worker's
Compensml as provided for by Section 37W of the Labor Code, for the
- _ - perto of the'work for which this perrom is issued. ,I•
1 have and..'B maintain Worker's Compensation Insurance,as rtquirtd by Section
3]W of the Latin
aMCsrk fur the dorm ice of circ work fa which<hrs pmmt rs
is, d.N W ke/ C pe ai In a c d oocy number sirp��
- Co. .-, } t• PuI'YN /e l'. t� .... I . .. _ T_.1_ ....., .-i t1s .!317•• .. -...,
'RT (CATION OF EXEMI'f10N FItOM.WORKI:RS \°fir - J�. f a` .+ a+;1 f l � �. •? , �l + ~/'t�.
(This salon m,,d nuibe'ccmpleied lf,he permit is for one hundred dollars
+ I I c n fy th t in Ibe pert rm ce of the od,f h M1 lh i t prorm, sued,.l _ _ •._..,- - - .f.,,.,t�*,:1j _, s .. .. .•• - _
,lull no,employ,any.person In any manner on as W become so pct to the Workers '
Compensation Laws of C.Ihm.h.Date.'
Applicator
'NOfICETO AIf LICAN T Ifafter mak, l his C,air,,s,O ofE' pt - you should "T
Deco 61emi+tlicWk C penst p n,of th Lalio C+Je,You mutt
Q Q 1'oh1 'the ply with suchpmvisi onOr th it permil shall he dcarn ed rovi.
CONSTRUCTION LENDING AGENCY, + r. I' I t•? '1 hereby ill th'a't then is d construction lending agency fon the Ivzfhnr n 0. i1 +
which this permit is issued Sce.309],Civ.C.1 -,.- -_ _ -- , . -__
df the work for
'Q Lcndcr'i Namc' '---- - -"
DZ it+ l it
U � .1 cenily that 1 have rtaJ this applicaien unJ state tha the shave infnmotion Is
% W'Ci. turmti'1 a.mc to,comply with all city and county ordiumcc,and I,m In.,relating
0 [) to building construction.andhem-by authorize representatives of this city to meupon
`r,;4 the b° elnt n d Progeny f Inspection P qw. -
F,s C. (We)all.16 sale.imilinnify andkeep h ml ss the City ofC pen Dag 31st
N liabilities.judgments.costs d expend which may In any y accrue against t aid
U Z Cly or genes of the gramin¢mit,pc t
. ,TUNDE DS 'ILL OMdL I' N INT
UR RE u ID/N�7 Issued by: Dale
S+y W'll toe upPlica lfl rxDOS hIATLRIALS DISCL URF t + '
Re-roofs
unVC
du'ldmg cups,,vole' h dl'h' ,dols manned . .. Type Of.ROOf_ ,. .. . - .
as d fi ed by the Cupen n M P I C Me Chepsar 9 12, nd the H,,hh and Safety
Cod'Secion 25512h1 - -310 3. ( i o °• }se t ' ,.,
oY Z.
_ All roofs shall be.tnspected prior to,any.roofingmaterial.being installed. _ ..._. ._
Will the applicant or,fumm building Occupant use equipment or devices which If a roof is installed without first obtaining an'inspecticn, I agree.to remove
emit hazardous air contaminants a defined by the Buy Area Air Quality Management
Minor,!
- v- all new materials for inspection. Applicant understands and will_comply with_
,; ❑Ys o "sill non= sour ala ons.
M1 dab h J ti for I r 4 t'u d C.1 o f.f of the t
alt H VB&'S fnyCJ Stilton,25505 255U and 25534.I ndc tmJ,M1at — j a
cif theBuilding d SnolN t ut m IM1 t t Y
responsibility to notify the _ _. .. .. .. ..
tlsw ,of the Not.men . ch ust lie- t poor m issmnce o a enifc eyt
"pay'' " III////(1`/ _Signature of Appli nt _ Date
o m zed sig " Dam. All roof coverings to be Class "B" or'better
OFFICE _-