01120014 (2) OF
CI BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22009 OAKDELL PL 01120014
ME: APPLICTION 5 B DATE
JAMES 121042001
` PHONE: SANITARY NO, CONTROL NO.
C rc Z ARCHITP.C'rIENGINEER: BUILDING PERMIT INFO
m O BLDG ELECT PLUMB MECH
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fate
S y i firCBNS[D CONTRACTOR'S DECLARATION Job Description
z_= Ili..70affirmmat1amyfry dunder watsslnI orenapmr.andan(commencing BATH pppfi�Q(�T�ppppTTT��/'p �+t�YLlGHT
wFc is bulltionyando isionJofteBusinexsatgProle oo C dm license yt�
_yf] In in full force atone I. / 6 C r �$
z a a Lions Clnss Lic,p f9 — —
o c r-' Dam _ ConOaarn
iLLav ARCHH-ECr'SDP.CLAR 1 h JAN 0 8 2002
9y� to'3 I understand my plans shall be used as public records
i p O Lireosed Professional
P. OWNER BUILDER DECLARATION
v I hereby alarm that 1 am exempt from the Contractors License Law for the B U I LDI N G
t?a fallowing reason.(Section 7031.5.Business and Prakasionx Cade:Any city or corm} $13600
f€D which requires a pencil u)construct,aim,improve,demolish,or repair any nosaure
w—m prior to its issuance, l 9it the ppl' t for suchpe 'u File a signal statement. �.a,.{'�`k,.,,
than[ It ,wit p Srsuh note ofD s fine Co tinct soja x� (Cbapt[r9 'Y3 G-tl 3'?lJIY`7�"A�a r. i ` v` ( Valuation
ormormencon,thurbe ,e with Section]000)of Do o fie B. ca dion Any ns Cade) t \
or tail he s exempt tercfmm and the basis for uc alleged eumpdoo,Any violauon
of Section 7031.5 by any applicant for a permit mbjects the applicant to a civil penalty
of nm mom than me hundred dollars(35001. l01AP-N 4k DVNE)ATION Occupancy Type
°Lmw
as astheir 102 - PIERS
--will do the work:-and the'.nranure is not intended or offered on .ale(see.70af4: 103 - UFER
Business vad Professions Code:The CommcmCa License Law does not apply to an Required Inspections" '
owner of property Who Wilds or imprmes thereon.rand who date,such work himself 104 - REBAR
or through bis own employees.provided tot such improvemt,ms ere not intended or _ •-_-.__ _—__
offered for sale.If.Wweve%the nrudingof improvement is sold within oneyearaf _. . 105 --- ANCHOR -BOLTS. .. . ..........__.. ._ .. .. _ ._ ..
emnpletion,the Owner-builder will have the burden of proving that be did not Wild our 106 - SEWER & WATER
imp u
Purpoa
_ _._____ -. _ .- __'* _ -- - -' 202 -- UNDERFLOOR PLUMBING---
°Lmowner ofjec p(Sec.7ton Business acontractingwithbeefede Clmmcmm .:'.lr '
ono-wm the does
project(Sec.pto a Business and property
who b codon The improves tmemrs 203 - UNDERFLOOR MECHANICAL •t
License Law tat not apply man Owner of a com who bunds se improves thereon,
and who eammens for such projecu with a romrecmgs)licensed pursuant to to _.. _. 204 UNDERFLOOR- FRAME - ---- - - -- - ------- --
01amexemyt`npae s«. .B&PC for thisroamn 205 - UNDERFLOORINSULATION
owner Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby afflmt under Penalty of rc:Uvey one of the following declarations: 303 - ROUGH MECHANICAL
t 1 ° I base ane will maintain a eenincrae of Consent to self-irma,rte Workers 3 04 _ ROUGH ELECTRICAL
Compensation. as provided for by Section 3700 of the Labor Code, for the 305 FRAME
performance of the wink for,which this permh is issued,
0 1 have and I will maintain Wil s Compensation Insurance,as rop,liffed by Section 306 - HOLDOWNS
37M of the Labor code,for to performance of toe work for which this Permit is 307 - INSULATION
issued. My WorkerS Compensation Insurance tamer and Policy number are.
3088 - SHEETROCK._... . .
Cam CERTIFICATIONOFEKEMPTIONFROMWORKERS'.' l . •303 '- :EXTERIOR,'LATH
O
CMPENSATION INSURANCE
�. _.
fmaectton�Idedno,Wcomplemdithe pmyritisrmonehandled!dollars 311 - SCRATCH COAT
010(ho,Icssi)
313 ROOF NAIL- . : .. ... ., _._ _. R.r.. . .... .._. ,
-ramal that G the n in any a of uc won ter come this permit a issrkeo'
:nml not employ any Person it any manner to as to become subject m me wn,kers 501 - FINAL EliECTRI CAL` ENERGY
Campenmtign l<sJs areanmto TJµ{/ 502 - .FINAL .PLUMBING..ENERGY
. Applicant v• _. .._..
NOTICETOAPPLICANT:If,aftf makid,this Cenincale of huornplon.youshould 503 - FINAL MECHANICAL ENERGY "
become subject the Worker's Compensmidn pmviunns of the Lubar Code,you most
z � ronhw;t comply asithsuch provisions ormispem6shanxdeemedresoked. 504 FINAL_BUILDING EN_
ERG_ Y
F � CONSTRUCTION LENDING AGENCY " 505 - FINAL ELECTRICAL
I b affirm that there is a constosnion lending agency for teperformanew tr
of the walk rwhichthia pro it isIssued(See.309i,Ci..C.). 506 - GAS TEST
y.p LenderxName" .. .. ....r_ .._,... _ - _ .- 507' = FINAL PLUMBING .. ..._. .. . ... . .. .. . _ ...._ _...
.`D. Z Ulider•snddress
U'O IanaythatIhavereadthisapplicationandstalethattheaboscrion lmnie 508 - FINAL MECHANICAL
ts:.t:. Forted.I agree to comply with all city vnd...my ordinances and nam laws relating 509 - FINAL GRADE
O U so buildingcornmmon.andherebymourimrepresentativesofmiscitytoenterrpan 510 - FINAL PLANNING
W the aWvcmemloned,pmpcny far inspersion purposes.
e, (We)to.to.mve,indemrifyand kecpharidesstheCity fCo,eriinoegainst 514 - FINAL PUB0,1C WORKS
rn liabilities,judgment,em¢and expenses which may,in any way accost,against at
U,Z City in conscgncnce of the gmming of tis permit.
"t A NT 'STANDS CO. PLY N-PY;+r Issued Date
F i15AT1 3NS: y'
or AppllcaMComm , " - _ate . Re-roofs
n - HAZARDOUS MATERIALS DISCLOSURE '
..:Will me�pphcaat or future Wiling ceculum state«handle natramors mme,;al Type of Roof -
-
as defined by,the Culational Municipal Cale Chapter 9.12,and the Health and Salty '(It•.-
coea.se[tmnassua)
0Yet °N •-' - All roofs shallbe cted,p
insperior to any roofing,ma[eria] being installed.
Will the pN cant or future building occupant use cqu pment tor devices which If a roof is installed without first obtaining an inspection'; I agree.to remove
emit hourytimp,e,corommumm,a.J f ed by he Bay n ea Air Oil Manugemeon
Dist t all new materials for inspection. Applicant unders
stands and dwill comply with
sit ❑r s.. ; . ON.
all Eon-point source regulations: -
�,p • Phit ve read thd haxardnus mamduls reymrcmems under Chapter 6.95 of he
Caliromin Health&Safe,,Code:Semon,25505.35533 and 25534,I undernmd tat
ifm bu ld due nm cu tly have a t[at mat its myrcpo bltyt notify the - -
ate p of ue re huh' y be et prior m iswance of Certificate of
°." /�l Signature of Applicant Date
0,.,nr vulbli.,at All roof coverings to be Class"B" or better
.. _I:.I --. OFFICE.