01040050 (2) CITY 11,1Ne,DIVISIONNo
l(g PERMIT CONTRACTOR INFORMATION:
BUILDING ADDIF0480 RIDGE VIEW CT 1'F.RMIT NO. 01040050
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APPLICATION I]�D T
OWNER'S NAMF.DCI INC 2 Lt ��.t L�—_f Ail,.i�_'T 'r' . 1./2001
Id HONE: W T74•Yr� VY QTC�/,ag-�T•V SANITARY NO. CONTROLNO.
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BUILDING PERMIT INFO'
O 0 ARCHITECT'?:NGINIiIiR: BL-DG/ ELECT PLUMB MACE /
Ir 5 CN C — C - L(,J�
�, LICENSED COM'RfuDECLARATION
Job Description
ZO z_� 1 heresy aRmuhvt 1 am Iiccnsedmaderum)tt provisions of Chapmr 9(commencing
with Section700IAof Division 3vfthe Businessand Pr/efessioax Co/de,q{p(�my license MODIFY CONFERENCE d TRAINING ROOMS
is in fall force and'elieel $•Y/ �J V
�a lan, Lie'" CONVERT TO ONE CLASSROOM d EQUIPMENT
3 LL v Dias i__[(Ly(rr S DECLARATION A l j l
a R H1TECusidaspoldic'TION �f1L• ' ROOMS WITH 'TRAINING FACILITIES.
1 .am ossa as pante rceoms
neE 0
p 1,'eensed Pro s
OWNER-BUILDER DECLARATION
=to to 1 heachy aM.a that 1 am exempt from the Contractor's license Law for the
>'
billowing retter.(Sccl703151hevins—analP feaiun,Cod Ally city or county
Owhich requires a perms to construct.alter,improve,demolish, terair any structure
d3 m
poor n insucause.tilso manures the+rpl L to such permit file.litioned statement
that his sed pursuant 1the prio4toons ofilic Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 70W)of Division 3 of the Business and Professions Code)
or that he is escmpt therefrom anti the basis for the alleged exemption.Any violation
of Section 7031 5 by any applicant for a permit subjects the applicant to a civil penalty y yypp
of not mom thav five hundred dollars($500) APN Number Occu?anc 0fd1D
t71,as owner of the pmpany,m my employccs with wages as their snle compersomen, - S
will do the work,and the suucmre is not intended or offered for sale(Sec.7W4, Ired Inspections
Business and Professions Code:The Contractor's License Use does not op to an 3 1 F p
caner of pmpeny Who builds or improves thereon,and who does each won 31606047
•�I3
or @rough his own employees.provided that such imprnvc, arc not in
offered for sale If,however,the building or improvement is sold within o year of
completion,the owner-Wilder will have the burden of proving that h'di 'dor R�/9 DATION
improveforpurpon, ofsale.).
❑1,as owner of the pmpeny,nm exclusively contracting whh Ileunsed co scans m I
cnnstmct the project(Sec.]t144,Rosiness anti Rvfewime,Coded The tar's
License law does nm apply m an owner of property who W ilds or imp
and who contracts for such projects with a umtmcmns)Iicens t pursuant m R
Contractors'License low. e
❑Tutu exempt under Sec. .B@PC for this renxvu K -"� R pLT5
'Owner Date /WATER
WORKER'S COMPENSA'T'ION DECLARATION
Ihereby affirm under Penalty ofPerjury one nthe following deelamdon.: 202 — UNDERFLOOR PLUMBING
203 — UNDERFLOOR MECHANICAL
0 1 have and will maintain o Certificate of Consent to self-insure for Worker's
Compenmima a, provided for by Seetaa 3700 aT the Lamar lot t the 204 — UNDERFLOOR FRAME
errarmamennhewmkrmrwmenm permhi,issued. 205 — UNDERFLOOR INSULATION
❑I have and will maintain Worker's Compensation Insurance,as required by Section 301. — ROUGH PLUMBING
3700 of the],,,he,Code.for the pc,fmmanca of the work for which this permit is
loaded.My workers ematpen.am.n ms ma,rearrlerand Puh;yi
tntta- ,3'02 — TIJB & OR SHOWER
'Carriersl_fC,(CeS,!_I�COTION'y�OF eicyMPI No nrMAOM wo�KDp,NS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE 304 — ROIJ0I.1 ELECTRICAL
(This section need not he completed if the permit is for one hundred dollars 305 — FRAME
(4100)or le".)
I certify that in the perfornmace of the work far which this permit is issued,I 306 — hIOLDOWNS
shall not employ any person in any manner so as to become subject to the Workers' 307 — INSULATION
Compensation Laws of Culifomin.Dare
Arplicam 308 — SHEETRnCN
NOTICE TO APPLICANT:If after tnoking this Certificate of Exemption,yon should
Obeeo.,adijea to the Workcis Compenution pononansof the Labor Code,you.all 309 — EXTERIOR LATH
forthwith comply with tach provisions or this pctmit shall W deemed revoked.
m CONSTRUC'r1ONLENDINGAGENCY
310 = INTERIOR LATH
a 5 Ihereby affnmthat them isaconsuuctiotlending agencyfor the performance 311 SCRATCH COAT
of the work for which this permit is issued(Sec.3(197.Co.CJ —
1y `q Ixnder'aName 313 ROOF NAIL
U O IcnderlrAdtiress 501 — FINAL ELECTRICAL ENERGY
I venire that 1 have read this application laand nae that the aside information is
li,ai0 U cored.Iagreeorcomplywhhallchyantieountyvnalvicesand damlawsrelining 502 — FIIVRI_ PLUMBING ENERGY
0 C.1 mnulldingcemilme io..unit Illy Ix
hyauthmlac represenwtivev of this city to enter upon r
meant(We)taree toolv, raccoshapecnknpharmle. X03 — FINRL MECHANICAL ENERGY
F y (a,j.d, a,,mast,an c ily ons keepwhich
hornless the City of Cure against
i ainst laid —
(n IiaM1ilities,judgments.msuemleapensesxhichtmeyinany wayncemeagainstxuid 504 FINRL BUILDING ENERGY '
Citt> APPLICANTin 9uence 0UNDEESTc�' .'D WIa eonP PLY WI 1'11 ALh NON-PONT 505 — FINAL ELECTRICA'^
SOURCE REGULATION.. t•+f- ��— ISSIICd by: 'T1atC
Signatureof A,heandConws nr —7 I—Datata' Re-roofs _.
HAZARDOUS MATERIALS DISCLOSURE 507 FINAL PLUMBING . .
Will the applicamnr forum huildingaxmpinal Mote or handle becomusmaledid Type of Roof 5708 — FINAL MECHANICAL
as defined by the Cupe"mr,n1{Inicipal Cade.Chapter 9.12,and the Health and Safety
Cole,Section 25532(a)? \y` ��p
O Yes' No All roofs shall b��lt�, ectef 1 alto A R.Fin�r,m, aterial beim installed.
Will the applicant or future building occupant use equipment or devices which Ifaroof is instarPl��withoGt 66t�i' if1 >iAketion, la�ree to remove
mit harerdous aur contaminants as defined by the Bay Area Air Quality Management
Dislid, all new materiah to inspcct1MA)ApP)JBh.1QerWERKFnd will comply with
°Yes No all non-point source regulations.
I have read the hamrdnm mmedals reynire ems under Chapter 6.95 of the
California Health@Safettt�yCode,Sections 25505,25533 and 25534.1 undentund that
if the building do yRTt cmrrvs'gtf ammml,that it is my rsponsiday to roily the
eeupvmof the }rhCRILuR.I wimeu�r to issuance of a Cenitivum of
Occupancy. -5,` _0'
Signature of Applicant Date
Owner oraadton7,ngetn Date All roof coverings to be Class `B" or better
OFFICE