02050154 (2) TY OF
CI
BUILDING DIIVIISIIONNOPERMIT CONTRACTOR INFORMATION:
12fEm°"l'PTAN JUAN RD PERMIT NO. 02050154
SSA ABRIELE L AU5(7 Znn"2
HONE: SANITARY NO. CONTROL NO.
w O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w E BLDG ELECT PLUMB MUCH
�Ni LICENSED CONTRACTOR'S DECLARATION aAMT1GE REPI�escription
Z_ I hereby a nto that I am licensed undo provisions of Cha ter 9 m
l-at with Section 70m0)of Divis I�'saM fe e m
is in full force and effect. ' s\\
c a License Clan. Liv.g 1
' a.U Date Conye<ror : f'
13 u{i, AR DECLARATION' .,% t'
t= at 1 amerstenJ my plans a used.s W lie rtcorlLs°
i u`•1 n �, M c
3-g2 E LicenxeJ-Professional Y•\
'd OWN the I '
= 1 hereby.math that I e exempt emitslum the Contractor's o License Law for the $1000
!'Z a following mason.(Section]onstr Business and improve.
demolish,
Code:Any city or county
S x e which requires a permit to construct,ths, .Iter,improve.demolish,or repair tanyed structure
r�3w priors.it,ienesed ,.air,an die srtvisions o formi commuctor"U..La aismtemem _
amtheislim,with
pursuant tdshe.fDivisiof the CeBusines and
Isw(chapter 9 g..•,l, s. .,, Valuation
fcommmcis a with gection mann° Division 3 of she Business and Professions Coded �, 1,'s 1'((, .s �l
or rhei be is exempt therefrom end the basis for the elleyiA exempion.Any violation
°fro room than rie`n dmd do[].m(s5ooj.tt subjects the.ppheantmaer.d Penalty APN .,, Occupancy Type
❑I,as owner of the properly,or my employees with wages as their sole compensation, 102 - PIERS
will do the wmkf end the structure is art intended or offered for sale-(Sec.7044, -
Businesennd Professions Code:The Contractor's License Law does not apply to as Required Inspections -
owner of property Who builds or improvea thereon,and who does such work himself 104 - REBAR
_or through his own employees,provided shat such improvements arc not intended or 105- - '-ANCHOR BOLTS
offered for sale.If,'however(the building or impmvemcm is sold within one year of
Iompletion,the.wnerbuilder will have the burden of proving that he did not build or 106 - SEWER & WATER
mprove far parpose of side). . 2.02- - UNDERFLOOR. PLUMBING._.
Cl 1,as owner of the perry.-- exclusively contracting with licensed contractors to 203 — UNDERFLOOR MECHANICAL '. :
,
conswct the pmpoe (S..7 .Business arta Professions Code:)The Cituractor'a . . -
Li<enss55,law n apply an ownerofpmpenywhoWildsorimprove;dincon, _ _204 - UNDERFLOOR FRAME .
end yfi.coat cts.for sue .protect,.with.e conuechms)hicemed pursuant m the. ..
i cnntren.a.0 me Law 205 - UNDERFLOOR..INSULATION
_ ❑Idmexender 'OY3eePef°rwareaann 301 - ROUGH PLUMBING
w ' J WOR 'SCOA1P SAT10NDECLARATIOON 302 - TUB & OR SHOWER
the yaffirm under penalty;orpnitiiyone nnhefnhowingdeclarations: 303 _ ROUGH MECHANICAL
❑ 1 have affflllnd will maintain a cimi mitteof Consent w selbimato for Worker's 3 04 ROUGH ELECTRICAL
Compensation, s provided for by section 37W of the Labor Code, for the 305 - FRAME
performance of she work for whichthis permit is issued. 306 - HOEDOWNS
❑I have and will mainat in Worker's Compensation Insurance,as acquired by Section 307 - INSULATION
37W of she Inbor Code,for the performance of the work far which this pcimif is
issued.My Workeei Compenpadon Insurance artier and Policy number arc: .30.8- 3HEETROOK. - - -- _ -
i C)}-
Gorier: r s E' 'policy I t''. '3 0 9 'i !EXTER30R .LATH,
C '
tl '. GRTIFlCATIONOF EXEMPTION MOM WOR
' : ,.
•,.-3
: - >''r man T•/�n r _-_ -- ' _ ---
COMPENSATIONJNSURANCE ... . ... .10_..._...1
This section need not be completed it the permit is for one hundred dollars 311-, SCRATCH COAT
aloo)prmaaa . 313 - ROOF NAIL
. .
1 nfythtmthep9eif rte nn wrkrrwnrhmapcmtt '.asuca,l 501 - F•INAL- ELECTRICAL,�,ENERGY
Comenasuon?s�'yalto°°°y yd mer °j` b � W° `rs 502 - FINAL PLUMBING ENERGY
�t y\/
NO
om E'TO APP is ANV It,an m M25 Cerlfiam or Exemption,yyou should 503--- FINAL -MECHANICAL_
"ENERGY
z sublectm worker.comp2nsmronpmvrsmnsofthel:,bnrC°e,youmdst 504 - FINAL BUILDING ENERGY
Bothwith comply with such provisions m thrs pemsn ahall be deemed revoked.
z 2^ .:. . . __..._ . - 505 - FINAL' ELECTRICAL _ ._ 1...... _
to CONSTRUCTION LENDING AGENCY ' '
I hereby afrm that there is a construction lending agercyfor she performance 506 - GAS TEST
� ' hich thispcapdt is issued Sec.30971 Civ.CJ
k7.p .Lender'.Name .: