00080159 (2)ase ayr vva rana,nv
Buu.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWNER'S
ARCHITEC rIENGINEER'.
LICENSED C11N'I RAC POR'S DCCLARNPION
I hereby aoirm da, I am licensed under nmeision, of Chapter 9 (commencing
with Section WMMB of Division 3 of the Business and Prnfes,iom Code, and my license
Lin fulll'orce and client. �.-p/ ���
icence Cl v s l.ic. a �_V%
Dam Contractor
ARCIIIrliC'1'S DECLARrcnON
1 undan mad my Nan,,hall 11a used as public recnNs -
Llacnsed I•rofcssik I
OW?IER BUILDER DECLARNUON
I hcrcby nt]irm that I ant clamp, fmm Ibe Conlrarm, s License Law for the
follm Ing ocant. (Srollon 7031.5. Bu, sand P,ofan :, Coda: Any v,,y n runty
which requires a Permit to construct, alter.impmse, denudlsh, kir repair any slonclum
prior to its issuance, also requires the applicant lin such Farah to file a signed statement
Ihal he is licenvad on,uwa In Ibe Prnvuioms of Ibe C..nlnrtmr, hicenw I.aw (Clionar 9
(commencing with Section 7M)) of Division 3 of the Business and Professions Cade)
or that he is exempt Iherelinm and the basis for the alleged exemption. Any violation
of Section 91315 by i y applieunl for a lentil n troks the aplillemt to a civil pcnldD
of nal mom than live hundred dollen (S50).
❑ I, as owner of Ilie pmpcny, t]1 Iny omployte, with wages as 11ho, sola canmensufmn.
will do the work. and the suueure is no, intended or offered for sale Sec. 70,14.
Business and Professions Cash: Me Contractor's License law dses not apply to an
owner of pmpcny Who builds lir impnrves ,hervan, kind who does web work himself
kir through his awn employees. budded that such vement manb cera not Intended or
offered for rate. If, hmsever, the building or improvement is sold within one year of
omplctilot the owner -hid .). will have the Horden kir proving nun he ;kid kine nand kir
lnpra.e rnr pmrlxaaa kir side.).
El I, u, owner of dm p,coy, :IIs ceclunsely contmetin, with licensed eon,aviors m
construct the project (Sec. 7134, Business and Podessiom Cale:) The Contractor s
License law does not apply to an owner of pmpcny who Wild, kir improves thereon.
kind who sanlmm, for such projects with n ,onraaor(s) licensed pummto in Ilia
Contractor's License Law.
01 am eaemnl under Sec. . It & P C for this mason
Dwner Date
W'ORKER'S COMPENSATION DECLARATION
1 hemby all maker rally of perjury ane 0 Ilie following dcdaatlom:
1 hove and will m'alntai. a CcnE,me of Consent m self-instrc for Worker's
Cumperi,sam, a, pn,iJW for by Section 31M1 of the labor Code, for the
Performance of the walk roe which this permit is issued.
01 have and will maintain Worker's Compnsullon Insurance. as required by Section
P(p of ,he Labor Code, for ,he performance of the work far which this panni, is
Issued. My Woa�rkk)cr', Cmllretls:nion Insurance carrier and Policy number are
Comer:R-14ACL�C-4S Policy No, 8(1?Ckraj:f I
CER'I'I IICA'f10N OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(']all section no art not be cmapleicd it penal is for one hundred dollars
(!0 00) or less.)
1 ccril'y that in die Pcriarmunee of the work for which ibis Permit is issued, 1
shat] not employ any Person ill ;in, Inalmer w to m hOi, a subject Io ,be WorksN
Cnmpensaiun Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, alter nmklng Ibis Cerllicute of Cscmptim. you should
Wcame subject to the Warkers Compcnmtion prnvisiaas of the Labor Coxae, you must
ltal comply with such provisions or this Permit shall W (learned revoked.
CONSTRUCPON LF.NGING AGENCY
I hereby or that there is a construction lending agency for the performance
of work for which his pornlil is issued (See, 3097. Civ. C.)
Unde: s Name
LemPcr, Address
I certify that I have read this application and scte, that the above inrmmeti m is
correct. I agree u) colnply with all city and county ordinances and state laws relating
os building cnmtmction, and hereby autbnriza npresa ak ivm al this etry to enmf upon
the vhove-mentioned Properly for inspection pmglnses.
(We) agree e. coact indemnify and keen hmmlms the City ed Cunenina against
liabilities, jodgnlvnls, costs and claroc, which may in airy way accrue against staid
City in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY W FII ALL NON -POINT
SOURCE REGULATIONS.
Slgmmure of A, icamlComm,lor Dam
IPA%ARDOUS MKfERIALS DISCLOSURE
W II the applicant or fall Wilding occupant .atm or handle hvnNuus neacrial
n dclined by the C. dome Municipal Calc. Chapler 9.14, unA the Ileabh and Safety
Coxae. Section 25532(11)"
0Ye, 0 N
Will the applicant kir future halld'Ing occupant tine cquipmend kir aevicca which
nn hazardous air conmmimmn, i, defined by the Bay Arca Air Quality Management
let .1
DYes ElNo
1 have read the llarnrdous mattrick requimmckin under Chapter 6.95 of the
Calltarnia lleallh & Safn yy Code, Nacho... 25505.25,5)3 and 25534. 1 and. ,and Ibm
if the Wilding does nm currently have a larla d. that i, is my re,ponsiali,y Ice notify the
«canard ntAc regnir,menti albich nlusl be nick prim to issuance kir a Cenilicam of
L'4]
NO
NO.
RLDG ELIfroou'vu PLUMB uses,; MECH
Job Description
REMODEL BATHROOM/WINDOW CHNG OUT/ADD
FINALE®
Sq. Ft. Floor Area .
APN N ) L
valuation
Occup:
•-
6 red Inspections
101 —
FOUNDATION
1.02 —
PIERS
103 —
UFER
104 —
-REBAR
105 —
ANCHOR BOLTS
106 —
SEWER A 14ATER
202 —
UNDERFLOOR PLUMBING
203 —
UNDERFLOOR MECHANICAL_
204 —
UNDERFLOOR FRAME
205 —
LINDERFI_OOR INSULATION
301 —
ROUGH PLUMBING
302 —
TUB & OR SHOWER
303 —
ROUGH MECHANICAL
304 —
ROUGH ELECTRICAL
'.305 —
FRAME
306 —
HOI-DO14NS
307 —
INSULATION
308 —
SHF_ETROCK
309 —
EXTERIOR LATH
31.0 —
INTERIOR LATH
311 —
SCRATCH COAT
313 —_ROOF
NA.TL
501 —
FINAL ELECTRICAL ENERGY
502 —
FINAL PLUMBING ENERGY
503 —
FINAL MECHANICAL ENERGY
504 —
FINAL_ BUILDING ENERGY
505 —
FIN91_ ELECTRICAL (,
Issued by: 506 —
GA3 TZT Date
Re -roofs I rl_ul•I�irvo
Type of Roof 508 — FINAL_ MECHANICAL -
509 — FINAL GRADE
All root's Shall bc`'t, aFj1-IfiiN1AAIdfaterial being installed.
If a roof is instatTik14,vi0holff ENAl,buti7([Q!ad 1bs[Wt3 ,,9 agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -p int source regulations.
C
8 -a 3 -00
St Tat re ol'Applicant Date
All roof coverings to be Class "B" or better