01080070 (2) CI ouOF
c DIVIISIONND
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
1159 SCOTLAND DR 010p800;170
Qtff
dASONG 08C/14/20A
0E1
PHONE: SANITARY NO. CONTROL NO.
w se ARCHITECT/ENGINEER: BUILDING PERMIT INFO
_ BLDG ELECT PLUMB MECH
<i
Z S r LICENSED CONTBACnOR'S DECLARATION Job Description
I hereby alTrm tat licensed under provisions of Chapmr9gommtn<ing PRESSURE TEST GAS LINE.
o,zaI_ with Section 7000)of Division 3 oflhe Business and Professions Code.and my license
m I is in full force and fcc
KOiLicense Class Lic.ro �
F LL O DJI[ Canlfaetof r-�
ARCHITECTS DECLAR N
1 understand my Carsshallll be he amd as public recoNs
f ili
icec Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby (Sect that 1 1. exempt from,he Professions
s Cod License Law for the
C
following uirereassom
sea emiiot 7031.5.Business Professions Ca de Any city or county $Cj 0
swhich=quirts a permit to cnnslrvct,cele.,improve,demolish,or rearmr any structure
i 3 Primmia vwamt.cele rcquimz the applicant rot wcM1 permivafkasigntd slammem - - -that he is licensed raccomm,hi,Ime,isim,ofthe Contractors License Uu,(Ch,pm,9 36g�12�0 @Pr;oam Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Cale) ) �'.l,'
tor that he is exempt Ihc=Gom and the basis note alleged ec enominn.Any violation '
mf Section]031.5 by any applicant for a permitsubjects the appl'mam to a civil Penalty ppff,,,.,/,,,,�
of not tire=than five hundred dollars l 85(X)1. 106`4 NM#13R & WATER " 'Ir Occupancy Type
El I..,..a,,offfic proluen,orm,employees i,h wages a,thal,adtoorntpers,oi.a. 202 - UNDER
will J Ili work.ood theCode:The
a not mended e offered Law for sale a<r].or 3 01 - ROUGH PLRH�IB&NOspections
'Bus do t and Pro.. ions Code The isContractors into Licenx Lew does nm apply to 4
owner of property,Who builds or improves merlon,and who does such work himsdr 302 - TUB & OR SHOWER
or through his own employees.lismodedfloo such imp=ameas arc not intended or-offered for moo,l(.na+.e.a.meb ave o;imp=+cmrnr::oldhadidoneyearof 502 - -FINAL;" PLUMBING ENERGY
omplekn,tut Dent.-d file.).wa1 b,.n to drrden or proving that Me ilia not nude or
improve rat sures ar wlel. 506 - GAS TEST
_. _._._..__..---- -- . _ _.. _ . _... _ 507' ------FINAL "PLUMBING--'---- _ —
01,as er,of the pmperry,a exclusively contracting with licensed comments to
.. / c
onstium the project(Sec.70,1 Business and Professions Codc:)Tat Contractor's j
License Law ams not apply,o an owner of property who builds or seimproves to the
" mmerm-,Liaas for such projects.wi,h.a comm�nm(sl licensed pursuant to - - --- -
_ .. ...tun ... .. ... _ _ ..._.....,___..__ ..... . . .____. ..... __._.... -_._.... _ ...._. .. ....
01 am exempt
picunde Law.
Glum azempt under Sec.' \� .B&PC for his rtnson
OwnerDate' 1 '
. WORKER'S COMPENSATION DECLARATION
. .' Ihereby affirm out, not,,of perjury one of the following doelm=lions:
0 I have and will maintain it Ccnifmtc of Consent=self-imine for Worker's
Compensation, ...provided for by Section 3700 of ,he Labor Cade, for the
performance of m,work for which this permit is issuN.
01 have and will riWmam Worker's Contpenmtion Insurance,as required by Section
?sIkl f the Lades oil f II I mm f the work for which this permit is
''uJ MyW rk� mr and Policy rather are
s
Cn "e n (PnIryN ..0 g1GL7—L�' 1- 1-00
CERTIFICATION OF EXEMPTION FROM WORKERS':' `
. COMPENSATIONINSURANCE°:.
!11•x. 1:,.:'111. :. t
iTficcilnn tired tai x camteJ pk .r me permit is mr ant nunutw dancers
e
IS 100)or ka.I
1 ten fY that in me rein antic,orbit k f hicM1 tee n owed,1
-'sm em
,shall noy any persotu any matter w ni.,to be c
me subject tt to the Warkds
Compensation Wws nr Califdmia.Dac.Applicant. 7"
'NOTICE TO'APPLICANT.If'runacAn, hsCnifcate of Icxciapaun.you should "
C 0 As subject bjeco theta k C p.nd,i provisionsof the LaborCde,you most
forthwith comply with. eh lausiAna,or do,ormin.hall be deem d resulted.
hkfo
CONSTRUCTION LENDING AGENCY
m[work f y'ali m that there is a commaction leading agency for the permis once
of
,-r'which- this per=il is issued IS3097,Civ.C.I
lander'i Address ..1'•"
'U.C) 1 certify in.,1 have read this applicminn all late in., be leave infortnaion is
'Gzs (•" carred.1 agree to comply,with all city and county commerce,and state laws relating ,
m building construction.and hereby motorize representatives of this city to enter upon
the above-mentioned pmpeny fnr inspection Paul s.
ski., y
(We)ayrecm.v,Jade rify and keep hsmleiithe City mCupeninn against
V) liabilities,judgmcom costa and,enpenscs which may an any way term,aguiro said
J,rZi City in comequenen of the tanto,or this permit.
APPLICANT UNDERSTANDS APilksWILL.COMPLY WITH'ALL NON-POINT
sot' REGUL S. ("< Issued by: Date
tprc of 1'anVCom tor, Dam Re-roofs
HA2AR Us MATERIALS DISCLOSURE : -
- . 'k
Win lbc'.Ppecan,orfuture himi remperandem«handle ha:;mou.material Type of Roof. (((
"Cefincd by the Concern.MunicipalCode.Chapter 9.12,rand the Heath and Safety t --- n •�- \ j•1 p n +'
Cade,Section 2553211 :, I'I1 r .- IJg ' .
0reses .,-oNa ,., All roofs-shall be inspected prior to any.roofingmaterial being.installed.... . . .
Will the applicant Rare building occupwcq p t devices which If a roof is installed without first obtaining an inspection;`t'agree-to remove
•eon h" d sal c namin,al,as Jefn J by the Bay Area Air Qua1'y Management,
n"ntt. all new materials for inspection. Applicant understands and will comply with.
_ ) ❑Yea oNa ; 1T • _ - all non-point source regulations,.,,
f• I have read the'humNnui niaerial requiremniu'under Chapter 6.95 of the
Courani.Heat,&Safety Code.Sections M505:25533 and 25534.1 mdersmnd Lha
if the building does not curtently have shown.door it is my responsibiliiy to notify the, '
occupant of the tarponme s which must met'1101 10 issuance of b Cenificaa oL
� Signature of Applicant __ _ . . _ _ . - - Date
aumari:e .�t; Dam All roof coverings to be Class"B" or better
} _. _.. .
OFFICE