02050167 (2) OF
CI BUILDI c DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10775 STEVENS CANYON RD BALDE NIARINKO AND LAURA M 0
OWNER'S NAME: APPLICATION SUB DATE
BALDE MARINKO AND LAURA M 05/28/2002
PHONE: SANITARY NO. CONTROL NO.
41
m teZARCHITECTARNGINEER: BUILDING PERMIT INFO
to
W
BLDG ELECT PLUMB MECH
rd� I'-'i I"-U CJ LJ
Z w i LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby O irm Not 1 am licensed under provisions of Chapter 9(commencing
�_e� with Senion 70oq of Division3of Nc Bueiness and Rofcsxions Code.and my faeces DEMO OF LIVING ROOM
is m full force and effect.
zU Liccnx Class Lic.N
Dare Contrucr
t)S 3 u ARCHITECT'S DECLARATION
C LL ON g 1 understand my plans shall be used as public records
N
an i p O Licensed Professional
a. OWNER-BUILDER DECLARATION
I� I hereby aRrm that 1 am exempt firm the Contractor's License Law for Ne
I_S-Z a following reason.(Section 7031.5.Business and Professions Code:Any city or county- $2000
Y E O which 9 pant t t construct. la p e demolish.h p any swuurc
an pricrrou issuance.also resumes Weapplicantri uch pemdtmfl agnea statement
3 that he t c sed Panama t90teprq ata of the Contractors Licenselaw(Chapter9 s ,$$ spp,(�p�p or•Area),Lt j-1i-. - Valuation
(commcncal;with Set 7000)of Division J of the BusinessdP lgOrans Code)
TSI J,�i�3t429197iU 921;"O.O./f.t.: ]a`iA i:.�.`l:
or that he is cacmpt thcrtfrnio and the basis for the alleged emmpdon.Any violation j
-of Section 7031.5 by any appiicenk for a,rani,subjects the applicam m a civil penaLLy ��gpppplI NN��mmhhCI
of not more than rive hundred dollars(S500). NO ASSIGNEL INSPECTIONS Occupancy Type
❑I,d the
work,
and the structure
my intended
or
u ed for s
wusimarthnd Pro and the Code:
The is not intended or offered for snot(spay lou: - - Re aired Ins ections''-
Business andProfessionsWWI
Wilds
The oyes Contractor License law does not apply to elf q p '
Owner ofpropertyhis ow Who builds or improves Ncreon,and who docs such work intended
or
of through his own employees,provided that mph vementemenrs arc not intended or
.tiffcrW ion.th, 1C'howerer:theill have dr improvement.solar within nos Wier of
completion.purpose
owner-builder will have the burden of proving that he did not Wild or t
improve for Purpox of seised.
• .i 0 aaawncr ohne, pony. -.. y gwt do
plus I c lraztn nCodc:)xdc Contractor's
,rte®
.:
construct the present(S . to a Business J Professions Cade)The improves
tmnor's � t ,t 11;,
6: License Law dcea noiapplyr-sac no an owner of,corny who builds m improves thereon,
_ .. -,'nd,who.commcts. Law. h Pelcce with.a mntranor(s)IicensW pursuant m Ne. ..._ _. .._. _. _.—..-.. NOV
Contractor's LicenseLaw. �, O.2002
_ ❑lam cx mptuad Sec. ` W&P C forthis reason
WORKER'S COMPENSATION DEC[ RATION
BUILDING
I hereby M.under pewity of perjury one of the following declamtions:
❑ 1 have'and 'will'dtaimam'"a Cinificam of Consent to xlr-insum for Worker's
4 Cmu,som on, as provided for by Section 37W of the Labor Code for the
performance of th'e'walk for,which this p,rmit is issued
❑1 have and will inainioln Wmmr's Compensation Insurance,as requited by Section
37W o1 the Labor Code,for the performance of the workfor which this permit is
iaaved My Worker's Coinpensation insurance carrier and Policy number arc:,
IN
C rtmr 1 'BCERTIFICATION OF EKEMPTION FROM WORKERS 's a i�ca l il..Aw L.,i•S)3e1 1 �1.}'�i t Iv
x (V F �"Y.AI s'4 `
COMPENSATION INSURANCE,�_ � L
__....1.. . ..:....:.,.FICA.,,._.._,.. _ .. ., .. -'_-'—_'----"---`ICICI-__ ,•. .
(This'sectinn need not lb "completed if the permil is for one hundred dollars d
1$100)or le".) „
1 certify that in the performpnce of the work Ina wp ch this pemi t m tasued i s, ? ,1,x ;
xh 11' 0. 1I.14M?CZA%
Y a nY�fr��99a^�/.__�,9 be b3ttt t w k rs
C meafC I P�m LMs.�L_ _
.A„hen - l iq a M 7t If fm g t ofE mpto y h IdM1e e K rk r C mph t , . ns of th Labor Cede you must
7w thcompywith. ch provisions or this permit shall be deemed revoked
Z '-t ._— _. .._ .. __. .. .. .. .... . . . .. ...._ _..... ._.. . .
150 'CONSTRUCTION LENDING AGENCY '
F•t
1 hereby affirm that di is a construction finding agency for the perfnmmnce
r of di
far this permit is isaued(Sec.3097,Co,C.);
A ...... _._ _:...... __.. _ _. .. _ _. _ ..._._ _ ....._. ..
of the work for which
T adef's Addre.as
.DZ :r. n ' s. ' t' i. .
U 0 I certify that)have mid this application and slam rhe the above information is
correct.1'go-no mm,ly with all city and county Initiatives and stain laws mlming
+ Q,U no Wdiingcon.xwction.and hereby authmm mpre.sentatives of this city to enter upon
,tri Pie t nedi ,eny for inspectionpurposes.
..
(We) t a n
' J 'fy and kpin lax the City of Ctpennoginst /q
IZ) liabilities.judgmen6 t and expenses Inch. ay in any way ain ue against aid }� T
U Z City qua cc fthe'g m gof nh pernut r'`
i PLC NT(T^EI�,S`r NT's ANDWILT COMPLY WITH ALL NON POINT'” ISSl1Ed by, Date
5 n t ll'A a JC tr tp t Date . ' Re TOOTS
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or f t rt WtW g occupant store or handle harmdona nnatcrhfl Type Of ROOF
a.tis f d by theConcertina Manic p 1 C d Chapter 9 L J the Health lth nd Safety a
'Cod S tn25532O - ' t" 'rat Qat @..Iris
17Y• ' j "° All roofs shall be inspected prior to any.roofing material being installed._ •. -
Will the ppl, t future building occupant uxequ pment ordNce hien If a roof is installed without first obtaining an inspection:1 agree to.remove
e t h e rdo r c i- no,as deli d by the Bay Area Air Quality Management
a:me naaa dp agerlalx regoircmrnts awre.cnapmr b.9a qrt all non- oint source regulations,
.;, PP and will comply.with_-
District? all new materials for inspection. Applicant understands
❑Y Nn p g
. - „ 1 hav he
Caldomla Health&Safety Cafe,Sections 25505,25533 and 25534.1 uadcramnd thin
-ti tvv cm of the es not mentacurrentlywhich
m st he met prior my responsibility to notify tate he
Of - -"
'ix<up it of the requirements which must be met prior to issuance of a Certificate of
°' ` Signature of Applicant Date
'o cr ,amhooi cdpgemt I>m All roof coverings to be Class "B",&better
k.. _. . ,_ . .. OFFICE -- -