00090101 (2) CITY DIVISION SIrN°
BUILDING PERMIT CONTRACTOR INFORMATION:
BU I hDING AUDR BSS: PERMIT NO.
OWNER'S NAME. `5SWEE I- OAK ST APPLICA9'ION SIID I
'H(INE: HOPKINS, UHHib SANITARY NO.
OQG ARCHI'IPC1l1iNCINIiHRt - BUILDING PERMIT INFO
NLDG ELRC'r PLUMB ME(11
S h i 1,1 CENSEDCON'FRACIOR'S DECLARATION Job Description
a = 1 herchy indi the Iran licensed umler provisions of Charm,1)(commencing
F
with Sccdan7a(pof Division 3 of the H atiness nndd'mmssions Cudc,ond cry license
6 m -! is in fall force and eBecl.
doyu ueenscela,, Lie." REMODEL INTERIOR KTCH/BATH BEDROOM
[)areGmlmcmr t
a.61-n
ARCHITECT'S
nARCDECLARATION
I ueecanndmY Planfiall be-cclioindifie
recants
ou q —
u_p i0y LiccnuA Pndcrionul
e.a o RI OWNHR-BUILDIiR DECLARATION
E
n I herchy allirnt mm I not ea,npt front the Cummcon,Limo,e Low lin the
F>T following rerun.(Section 7031.5.Business and Pmfessim,s CMe:Any city err county
`S D
which 1c,laimsa Pennit ct)cononict.alI improve, I I sh P 'ny sinecure
n 3$ prom t c mm I theapplicant f u n N n 1 g J a t em
n
tthir,he is ircowd Ina—at tt n P the Commence,L1 ('n_ vrpmr9 Sy. Ft. Floor Area
(Commencing with Section 71(X1)of D vallum 3 uI the Br ,cm:td 11 n,fasi o,6 lt)
of chit he is exempt therefrom and tic basis for the allege)emmption.Any violmimr '
of Section 7031.5 by any cnpFlicant I'ar a permit am"t,the nppllcam n,a civil Penalty
or not tame than eve hundred dollars asap. APN Number c
191,as owner of the pm,cny.or my employees war wages as their sole comPermion,
odic do the wink,and d:c snname is seri intended or ofmmd lot sane(Sec.7(44, .4� '-RJ• red Inspections
Bmanucsn and Pmfesslnr Code:The Comracmr',Liccnsc Law does not aPNy ,,an p
of property who hnile(m improe,thereon,:rod who dormsach work sin self
or through his own employees,provided that such imprmcmenuam not Inended or
otfered liar sale,u;however,the nnilding or i,npm culan is sold wimm one year of 101 — FOUNDATION _
completion,me owner-hnilJcr wet have me hunicn of prating that he did not hand or
impmvclot puTawaf.:de), 102 — PIERS
Ajasowner onp
nempeny,amsmlmiclycontractinswdmhcensedcontmetomn 103 — UFER
immucit protea(See.7044.Ilnsincs and Prumssums Code,)"rhe Cmml:ear's
icense law does am apply to an owner of pmpeny who builds or impmte,thereon. 104 — R E BA R
Cnut who a,wets for sant ,.Ojc,t,with a contrnaonnl licensed par aunt m the
,:momn,�lionacc Law. 1.05 — ANCHOR BOLTS
❑l no exempt under Sec. Bir PC formic movan
1.06 — SEWER & WATER
Oncocri(lic—b-cil 'Dam q�I tgl O� _
WOR' R'S )MPENSA9'IO DR'l.1NA'I'ION 202 UNDERFLOOR PLUMBING
Ihereby mennunder ltenalmalIcdmf
yone„ oiefounwmgdeewraaa:on203 UNDERFLOOR MECHANICAL
❑ 1 have and will maintain a Cc, neate of Consent is wl6insme far worker, 204 — UNDERFLOOR FRAME
Contrt as anointed far n, Section ata) ol he Lane, Cade. lot he 205 — UNDERFLOOR INSULATION
,—IF n:n c,,at clic work for which thin permit is issned.
0 1 he”,1 il ill onaic'"in Worker's Ciropematin.a Insurance,as required by Section 301 — ROUGH PLUMBING
37W of the LaMar Code,liar the pamornmucc of the.,,,it for which this permit is 302 '— TUB & OR SHOWER
Issued.My Worker',CentPammiaa Insurance carrier and Policy number urea
corder: Purer No.:
303 — ROUGH MECHANICAL
crarnElcnru)N OR;ExliMrrloN FROM woRRrins' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE
305 — FRAME
tThisnenion need urn be aomplcmJ if tic permit is lin one hundred Jnlmrt
ala»rola., 306 — HOLDOhINS
I certify mut i:t the perlhrinance of the work for»loch this peons is issued.1 307 — INSULATION
shall not cold,lay pe,,an in any manner ser as a,become ounce,a,the work,: 308 — SHEETROCK
Cum,n,,nfiaa Law,of Cmiforttm.Dam
Applicant
NCTICETOAPPLICANT.If.after making this Cin"ificam ofEtemption.you should 309 — EXTERIOR LATH
anmhjccl to the Worker,Ca:opensnts Proona
uivia , nhe{.tmot Gsm
ale.yon ut 310 — INTERIOR LATH
Q 0 Mor
Ihnhwith comply withsuch provisions or this pemin shall be)caned otoked.
H ^ CONSTRUCTION LENDING AGENCY 311 . — SCRATCH COAT
>
ol nemhy effinto mat more is a amntnc a lending agency for the penmtnarme 313 — ROOF NAIL
f tic work far which thrm
is peit is issued(Sec.3()G.civ.C.)
oma. c l'=nd01',N; le 501 — FINAL ELECTRICAL ENERGY
I.m1cr's Address
UO 1eenifyIn.,Ihave read Old,amph,annnand.mmmmtheabovelotm...mir,0i, 502 — FINAL PLUMBING ENERGY
mF e,tea.1ager,mc.....plywithallcityandcram,nmounne,andsetslaws.]mart, 503 — FINAL MECHANICAL ENERGY
V n building aortmaion•aM herchy and we nprenatunivu of min en,It)comr rap,m
y me:dove.matfionedfoolery for im,echmtpurposes. 504 — FINAL BUILDING ENERGY
F M. (We)agrees anvr.inh, it.,end keep ha:n.less de City of Co,anlnn ngninst
(n liabilities,judgment,,cost,uad cspen.w,which may in any way a«me again,,aid 505 — ;J NAL ELECTRICAL
I CRL
U Z Cit I he a::•of thin permit,
in gra:, duJ
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: 506 — TEST pate Zg--
SOURCE REGULATIONS,
Sign a,at ApplicuntlCommatm Dam Re-roofs —
HAZARDOUS MArER1ALSDISCLOSURE 5083 FINAL MECHANICALWillme applicant m future wilding occupant sane sane or handle hnamdau,material Type of Roof
as dceaed by the Culwo as Mmdeipal Code.Charter o,12.and the Heahh ami Sanely 509 — FINAL G RADE
Code.Section 25532(,)^ -
❑Yes ❑Na All roofs shall befit{4{1eMd5AtifA.arl?lr( ALIAS t,(terial being installed.
Will meappecantOrfuture colliding occupant use egnipmem(it devices which If a roof is instalf5d.*ithouFi NAhtaiMb&nIBpbdtda, &gree to remove
emit haz.ohn,air comantimams as defined by me Bay Amer Air Quality Managcmcm
Disc;<n all new materials for inspection. Applicant understands and will comply with
0W'cs 0N all non-point source regulations.
I have read the nasafJous material.,reaPireaccus under Chapter 695 el the
Cali lnmia He' &Safely CstJe,Seain 0,25505:25533 and 25534.1 understand that
If the building Jces not cumently ham a mount,mm it i,my mpam,ihility m nosily the
eaaWant of the requirements which must be met poor to issuance of a Certificate of
/J. I .
Signature of Applicant Date
Occupancy.
Ownermamno mdagent 1 Date All roof coverings to be Class "B" or better