00080007 CITY c DIVISIONNo PERMIT CONTRACTOR INFORMATION:
`
BUILDING AlT10335. DEMPSTER;, AV � � PERMIT NO @@080@@7 '
Y .e r
OWNER'S NI• APPLICATION SUB DATE
AMLFS RONALD H AND •SLAIN G 08/01/2000
PHONE: SANITARY NO.' CONTROL NO.
O CHITIiCTIENOINEER: - BUILDING PERMIT[NJ
'm❑ ` BLDG ELECTPLUhIB' ,- MECH
N rz Is 1-1 CI I� 'LI•
'S yLICENSED CONIRACIOR'S UECI:AHAI'ION. Job Description
I.hereby affirm that[am lieaned under provisions of Chapter 9(commencing f ,
F= 5 withSel70101nfDivision3oftheBusinessandl'mfessionaCMe.andmylicense KTCHN REMODEL
arfull l.rcca eRat. - '
x o a
'unsrsO Contractor_ - 'r
ARCHITECT'S DLCLARAI N
1 d t 1 y plansshall be d a public rd.
tit ap 0 Licensed Professional
n E o Oan NER BUILDER DECLARATION
ARATION
17i 1ny difird, I 1 cal tat the c [Accuse Lew in. VY(.//
C?a Poll C (Secfun 7031 5 I{urine and Professor,Cornell:Any p rcoury ` A - ' -
I F'� wh'h rwmrcs a No t to ronawct,atm, p_ve,'demolish or avian any structure L
ed
3 pit I f smaller.,al eq Ih ppll tl hl miu I ig ed atalemem '
—
to'Its lie: Iprf.mon(o m I'v ouln Centimeters License Low(Chnipar,9
$y. FL Floor Area " Va I
ten g verb sea 7000)at Division 3 f fl B mina d P f 'cions Code) $GgtAon .
or that he is exempt therefrom and the basis for the allepd exemption.Any violation YJ .
of Section 7031.5 by any applicant for d permit subjects the npphiled to a civil pcnnllyor not more than live hundred dollar,(S500). P APN Number - 'Occupancy Type
-Ole as onvocr
wink,
gorinyc employees intendedth to s rs.feed .In compensation,'
3254.7@8@. @@
will d 0 k, ssi the a t C rot intended el Lm I' (Sec. toit,44,in Businessesd endee.i Code:Thecont e 1 bene 1 d n apply t alf Reqc�uired Inspections
mincorthr fhhisow cr dr II: prove thereon,and whohwork h himself 101. — FOU,NDF7TION
of through ors own howeveees.provided than such improvementsmtisulerre nm imemle0 of '
offered for ode.IL howeve.: w handing or improvement is a..Id he one yuan of ''•1 02 — PIERScompletion.nJhcawerdeilderwillhuvethchurJenofpmvingthathcdiJiiotbuilJor' UFER
improve for Purpnac of..IeJ. � ],@3 — - -
a
❑Leta owner ofjecd(Secn70r .Bcltisiv and Provisions remade Com m.bee 104 — REPAR
License the does
n (Sec,]TAU,owner
w Basin—o and Profusions iIde:)The Coolra neon,
License I...cw, 0nm....Yman..wnenr a cpenrwho bulIdsice nrimpmvu thereon, 1@5. — ANCHOR BOLTS
tied me common.for such pI Jcuts with a anmrvcmlVJ Ihvmd purenrm m the -
' cnntfaenraLicense Low. 10E — SEWER' &. WATER
0 l am exempt under See. ,B&P e for this Mason - • 2@2 .UNDERFLOOR PLUMBING ' • '
.caper WORKER'S COMYLNSATIONDECLARATION 203 — UNDERFLOOR MECHANICAL '
ntdrcny urrnnymlef penmty of pleijmy nne..nhn far.,vhig dodlia,ia.6.: - 204 — UNDERFLOOR FRAME -
0 I have Cad w01 arafolam a CeniEcme.f canmob1,wIfamn,.for Wowed 205 — UNDERFLOOR INSULATION"
,a rionamn, a.. provided for br Seem.. 37W of the lain... C_mlc. for the 3@i ROUGH 'PLUMBING ,
in .0 ce.kine work for which In,pennit'u issued... 7 - '
0l base Cad vial nournmiiWowers Canis,...Ii..ln.mul as reen-hol by Seetinn 302 TUB &• OR SHOWER .
3700 of he Labm Cede,tui. he arfmmnnen of the work for which flux In, i,t. 3@3 — ROUGH MECHANICAL
'.sued.My Worker's Coal,..mfirm ho,dea a wrier and Policy norther are:
CwmerAl?61AA?N P.hcyN..:f-.�ge1j130 , 304 — ROUGH ELECTRICAL_
CERTIFICKImNOE EXEMrnON FROM oR`12fR`S' • t - '.3@5 - FRAME -
COMPENSATION INSURANCE
(Thisseddolneednn(coonid,ledinhepen,mlxrnroahundreddollar. 306 — HOEDOWNS
(SIOO)oI'iers.)" - 307 — INSULATION'. .
I eenfy the tit the perfi a fth f` `f hch thispe ini d,1 308 SHEETROCK . _
shall t pt y,I P Y /d Yet Au tiw. c hJ t i , imkv.'
C, p fi ole I /CW 309 — EXTERIDR LATH - .
°P )� �1@ — INTERIOR LATH
NOTICI I'OAP�/ICARt'❑ mak gIh'C nl vat off ipu you should' v
II [lew k c ..n evolution shim Lan rcd.youmust
0 0 hmhwnh comply with such pr viii...or w permit.hull he deemed ked. 311 — SCRATCH COAT ,
E-I LI) CON Sr rRUMON LENDING AGENCY 313 — ROOF NAIL '
a 5 I hereby alBna[in.[there isu conameio I lending agency nor the[u,formanea —
a � arfueen^norwdentni .peamti.i<,ud(see.30],cm.c) 501 FINAL ELECTRICAL ENERGY
-D z Lv.der.Address 502 - FINAL PLUMBING ENERGY
0
D ^V i-
r 503 — FINAL 'MECHANICAL ENERGY I[nfY that mallapplication ❑ i Ih1h bit I tcorrect1 t ply Ian nY d t e nI mi r : I .
mit II' yea II nyd p teIn Tyt i 1 504 — FINAL BUILDING ENERGY
r w "` " et.. °"dr " p"`P 5@5 — FINAL ELECTRICAL
C6 (W) g n a d rc and ph Pena cry of y;nt •S@6 GAS TEST
tx] lahlt effluent I "': nIt any in any Y bx na til S
C,) Z A :q tfhgror IW pent. , "
APPLI UNDERST ND WILT COMPLY WITH AL N NPOINT
I� Issued by: 507 — FINAL PLUMBING Dale`''
Sou —REGUTA 2 �6
508 ll FIECIl
Slg.ai�in•„ry c.iLA AKDOU 3• Date Re-roofs r5@9 _' FINAL GRADE
fiAZAHDOUS MATERIALS DISCLOSURE
Will the applicant orfuutre building.catprm care of handle Inronllnl.m:nedolType of Roof _
.IF defined by the Cupenion Mnnielpal code.Cromer 1).12.and ate Heath find saner , 510 FINAL PLANNING
I NG
Code,Section 25532(x)? - •
Oyes IN' , 'All roofs shalF+t%specfedrvt(R1Pk UogWi FWN being installed., '
Wm the app]card or mere bili being Decorum use equipmen'or device.which If a roof is installed without first obtaining an inspection, I agree to'remove
emit If...Mo.,eit emo m curds as dermad by the Bhy Ama Air Quality Management
1)i.ridn? •. . - - all new materials for,ihspection. Applicant understands and will contply'with
❑Yd. pdrvd all non-point source regulations.
I hove read th<hxwNous inatefiols requ idnams under Choosel h.95'of the I ^a
Wifor.ia Ileollh&Sufny Cale,Sections 55(15,25533 end 25534,1understand thin(' r '
it he bonding due,not currently have at no that it is my isspmrti lily to notify the '
'siwupam of nh rcquiremems w ' t be met prior m isduance f a eni0cnm of
Occupant
�.' Signature of Applicant, . , Date'
owner..r uin.n:ed m . .safe All roof coverings to be Class "B"'or better -
. . - OFFICE " - • _