02090144 CITY DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
I�u1�D?ry r'98MESTEAD RD (BLDG2) BLACH CONSTRUCTION COMPANY PE IT02090.1yrT44
W56" §hMARITAN UNITED METHODI 1650 LAFAYETTE ST APPLICF�J
NSJ O/ LOO2
(408) 244-7100
I PHONE: SANITARY NO. CONTROL NO.
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W O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
E pg BLDG ELECT PLUMB MECH
<iK r -I E= CI C__j
ares_ LICENSED CONTRACTOR'S DECLARATION ,,�JT(Q{y�D �[�Dty�Qj�
O Z-0 I hemby aRurn Nat I am licensed under pyy visions or Chaplet 9(commencing 3 O DA [ P PERL11 1 T P 1 K):. 10/20/02)
F:tw wiNSei,dual0QQQQlof Division3ofine Businesg9pd Professions Code, M license
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E 0 u Lic nu Clv(�� _` L Lia.♦ (/]
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ARCHITECT'S DEC ATION
-,0y g I undemand my pions shall be used ns public recoNs ✓/'�/s[f,'jII
�s a p Licensed Pmfexsional OWNER-BUILDER DECLARATION
nn=m 1 hereby affirm that I am exempt from the Contractor's License law for the
C?< following reason.(Section 7031.5,Business and Professions Cade:Any city or county
E 0 which requires o permit.comwn,alter,improve,demolish,or manic any structure .�
3m poor.its issuance,also requiresmeapplkant rot such permit.filevsigrudsusemem - - - ----8250000 ....._ .
Igatna bibbe-zd pubic}h31b the pioi4siom ofthe ConumlWs Liceme Lvw(CTwq«9 ;. 'Sq.F[ Floor-Area,- • J Valuation
(commentingg with Sggtiom]000)of Division J of me Bu}mess and PrOfwions Codel •`' f;'s y r= C•t es (;v
m mai He i4 deev.pf thereon"and the basis for the mliged admyiion.Any violation 316 O's 0 4 7 . O 0 �l.
-of Section 7031.5 bYmr,implicate fora permit subjecn Ne applrcml to a sivd—.1
ofcant more ch.fivebundmual.q.With). APNNumber1cupancyType
❑l,a:nwn«ofineproptht,mmy employees with wagn as their role compemation, 101 - FOUNDATION (f
-will'do'the'work-and rheswcWre'is'not intended oroReredfatalle'(Sa:]au: —102 - PIERS Required V_"N'
I BmiiheiYand'Piofe..ions Code:The Cammctor's License law does not apply m m q..of property Who builds or improes Hereon,and who clog h work himself 10 3 UFER
m though his awn emplayces,provided Nat such improvements are not intended orfreed for rale:If;however.the wildin tri ice iomement issold withinoM earof - ---- -- -- -- —- ------'-- - ---'•Mmletion.the owner- e m Y --- ---
improve for purpose of v�i.j will nave lou when of proving matwdie net build or 105 - ANCHOR BOLTS
- ------ --------------- -' -- - - ---------106- ---SEWER--&--WAT'ER-- - — - ----- - - -- - -
pl;es awncr,gf me ProprtY•am cxdusivdy cammming wit litresed
ncomenctanto u . • iib c,- 1�.'.'
construct the project(Sm.7oda.Business and Professions CodeoThe Crucia res 202 - UNDERFLOOR PLUMBING �._En Iv-• us
-License law does not apply to an owner of pmpcny who wilds or improves thereon, -
S'�: _. -and_who.,marecm.for.such poiccls.wit.n.comac.fO.
rrlicensed.parsuent to.m _,_.
e. ..__ __203--'-UNDERFLOOR-MECHANICAL
m --"-'---`--"-----' --
Comc.rs License Law�,;
❑Lem exempt under Sec: '' -,B&PC for cots rtmon 204 - UNDERFLOORorFRAMEIif::
owe 205 - UNDERFLOOR INSULATION
' ' WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
-1 hemby affirm under penalty of perjury ons of me follnwingdeclaruions:-- 302 - TUB & OR SHOWER
t`: - O 1 have and will'mainutn'3'Ciniw
fcate of to self-insure for orker's 303 - ROUGH MECHANICAL
i. Compensation, as provided-for by Section 3700 of the Labor Coda, for the 304 - ROUGH ELECTRICAL
'perfarma f the'work for wh h the pe t ed;
O 1 h ve and will maintain it k 's Compensation lostartancleast mquired by Section
305 - FRAME
3700 of the Labor'Cod for the Performance of the'work for which this vatmn'is 306 - HOLDOWNS
Issued M W k" Com nsanon Inau...r rr«0nup [cY number
-: 307
CERTfFlCAI'IONOFEX PTIONFROOM WORKCRS$�T�`. + `a J l Ora tSH'E'EtROCK'.
snntirvINsugarvcE' a 309 EXTERIOR-LATH _ -' -_.. ...........
COMPEN, ,. A _ _ __ _
Cfhtseati�,,'n'nced not hecnmideeo if the pions for one hundred dollars 310 \! INTERIOR LATH
IS 1001 rl '1
..311--,.:..:•.SCRATCH COAT J
rul-mni'm the efrrh' . fm'wokf s
Y P„ rlchm Permit _
sh11ntatim any PC .y manors at hfeImmdw kit 313 FOINALNELECTRICAL -.ENERGY-.
ch.ien hl Lo'x f C41.f mm-Appi ant. .Dam 501 _
r NOTICETO APPLICANT It miler d,akmg.hl Crsifcmv ofE.nasion;you sho ld 502 - FINAL PLUMBING ENERGY" f"
& m suhlecno m is C oper,m n pr .'t ni of the Lub r C Je y u mu.t -
O C fnnh .she m 505 FINAL ELECTRICAL
py ice ch prosmnsnshsp IhIlbcJeemeJrcokeJ FINAL MECHANICAL ENERGY
.. ..
� * s ct•CONSTRUCf10N LENDING AGENCY ' " SO4 FINAL BUILDING ENERGY - � -�a-
ml m s m < s e cmnpm<u n kndmgg agency f r me p f rmunce -
W-.('�
1 hereby fR
5.06 ..__._GAS TEST....
Z aeranapree 507 FINAL PLUMBING
V 1 of matlhaercad mica 1 t ds.m lk uhe aw emfommtim it
s➢:O 'crrrect-I.agrcemcpmply nhell,citypnJ umy Nman Mmtelawsreliams 50 - INAL MECHANICAL
O V mwmmgconst «on ache by num nie p em dv nh ty. emerupan 5 9 - INAL DE
(,T] the awe .toned property for inspect on purpose. .
��.rr a. (Wej agree m sere,.damnify end keep hornless the Coy of Cupenin"o against 51 - I NAL
liabilitics,judgmema,costs and expends which may in vny way accrue against said
U.Z bty in consequencfoF.heg mmg of th perms 514 - F RKS
�APPLYCA'M1 fi - -VDrS AND WILL CONf9.PWITH AtL HON-POINT' Date
01R �Z etlssued by.
�gnmure.af pticpm/Com itim. D Re-roofs
' HAZARDOUS MATER IS DISCLOSURE
WJI me ePPI cantor furore haddi cupant nae m h ndk ha>sdom rw«.el . .Type of Roof
sa4efnedbyme Cupenmo Munc ode Cnapm 12andthe Healtend Sa(ety ..n,.J 'r ) n.,•1Y.i."i sC.' -"�. kob:,.;, :^
Code.Oyes 25512,0) qb i .;l a •,
"` _ -All roofs shall be.spatted prior to any roofing material Bing installed.
11thus applicant orfuturewi goccupamudaquipmemordevices which If a roof is insialle&Without first obtaining an inspections I'agiee•to remove
emit hezvdous air comeminants a 1.1 by the Bay Arta Air Quality Managemed,
Di5uin7, ,. .. all new materials for inspection._ Applicant_understands and will comply with
-Oyes •- - ON. -. - •- .._. .... . .- -.. .., -
„ , ,. all non-points e8' bons,- 1 - . . .
I pave fend ll,, .1..'ad 1.tequirearenm miner Chaper 6.95 of the
Coliform.Health fery Code.Sections 25505,25533 and 25534,1 understand that
it the build I currently ham a tenant.that it is my responsibility to notify all
.cupof. qtr' which must be met prim to houance of a Certificate of
pant Jam/
.- . ignature of Applicant _ __ -- -_ -_ - - _ -Date _ - __•_ __
W { «,nrdmmm ud ngent
Dow All roof coverings to be Class"B"of better •,