00080024 cl BU off currISION " CONTRACTOR INFORMATION:
nun,Dwc nrvPswty PERMIT
❑GILDING ADDRESS'. ' PERMIT NO,
'3510 1.4011ESTEAD RD .LIR1C1T1(OP"',
OWNER'S t ME: 0 V-" / APPLICATION SUB DATE
G I_]:IrII W 061/03/2000
)NI!: SANITARY NO, CONTROL NO.
OO ARCIII'ITCIIIiNGNEER:, Y BUILDING PHR HIP INFO
m u BLDG ELECT' PLUMB MECH
r~n 6a, U U U L71
y
L"T"
CONTRACTOR'S DECLARATION
5 y a I nems tricot dant I.on ucanaW ower Job Description
-
p 2—p Y n ptovlsions m Chapler9 fc,+....using P
F�tw
with Scclica70(HDof usision for the Business and Pmf—no Code,and my Ilocust,
I, All-RF:'MCIDF.a_. hiETAII_ STORE/SHOW CENTER
C i U Limnnc Class Lic.p
Dam camecn,r
a u0 G ARCfII'I'T:CI"S DECLARATION
I undersmnJ my phone SIU 11 b,used as public records
i
is,
p C Licensed Professional
OWNER-HUILDER DECLARATION
I hereby.affirm tea Ian aseu t from Inn Canlnnon s License Law for the /
t?6 following reason.(Section 911.115,Bminess and Profession,Cove:Any city or county O
F D which requires it permit le mnlroci,alter,improve,Jmn,lish,or repair any structure -
i3_ prior to its issuance.alm requires the applicant for such Went to file a signed statement q
malnetxhcenKJparaaantrantepnwisinnsafthe cmttraamrxuaen.eLaw(enamer9 _ Sq. FL Floor e Q 9a�utlLh7�0
(connnentlng with Section nHH)of Division 3 of the Business and Profusions Code) S r
nr
but he is exempt therefrom and the basis fur the alleged ucmption.Any violmn. mI
of Isanon7031.5 by any appleoul torn permit suhjeos beuppliennt to a civil penally ']P
of ant mare than rive hundred dollars($500) - APN Number Occupancye
P1.as owncrroflhe property.ter my employees with wagesaa their side compensation. 3f3G01.f:11.8. 00 '
will do the work,and the ntmctute is not intended or offered for sale(See.nus, Required Inspections
Business and Professions Cohn Tna Contractor's ctor's License Law toes not apply an
owner of property Who builds or intpmves(hereon,and who does such work himself,
or through his awn employees.provided thm such improvements are not intended or 1.0:1. -' 1='OL1hIDA7:I:OhI
offered far ole.If.howoer,the building or impro iann m is sold within ane year of ].02 -- PIERS
completion.the owner-builder will have the burden ofpmving that he did not huild or
Impmva for po,owofsel`), 1.03 '-' Llf'ER
;"awnerof anc property'.um clusivcly cmnrncting win licensed c,un...from ( .-. YS
Tat et the project(Sec.nHi,exBusiness and P:nfe¢iom Code:)The C-downr's .I.0 } REBAR
License Law does not apply to an owneroffoopccry who wilds or impmee.thereon. 1.05 — ANCHOR BOLTS
and who cmurai fur such pmjcns with a enmmnartx)licensed puouom to the
Cmtowou"LicecLaw. 1.06 SIi::WE,I! 8 WATER
❑I um exempt under Sce. ,B&PC Fir thisrms0
owner EZ — - Date ?C1i? UNDERFLOOR f-'LUMi;TNG
KER'S COMPE,NSATIO E LARATION 203 — LINDEI'iF'LGGk I'1EC1"IAI`I J.[.AL..
rtnyanirmanaerpenaltytlrpefimrmearmae+uowingaealararmn= (.204 l.1NDERFLOOR ,17R(-)VIII
3 I have and will maintain a Ceniream of Common-to self-Imam fnr worker, 205 - I IhIDERFTL^OOR IhlfiULATION
mopemmum. as Pmvhled for by section 3900 of he "boar Code, for he ,301 — ROUGH PLUMBING
of the work furwhicn Ipermitsm
bis is ied.
❑I have and will moutimn Worker'sCnn,pen neon lm,onnae a,regahea It,s,:aden 302 •— 'T'L11Ei K 01'4 SHOW_Fi
37011 of the Labor Cede,for the performance of the work for which this pem,it is
Issued.My worker's Compensation Insurance carrier and Policy number am: 303 - ROUGH MECHA111ICAL
Caricr: Policy No.: 304 -- ROUGH E1_F:CTRIC611...
CCRI IFICATION()I'EXEMPTION FROM WORKERS'
COMP17NSXI'ION INSURANCE305 '-' I-FIAMIu
(This section need nal w completed if the permit is for one hundred dollars 306 -- 1-IOI_DOWP{S
($100)orl"x,) 307 - INSULATION
I certify that in the peSono,we of the work for which this permit Is Issued.I �:` `/
shall m employ arty permn in any mnnner.,,rix n became.object to the Worker. :3011 .• ,F'IF-:Ic:TROG1`
gnmpepplicant mahonLawsofCalifornia.Date f::XTERIOR LATH
NOTICE..TOAPPLICANT:If.me,making this Cciitiewcof Cxempon ,you should 310 — INTERIOR I._ATI-I
budm
ranme sobjecn W..eea Compcuoil l prnvninn of bu Labor Code,you must
O O dim his 111,comply will such It visions or this print t shat l be deemed revoked, 311. •••• SCRAT'CF•1 COAT ,
(•• tq CONSTRUCTION LENDING AGENCY 31.3 ROOF HAIL-
I hereby affirm that them N� ? a nio
commun lending agency for the performance nn n of the work for which this permit is issueJ(Sce.3099,Cie C.) �';)01, ^•• Fr�I' NAI_ ELECTRICAL- EI+IERGY a
Lender's Name
Z LcmacrsAddresa 15612 1=:11\IAL. I-1I_I-11a1BIFI[7 h:111E.RGY
U O IcenirybillIhave read his application and same that the aMsemformmiania 503 - F'T.hIAI_. ,MSCI-IAN]:CAI_ ENERGY
�• [.. correct.1 agree to comply with all city and county ordinances and state laws minting
O U it,hoilduff emotion l. ad hereby anihorize miumsenalives of this city In enter upon !;-004 - h]:hlAL PLI:f.L D7adl:i ENERGY
', W the nho(We).c-mc,me at pmpcny for indemnify
ad keep
purposes.
E a es,jagmen and voryanewhihmmletnthe anywayfeupemmoagama 505 — I ':I:hIAI_ ELECTRICAL
UZh city I.oc judgments,cons and expenses prom county in any way scone against said
ChyinconsTUNDarthe NDSADWEpcCO 506 -- GAS TEST
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT IS'uedb TAI FI_UpIHJIITi Date
soulecE REcuL s.�i�..— y: !-)[d8 -- 1-'I'h ' \
g Pp Re-roofs
Si nature"IA IINa✓Geatmett )a !7 a ._ v ... . ...
the HAZARDOUS MATERIALS DISCLOSURE
wnyteColenorfuture wadCoeChamstore 12,ahandle Hv.IthandSafem Type ofRoof `09 — FINAL GRADE
-as d,ScJ by thei32 anino Municipal Cole,Chapter 9.12,and be Hmhh and Safety n- —
cnaa.oYonxsSucen' •.,1.D - I-Ih1611... Gl...flblhllaal(i
za . XNo - All roofs shall Ig:j.t4peeteTl"dtf .to aFt'}J11if414 nidURKSeing installed.
Kill the applicant or future building occupant use equipment or&v ices which If a roof is installed without first obtainingan inspection, I agree to remove
e ii hazardous air contaminants asdefined bythe pay Area Air Qual' gem
try P g
!rtldmp all new materials for inspection. Applicant understands and will comply with
°ie )(No all non-point source regulations.
I have mad the hazardous materials requirement-under Chapter 6.95 of the
California Health&Safety Cmle,Sections 25505.25533 and 25534.1 understand that
if the Imo ing does not currently have a tenant,that it is my responsibility it,notifylhe
oc
cupula of the requimnmnts whalt most be uta fain,to Issuance of a Cenifcae of
ocamppney. Signature of Applicant Date
�rmom,//S All roof coverin s to be Class `B" or better
Owner or authorized agent ( am g ,
OFFICE