01110132 CITY n DING DIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
TAKESHI TAKEI 11/30/2001
PHONE: SANITARY NO. CONTROL NO,
TFF
U ARCHITEC iENGINEM, BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
N<`�
c =i= LICENSED CONTRACTOR'S DECLARATION Job Description
Z v-C I hereby effum that I am licensed under Provisions of Chapter 9(commencing
mCw withSec,ion]000)ofDivision]ofd¢BusincssandProfessionsCode.endmylicense TENANT IMPROVEMENT-REPAIR
e se 5 is in full force and effect.
Yz a Lmmsecrosx ont,aamr (BY HEALTH 7 BLDG. DEPT ' S CORRECTION NOTI
o d Date Contractor
ARCHITECT'S DECLARATION
r g I understand my plans shall be used as public at
�
iS p p Licensed Professional
Oat I am exempt
from
DECLARATION
m I naso,(Etta on 1 1. exempt from the ConvectCia License Law for the
CZa
following massa(Section 7031.5.Business aitessmpr Professions C"e:Any city or county
O ,lwhich requires pe a crus at her tfar such
entail to
s.iqueany xuucrum .- _ -
a3 .pct , , Is.rcqu pr ispocsntfor such Penn's flu g WChaptem. ._ ..
than alicensed thSstint Inn,7") sins nfthe 3oftheBusimu«aLaw
onsCar9 S Ft Floo Area r•. aeon
or(commencingwi[h Se,o ]aa) rdrvisisor drne Busmesxpil Professions Cade)
.a9'1 .}A
or that he I7 31.5 bl Ncrtrrom and the basis for.bc alleged eamnpsod Any l pennon
-ofSe"on903L5by hundred
didt ($50rmit xubjccrs Ne applicom me evil penult ! _ p yTYp
io(ass more than five hundred dollars(55001. y b r "�V Occupancy e
❑1,as owner of the property,or my employees with wages as their sole rompensoiion,
-,ill'do-the work,,- ad the slmctnrc'is nor intended or'tiffercd'for sale'IScc'7 i , - - - -
alaimass'nnd Professions Code:The Cialrim's License Law docs not apply to un (red Inspections
owner of property Who builds or improves thereon,and who does such work himself 102 - PIERS
orr through h his own employees.
g provided that such improvements is sol me not intended or _
offcied for sales If,howevei,`Ne building or impmvemem ix sold wiNin one Y<m of --- - ---��-_.__... ._.._. . _ _____.___ _ t ` ' _,_ _.__,__
completion,the ownerbuilder will broxi me burden of proving that he did not build or -
103" UFER'- •. ,..
impsivefnpurpouofarle.). 104 REBAR
x, L!Tl;ps°wnenof the prnpcny,am exclusively cnnrmcting with licensed convenorsm 105 - ANCHOR--BOLTS..-- - - - ft.N;(I::1..construct the Ne protein ISm.7W Bus ness and Profess ons Code)The Comremr x 106 SEWER & WATER
License Law does not apply to an owner of property who bolds or improves thereon, 202 - UNDERFLOOR PLUMBING _
end who cont.....for such pro3au,wl,h a c°mraeards)1 cans"pursmm m Ne __ _ .. ._
t License Laws
grtfi r` adaosed es PcmrN:rcaon 203 - UNDERFLOOR. MECHANICAL �
�aie-///�— " 204 - UNDERFLOOR FRAME
r.
W onmENsdlw7N DecuRAnoN� 205 - UNDERFLOOR INSULATION
L I hereby alTmn under penally orpajary,oue sr Ne following declamdons: 3 01 - ROUGH PLUMBING
�� El 1 have and will maintain a Coniheme of Consent to self-insure for Worker's 3 02 — TUB & OR SHOWER
cnmpensmi... as, ....ided for by Section 3100 of the Labor Code, tar he 303 ROUGH MECHANICAL
p4ifonhance of the work far whim to.Fermi,is issued.
304 - ROUGH ELECTRICAL
t ❑1 hale and will rramtmY Worker's Compmaiion Insumke,'as required by Section
305 - FRAME
3700 ofrM1 Labor Code for N
pens nee of N
work'for which t period is
xsu yWorkersCompensation insurance caurier and
P L`y"" b r" 3 0.6 HOLDOWNS
,PPnLyN t r30P7 ., k,INSU;LATIONS Lr,
„�t r ( rCCRTII'ICATION OF EXEMPTION FROM WORKERS- ' I l i i' 1(. +T L.8 F'I a: '
.�, COMPENSATION INSURANCE ^a
3rA . (Du:
section not b<compleicd It me permit is for onehmdred collars 309'-'-',-,EXTERIOR LATH
islq°)°ries )" IL
_ 310 - INTERIOR LATH
_ --
I cemtro.that perperformance hew k fora ph- issued,l
311 - SCRATCHshall1 empy.anypes n m any mtnnaa to become subject to the Workers
cnm� m "wadrConformalDate
...
313 - ROOF NAIL
-Apps cent ,..1 .,..
'NOTICE TO APPLICANT [Latermel:ing this Certificate
nfE emphoa you sh°tad '501 -FINALELECTRICAL.-ENERGY" ,..
bac ariaemaiploNc eachprCisionsrtisPermitiOa°nfreviiedCodayoumust 502 - FINAL PLUMBING ENERGY
Q Q fonhwi,h comply with such provisions or this permit shell be deem"rtvokW.
co sraucrlDNLENmNGAGeNGY 503 "=--FINAL MECHANICAL'"ENE?GY;. _ 1 ' -
aIh 'tiyaffirm No1N - ac-stro"'nlMdgg 'jencyf Npeiformance 504' - FINAL BUILDING ENERGY" ...1•'-
ofda work for which thisrm
pe , ud(S 3097 Cs.C)
W p -Li de N m --' 505..-_.. -F-INAL--ELECTRICAL .- . .-
., Lenders Add s _ ....._.__ _.. _. .. _._. .. .._
o.z , .i , _..._t 506 - GAS TEST "
_ U'O •,l antsy Nm thele read city
and ordinances an stat i laws arati is 507 — FINAL PLUMBING
1.Wil.I agree to comply with all<Ily and county°,-haves of
state to en er upon 508 - FINAL MECHANICAL
mbi iidingconnnied ,opndheminspeconumrowes. ilea sf Nitcity to eine,upon
yy .me bo monedp,open,for ,peat prpo 509 - FINAL GRADE
E_, (4 g tax Indemnify ph yintheC City acrue against,
I d '
LLrr fA liabilities) dg tine, a rid i p uses which may in any y aceru<agnmsl sold
U
City e q m«dnn training r permit 510 - NA P NG
"APPLICANTUN)ER$TANDS- LCOM 7TH ALL Nop:POINT'" Obi
rL URCE REGULATIONS i'1 zir Issued isyl4 - N RKS Dia
_ ollartmainAPPB.aVC.1 or.i" "" "^"^ °' 'n(",.Dam Re-roofs
r, HAZARDOUS MATERIALS DIS'LOSURC
g cecupanr site or handle ha' ous m ml Type Of Roof. _
a defnW b Ut<Cu enanl Mune al f de Cnapte 911 and the Health -Sof ty
Pp
,Code Seen1 155 1 cant or Tum b h 9i o- r. 4 r'! t 1. ph b
i. If roof is 9nsltalled without first obtainingro an
inspection;Ica
11(nl t P f t' J CI(
oy Y t 1 J era!1 Z A 4 d k 1
4 d ng mss
-,s' W It the ppl cant o Into rt bu Id ng mcup i u equtpmem d ccs h ch e't remove
amu haurdu arconi em dep6W byN Ray ArtaArQualny Management gra
District � a new materials for inspection Applicant understands and will comply with
al]
❑Yak '�No'r' mi(I ._ .,: ..
"non-point source regulations
4 ' 16 c'read:N;hozatd m
a' iieiiah repi!161nismnder Chaptei'h 95 ii the
6tifittomi H ith&Safety Code'Sections 15505:15533 and 25534 1. nderstand that
-If the buildingdoex otc rlyh ea re ,Nat ,'e my report bdryt miley rhe
°tic pant of rbc rc rt m I h mei at prior 1° tau pc f Cmtfcem of
Otte Y t o .l. .
"��i Signature of Applicant Date
ato it',n ma'e , Data All roof coverings to be Class"B" or better '
t1 t -:7. .OFFICE.... ,. .._.,._. . ,.._ .. ... _ ._ _. _ . . . ..._ ._...
a.