02010055 OF
ct eut DING DIVISION'
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22622 MARIANIST WY 02010055
OWNER'S NAME: APPLICATION SUB DATE
MARIANIST NOVITIATE 01/15/2002
PHONE: SANITARY NO. CONTROL NO.
4089415974
Pa a_O ARCHITECUENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
a5 DEMO POOL ENCLOSURE
Z�?2 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9lcommencing
QLt-u with Section 7000)of Division 3 ofthe Business and Professions Curland my license
he
zK 6U ,,a full force and
o LcnseCl
Sc Lic.pimD
3_ s
Contractor�•
u.on a 2_ fir, n t11TECr'S DECLARAT N
Y, ttfi3! m/s(f9f tghyIIPl%t YslshgAlFY<A1�ars/ylwzm cards
at E0 0 Licenced Prof conal
a. NER-BUILDER DECLARATION
u. I hereby aRrm that 1 am exempt from the Contractor's License Law for the
!' a following reason.(Section 7031.5.Business and Professions Code,Any city or county-
Y F O which requires a permit to construct,alter,improve,demolish.or repair any structure
-prior.to its issuance,also requires the applicant for such permit to file a signed statement
disube'is liccnud phairmt 1.be pmviuons of the Cmomsror's License Law(Chapter 9 S FL $loon Area- Valuation
(commencing with Section 7000)of Division 3 of the Business and Pmf<ssions Cala t- \s9,r ..1 C Y:A{�•�rs f.P l,,i
or that he isexunri
pt thammn and the basis for the allcsed exemption.Any violation'. - -
-of Section 7031.5 by any appiicani fm a permit subjects the applicant to a civil penalty'.,
•of not seam than five hundred&R,trs($500). APN Number 'v' Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation.
:will do the work.and the structure is not intended or olfemtl for sale(Sec.70614,;
Business and Professions Code:The Contractor's License Law does not apply to on Required Inspections"
Owner of pmpcny Who builds or improves themon,and who does such work himself
wr through hissal own employees t. building
that such Improvements are not intended of
bRcrcd'tor sale.If.howcvc{the SuilJin �" -- its sold within dn2'�or of - --_..._. . .. ...... ....._ -.__._....._.._. .- ...-___.-... _..__..__ ............_ _
g ser improvement y �..
improve for the owner-builder will have the burden of moving that he did not buil)or
improve for purpose of sale.).
as Las owner pr 0c p(Sec.7,nm exclusively nontrading with licensedc:)Th C contractors to - -- --.:I ':a .. -
- omwct theLaw
does no(Sec. to a Business and Professions CWo:j The Co thereon. t -
License Law does not apply m mj owner of property who builds s improves thereon.
,.and who eomractse Law ch Prul<us with o cunuaam(s)licensed.Pursuant-tolhe: .-.. .... .. _...__ ... . . _.......... .._._._.._..___....__.J—
Contramfs License law.
❑lam en<mpt under Sec: ,B&PCfar this reaxonOwner Data
- Dae ' '•' �i
"WORKER'S COMPENSATION DECLARATION
1 hereby offimt under penalty of Perjury one of the following declarations
' -0 1 have and will maintain a Certificate of Consent to self-insure for Worker's
,Compensation, as provided for by Section 37M of the Labor Coda for the
performance of the work for which this permit is issued.
❑Ih td will mainatim Worker's Camp t Insurance required by5 t
70)of the labor Code for the Performance of the work for which this Permit Is
su J My W k s C pe s t on Insurance comer and P he n rt: -<• x_r ^.-- „ry _.-^^.,,__
W� f�Oso� __,..
Ca .,TIF\hCATION Oh EXF,MPTION FROM WORKERS' l f3' r ;% f u.^ ., hb, ..rtk�. .`
(Tms seett°b need not be completed rids,Perri t is for one hundred dollars -
(SI00)ore,j t
t 1 nify that in the performunoe of the work far w c Ihts pc'rmt is issued i - - - it, - - - - - -
'shm soall nemploy any person In any manner as to become subject to the Workers ^s s -
Compensation Laws of California.Date
.lApplicam
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should `
0 'become subject to the Worker's Compensation pmvieiob.k of the Labor Coda.you mist
C) forthwith comply with such provisions or this permit shall be deemed Oo.ked.
'F
^ t:st f CONSTRUCTION LENDING AGENCY
,a Ihereby affirm that there is a cnmtroction lending agency for the performance
'of the work for which this permit is Iszue0I Sec.31N7:Civ.C,t -
.� Q 'Leader's Nome'c _ .. .. .,1_+._. .. . . . .. _.. _.. .. .._ _.
-_7 Z Lender's Addresx
U1 certify that 1 have read this application and state that above information is
R. [.. 'correct.I agree .c0 ady with all city and county or&aanees and.state laws relating
Q Utots.ding conatuction.and hereby authorise repreunmtivesofthis city tomer upon
th no extraction.
p pant for inspection purposes.
_
y (W) gceia dmtyaWkeep harmless the City ofCPrtimoginst
V] Cliabilities.nJ de , costs a passe which may in any Y accm against.and
U Z C y y ce t th g g l th p i t
" ;APPLY ,V??oUnl ?R.STAv \?' H'ILL""!IPLYN'nHALLp �if r'' Issued b r` Date
„si rear prpanA7ARD—� . ',Pats Re-roofs
SOUR r 1
HA2AR000S MATERIALS DISCLOSURE
'Will y le t- Municipal building ec a le,9.1omi a t m n d ad Safety
m _.Type of Roof_ _.__ _. .... .. ...
asdfn dby the Cuperi CW Ch pt,912 doh Health dSafry _ si . t 5 �, t -
tCd s f n255CU .j•. A,I q � s �.
aY f .,,.All roofs shall be inspected prior to any roofing,matenal being installed
.
Will the Pplic a,or iture W,idirsacupan use cy 'p em or devecwhich If a roof Is installed without first obtaining an inspection, f agree to remove
em t hazardous it contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
oY p ., , h°- -- - all non-poinf source regulations. - -
i 1 have read the hvear ores materials q ants under Chapter 695 of the
California Health&Salary Code.Sections 25505,:5533 and 25534 1 understand that
If the building does not currcndy have a tenant,that's is my responsibility to a tfythc' -
ncc tfa ,of tha requirements wti must be at an.,to i"mme of Cent
cam u
Occu,or. t
Signature of Applicant Date _
17 'own< Than a,,art' D to All roof coverings to be Class "B" or better .
_ - -- - _
OFFICE
• . r. , .i
OF
ct eut DING DIVISION'
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22622 MARIANIST WY 02010055
OWNER'S NAME: APPLICATION SUB DATE
MARIANIST NOVITIATE 01/15/2002
PHONE: SANITARY NO. CONTROL NO.
4089415974
Pa a_O ARCHITECUENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
a5 DEMO POOL ENCLOSURE
Z�?2 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9lcommencing
QLt-u with Section 7000)of Division 3 ofthe Business and Professions Curland my license
he
zK 6U ,,a full force and
o LcnseCl
Sc Lic.pimD
3_ s
Contractor�•
u.on a 2_ fir, n t11TECr'S DECLARAT N
Y, ttfi3! m/s(f9f tghyIIPl%t YslshgAlFY<A1�ars/ylwzm cards
at E0 0 Licenced Prof conal
a. NER-BUILDER DECLARATION
u. I hereby aRrm that 1 am exempt from the Contractor's License Law for the
!' a following reason.(Section 7031.5.Business and Professions Code,Any city or county-
Y F O which requires a permit to construct,alter,improve,demolish.or repair any structure
-prior.to its issuance,also requires the applicant for such permit to file a signed statement
disube'is liccnud phairmt 1.be pmviuons of the Cmomsror's License Law(Chapter 9 S FL $loon Area- Valuation
(commencing with Section 7000)of Division 3 of the Business and Pmf<ssions Cala t- \s9,r ..1 C Y:A{�•�rs f.P l,,i
or that he isexunri
pt thammn and the basis for the allcsed exemption.Any violation'. - -
-of Section 7031.5 by any appiicani fm a permit subjects the applicant to a civil penalty'.,
•of not seam than five hundred&R,trs($500). APN Number 'v' Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation.
:will do the work.and the structure is not intended or olfemtl for sale(Sec.70614,;
Business and Professions Code:The Contractor's License Law does not apply to on Required Inspections"
Owner of pmpcny Who builds or improves themon,and who does such work himself
wr through hissal own employees t. building
that such Improvements are not intended of
bRcrcd'tor sale.If.howcvc{the SuilJin �" -- its sold within dn2'�or of - --_..._. . .. ...... ....._ -.__._....._.._. .- ...-___.-... _..__..__ ............_ _
g ser improvement y �..
improve for the owner-builder will have the burden of moving that he did not buil)or
improve for purpose of sale.).
as Las owner pr 0c p(Sec.7,nm exclusively nontrading with licensedc:)Th C contractors to - -- --.:I ':a .. -
- omwct theLaw
does no(Sec. to a Business and Professions CWo:j The Co thereon. t -
License Law does not apply m mj owner of property who builds s improves thereon.
,.and who eomractse Law ch Prul<us with o cunuaam(s)licensed.Pursuant-tolhe: .-.. .... .. _...__ ... . . _.......... .._._._.._..___....__.J—
Contramfs License law.
❑lam en<mpt under Sec: ,B&PCfar this reaxonOwner Data
- Dae ' '•' �i
"WORKER'S COMPENSATION DECLARATION
1 hereby offimt under penalty of Perjury one of the following declarations
' -0 1 have and will maintain a Certificate of Consent to self-insure for Worker's
,Compensation, as provided for by Section 37M of the Labor Coda for the
performance of the work for which this permit is issued.
❑Ih td will mainatim Worker's Camp t Insurance required by5 t
70)of the labor Code for the Performance of the work for which this Permit Is
su J My W k s C pe s t on Insurance comer and P he n rt: -<• x_r ^.-- „ry _.-^^.,,__
W� f�Oso� __,..
Ca .,TIF\hCATION Oh EXF,MPTION FROM WORKERS' l f3' r ;% f u.^ ., hb, ..rtk�. .`
(Tms seett°b need not be completed rids,Perri t is for one hundred dollars -
(SI00)ore,j t
t 1 nify that in the performunoe of the work far w c Ihts pc'rmt is issued i - - - it, - - - - - -
'shm soall nemploy any person In any manner as to become subject to the Workers ^s s -
Compensation Laws of California.Date
.lApplicam
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should `
0 'become subject to the Worker's Compensation pmvieiob.k of the Labor Coda.you mist
C) forthwith comply with such provisions or this permit shall be deemed Oo.ked.
'F
^ t:st f CONSTRUCTION LENDING AGENCY
,a Ihereby affirm that there is a cnmtroction lending agency for the performance
'of the work for which this permit is Iszue0I Sec.31N7:Civ.C,t -
.� Q 'Leader's Nome'c _ .. .. .,1_+._. .. . . . .. _.. _.. .. .._ _.
-_7 Z Lender's Addresx
U1 certify that 1 have read this application and state that above information is
R. [.. 'correct.I agree .c0 ady with all city and county or&aanees and.state laws relating
Q Utots.ding conatuction.and hereby authorise repreunmtivesofthis city tomer upon
th no extraction.
p pant for inspection purposes.
_
y (W) gceia dmtyaWkeep harmless the City ofCPrtimoginst
V] Cliabilities.nJ de , costs a passe which may in any Y accm against.and
U Z C y y ce t th g g l th p i t
" ;APPLY ,V??oUnl ?R.STAv \?' H'ILL""!IPLYN'nHALLp �if r'' Issued b r` Date
„si rear prpanA7ARD—� . ',Pats Re-roofs
SOUR r 1
HA2AR000S MATERIALS DISCLOSURE
'Will y le t- Municipal building ec a le,9.1omi a t m n d ad Safety
m _.Type of Roof_ _.__ _. .... .. ...
asdfn dby the Cuperi CW Ch pt,912 doh Health dSafry _ si . t 5 �, t -
tCd s f n255CU .j•. A,I q � s �.
aY f .,,.All roofs shall be inspected prior to any roofing,matenal being installed
.
Will the Pplic a,or iture W,idirsacupan use cy 'p em or devecwhich If a roof Is installed without first obtaining an inspection, f agree to remove
em t hazardous it contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
oY p ., , h°- -- - all non-poinf source regulations. - -
i 1 have read the hvear ores materials q ants under Chapter 695 of the
California Health&Salary Code.Sections 25505,:5533 and 25534 1 understand that
If the building does not currcndy have a tenant,that's is my responsibility to a tfythc' -
ncc tfa ,of tha requirements wti must be at an.,to i"mme of Cent
cam u
Occu,or. t
Signature of Applicant Date _
17 'own< Than a,,art' D to All roof coverings to be Class "B" or better .
_ - -- - _
OFFICE
• . r. , .i