02030106 OF
CITYBUILDING c mvEiSIio;aNO PERMIT CONTRACTOR INFORMATION:
BIJfL '9FC lj)RF&$ OLL CT PERMIT NO. 02030106
otYfflSSllffE&111111DEBI CIARDELLA
PHGNE: SANITARY NO. CONTROL NO.
IN I
G O Zp ARCHI'rECTIENGINF.F.R: BUILDING PERMIT INFO
0— BLDG ELECT PLUMB SUCH
or
SP,i LICENSED CONTRACTOR'S DECLARATION I�
K. IherebyaRrmthvlamlemmedunderpmvisimp,ofChapter9(commencing ADD 121 SQ. FT, '944&Ably KITCHEN.
w� withsmtion70Wlof Division3rfthe Butinessund Pro&sslons Cede.anderylicerm
;x�, sWfill force and effect. 04/24/02 CUSTOMER ASK TO CHANGE VALUATION
v z z a License Class Lie.e
'o e Date Contractor
$120, 000 TO $60, 000 .
+n o Cr ARCHITECT'S DECLARATION
,j 1 undccaund my plans shall be used a,pabli,we ds
i a p O Licensed Professional IMA
' er OWNER-BUILDER DECLARATIO
h
1 herehy affirm that 1 um exempt from the Connector's License Law for the
E?C following rwwn.Rection 7031.5.Business and Profdemols C°de:�ttS yyWp Q
F which ls Permitlcompact,pplictmpul t for
Permit
orr�o�ytatemu2 ZOOZ
so. prio [toils'. I theunt cam for Comeni'mfleas ow((Chapter
-- — — — - --- - -- — —
thatnen cdprsinto the 7")of sin3oftheBusi sLicense WwlchCore) ,. ., Sq. Ft.,FloorArea , ,, 600NltOtation
(commencing work Section]000)of Dunton J of the Business end P Cade)' ( r s i.
or that h2 is exempt therefrom and the basis for the alleged exempts pr 'of Section 9031 5 by any applicanl tar a permit subjects the applicanR T<q,Ml§
of net ramlham five hundred dollars($50% 326kTNQ9a3nbM i Occupancy Type
01,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.]1144,'
Business and Prefectures Cade:The Contractor's License Lew does not apply Ire an ]red IOSpeCt10n5"
or through
r of property Who Wilds or improves moron,end who does such work himself 102 - PIE
RS
or through his own emplei t provides that such improvements cul within
net intended or
,or rortala.If.however.the building or improvement is sere wilnm ane r<a,of . .._... ..10 3 - UFER._. .. .... . . . . _ . . .. ... ._... -
completion.the°wner-Wilder will have the burden of proving that he did not build or 104 - REBAR
improve for Purpose of sale.).
l at owner if the ._ i,old . . -" - .-.. -- 105... ---"ANCHOR-BOLTS
p(Sec.7 ae Business
a d Practmg with barred Contracts ro
License theoes no(sec.Ts money and Pirt,who b Cade:)The Contractor's
106 — SEWER & WATER ..1 ,
andwhsewossahatapplytmanownerthpropertywnmbaimtmed improve, t;.,ne. . .. .202 .-. UNDERFLOOR...PLUMBING_..
:i and.who corrects for,such projects.with u comructor(z).licenzed p -
c°mm"er'aLi"nwlaw. . 203 — UNDERFLOOR'. MECHANICAL
❑lame��Ft unde^,S'eq ,B&PCf,this reazon
arlkll Xtra'' D� 204 - UNDERFLOOR FRAME
„
WORKER SCOMPENSATID�a$ECLARATION 205 - UNDERFLOOR INSULATION
Ihereby afTumorder PenahyrofPerjtr:yane° the following declarations: 301 - ROUGH PLUMBING
p 0 1 have dad will maintain "CeniBcaie of Consent or self-inm a for Walker's 3 02 — TUB & OR SHOWER
Compensation, as provided for by section 37W of the Labor Cone: for the 303 - ROUGH MECHANICAL
p<rf ormove of he work for which this permit is i.satoo
.
❑Ihavcadd will maimainWarkcr'sComp<nsationInsurance,exrcquiredbySmion 304 — ROUGH ELECTRICAL
37W of the Labor Cade,for the performance of the work for which this pemlit is 3 0 5 — FRAME
isahed.MyWorkersCompensationInsurancecameranofPolicynumberore: 306 .HOEDOWNS. ... _ . .
c.me `. 't: Policy No.: ':} "•307 'INSULATION
CERTIFICATION OF EXEMPTION FROM WORKERS' '
...
COMP INSATIONINSURANCE. :. . . . .�.......... .... 308.-..-.._SHEETROCK.----..._.._.........-.
(This section need not be completed if the permit is for one hundred dollars 3 0 9'- EXTERIOR LATH'
-
(slnmanns..7 .310 — INTERIOR .LATH
1 coarofy hat in the performance of the work for sen eh this permit is issued,1 311 - SCRATCH- COAT, '-
,,hall nonemploy
d pl y y pc,zan m b) t to the,Worked
ppemsa °7 ; la .aysP�I�o� 313 - ROOF NAIL
izsf It J .._ _ _-._ . ... ... .... ...
N ad�NT:If.after making this cenmcamofExemption.you should
501 - FINAL ELECTRICAL ENERGY
z baso hjcnmthe Woikcr's Compensation provisions of the Labor Code,you must —
p fonhuithcomplywithsuchpmvisionsonhisp mlitshallb deemedrtvoked. 502 FINAL PLUMBING ENERGY
E.:In a_' ',� CONSTRUCTION LENDING AGENCY" 503' - FINAL MECHANICAL ENERGY"I her,by off...hat form i,.conswclumecnding'.,,a,,lathe Piorfnter a 504 — FINAL BUILDING ENERGY,
of the work for whichy' this Permit is issued(Soon.3097,Civ.C.).p Lander:Nm
ae ._. .... ..t:. GAS TEST
Lemertnddrea.- 506 505 FINAL ELECTRICAL
o:z -, ^ /
U OI event,that l have read this application and state that the above information is 507 — FINAL PLUMBING
cmreet.1 agree to comply with all city and county.ordinances and state laws rehting
O U mWildingc°nNuction,and hembyanhrurcopresenetivesorthis city toone,often 508 — FINAL MECHANICAL
w the uW(Wee tinea live.ndemify and kmpurposse.,
o eWe)ugmeestree,indemnityand keep h rmlessrata city of Cupeuma against 509 — FINAL GRADE
y Liabilities.judgments,costs and expenses which may,in any way seems againn Baia 510 NA NG
.C.) City in emsetryence of the granting of this permit.'
APP, AIT UNDEAST NDSANO WILLCOMPLY N'ITH ALLNC - CNT�t I$$ued 1 Date
S I'f.: C U ATIO 1 A^t `�i
W�
Appfican✓cammctea c Re-roofs
' HAZARDOUS MATERIALS DISCLOSURE
Will ytheChe applicant M building Chaut store pter 912.add andle
Health
an Safety'al Type Of Roof _ ._ . - ._ ...... ..
as
defendhy the capelin Municipal code Chapter 9.V dna the linhh dna s f ty .,
.. CMc Sanson 255321u) � '.- ,' ' r,'< ' I' s
D
Y'
` ' l`'° I 1. "�' ' All..roofs shall be'respected_prior td any roofing material being installed. --
wulmeopplkantmmm,eFundingoccupantuseequipeemax041006which If a roof is installed without first obtaining an inspection; I agree to remove
to hamrdous air conmmeams as defined by the Bay Arco Air Quality Management
Dituice all new materials for inspection. Applicant understands and will comply with
•:over S�No all non-point source regulations.
4J I have lead tiasmd2`materials requirements under Chapter 695'6f the
California Health&Safety Code.Sections 25505.25573 and 2553x.1 understood that
irlfie¢uildeg docs not currently have a tenant.that in is my responsibility to notify the -
mYupant of the requirements which must be men prior to issuance of a Cemificam of
Signature of Applicant Date
w amnornpa agent Do,, All roof coverings to be Class "B" or better
. t .. . • .. ...OFFICE . .