02080021 (2) OF
TINO
CIBUILDING DIIVC,ISSIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMrf NO.
7728 OBSIDIAN CT KAVENY JOHN J AND DIANE W 02080021
WAM APPLICATION SUB DAT
N JOHN J AND DIANE W 08/06/2002
pppPHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a Z LI LJ C_I L:7
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i LICENSED CONTRACTOR'S DECLARATIONJob
PESIhcrebyalarmthalamofthedutWerprovpiofssinsCodr.acommencing ADD BAY WINDOW (DWQo^L�
F.t wire «,ioceand of Division 3of the Business lml professions C°de.and my license
rs c and eff«t. \vR/
Or aca aim OCT 1 p
Gnnmr
3 u G ARCHrrECT'S RATION ZOOZ
h g I undrrsmnd my plans shall be used a. tic records
Licensed Professional
BUILDER DECLARATION
BUILDING
LDiyG
1 hrmby alarm that 1 am escrupt from the Contractor's License Law far the
t Z a following eason IS«tion 7031.5,Business and Professions Cude:Any city or county $1500
Y F o which requires a permit to construct,alter,improve,demolish,Or repair any swemoc
ca -_prior m I%issuance.saw tequi,esdin applicant for such parent to File a signed statement
mat he is lierntcd pursuant o the pmvisnons of the contractors License Low(Chapter 9 Valuation
(iommeiic,ing with S«,icnt7(XX))of Division 3 or the Business and Professions Court'
or that tie it'eActnyt thcrdfrom'dnd the basis for the alleged ei emption.Any violation
of Section 1031:5 by any applicant for a pemut subj«ts the applicant to a civil penalty
:Of no,mamthan five hundred dollars n5W1. 101ARNPlg�ATION ^ t.:f`'"' Occupancy Type
E3 1.as mvneref the pro,srty.or my employees with wages as their sole compensation, 102 - PIERS .
-will do the'works:and-the mmaure isnot ctor'sdoro erefor sale( nits' --- - 103 - UFER Required Inspections
t owner of end property
Who
Case:Thr Contractor's License law docs not apply m an 9 '
owner of pmceny Who builds or i provided
t thereon,andmpr who encs such work hded or 104 - REBAR
or through Tial own however,
o ever,t Wilding
that such improvements are not intended or '
offeredri le-Ii ho build the Wtld n "m poising
sold "ih n nod"Wild
of -- - -'- -" ' - 'DOL
'complei on.the owncrbu ld«wll have the burden nrpmwng mat he a,a not woe pr I05- - AN TS .'.'r,,, .. .1,t ,..,
improve for purpose of sale). 106 - SEWER & WATER t
......_ _._.-_._.orae..--. _.Iice....__..__.__..._. . -2 _ -- ---' - ... -
'O�Lasown«pfthe-0mcen y,acre Business and tractingwithbcenua Contrmtam -
- =
construct the rent«t(s«.1w .Ba.mr..aria Prorraai°ns caee:3 he enntmrta;t203 - UNDERFLOOR MECHANS-CAL`;: ' n
l - License law does not apply to an owner of pprny who builds m improves thereon.
.. m
<> _and.who.contmcu for-such projects wit.axontrucmrts),licensed.pu mans m.the. 2 04___-..UNDERFLOOR- FRAME__
o Coyramor's Licrnsc Low. „,.n\:'i' � 't.;t t:. -
W1ame.rmppngerSer. '' :BiPcforthisreamn 205 - UNDERFLOOR)i'-INSULATION
ovine �� ?ftle�lp
Z301 - ROUGH PLUMBING
OK.R'sCATION3O2 - TUB & OR SHOWER
Ihemnyafrr,ma relwnne.ingdecl,raE°ns: 303 - ROUGH MECHANICAL
0 1 have and will
{maintain a cehircme or consent m self-maum for workers 304 - ROUGH ELECTRICAL
Compensation,-as provided for by Section 37W of the Labor Code, for the
erformanceof the work for which this permit,is i.syrd,„t 305 - FRAME
❑1 nave aria will my t n Wo k r Cnmpe , Insurance us mq tree by s tion 306 - HOLDOWNS
31W of the Labor code f the perform f the work f'r which this perm fis 307 - INSULATION
so ed MyWorker's C penwt on lreumacec dPol y robe arc: '
Czmr re. `.�.-.':' t — -- 308 ;t -SHEETROCK-_._._---'-___--__'._._V;,! m__,,,.-,.-_.,..._,.
'+ a 4 PolcyN x ,
(II' CERTIFICATION OF EXEMPIONFROM NCE•AR"R% '. �t•) 1t3O9 c1-).EXTERIrOR IiATHz+
ITnss«conn COMPENSATION
O l,PENS lTIONINSU
e
�.'? . ern. � t?,'4nn 0: IrO•`
311 - SCRATCH COAT
- " ROOF=-NAIL _ ...:
err I c mpl that in the pf rices fthe' ark for wh,h i pc 't s s ke I r r'• t'.r
.H 11 ply Hyp yy to ince t .•�nl t, m Workers' 501 - FINAL ELECTRICA'li' ENERGY
'Co pc tIf _ r
Ap tit , .. .... ._.502.___._FINAL PLUMBING_...ENERGY . _............. ---------
1
.. ._.t N IC TO PPL If rt making this C o,L oIE a pt you ho Idt '" ' �•
H a aq«„ mew k c rip t vn�a°n. rte aba caa ya m t 503 - FINAL MECHANICAlit ENERGY
O Tonhwnh comply with n p mutat°ria minis cermit anon x deemed rcvnkea. 5 04 - _FINAL-..BUILDING_, ENERGY-
•.`•t � ,f. 'r CONSTRUCTION LENDING AGENCY °" 505 - FINAL ELECTRICAL
!� "'l hertby aRiim imtth<k ishcomwcuon lending ag Hcy form perform me 506 - _GAS TEST ELECTRICAL ,
W
=11, lochpsconssued _ ..�... . - . . -
lame-
PLUMBING
ndr
Oz mbuaamnafy that I base eMhrehb'ipPh'mirn mi ^m�cp the aboei1hsnn,Jion`is 508 = FINAL MECHANIC
U O MECHANICAL —
W_F.t ;co t1 g to comply with II countytyand N and state 1 ling 509 FINAL GRADE
C:7 1 8 Ysau P Y nit pm
thabove-mentionedproperty r p«, pryn 510 - FINAL PLANNING
Fy (We)agreeio e t d,m fy and keeph 1 the City OfC penin'against
(A liabilities.judgments,cot and pense which may n any y ace against said
514 - FINAL UB C WORKS
V z Ci,yl sqe euf meg t g°fret print - r U t/
APPLICANTUNDERSTANDS AND WILL COMPLY WIIHALL'NONTdINY Issued by: Date
DUROR REG t T M1S. t Y
§ifilbbiam o,ApplicandsCoutmttor -"p r'f i',•,' - i' Re-roofs /
HAZARDOUS MATERI CLOSURE
Wllm pplc t ,frau bolding tm,p°t t 'r handle hlrmodove'm, el TYPe Of Roof.. .- .••.•--•--•,•••
as delndnymacuPenn NO ICad Cnpt 912. oath x Ith nds r,y ), t. t t
,Codes t n25i32 a) $' , .b V , ( fl}` , 6 is �.�', ( \ [t3�rt�.
ttOY ' ''� `f fdN j�,' S All roofs shall be.inspected pnor to.any,roofing,matenal-being Installed.
Wllth ppl to None bult goo p se`eq p ent.,de ice which If a roof Is installed without first obtaining an mspectt6n;4 agree to remove
'cot ha;.Mouistto,cont' m a do dtiy h Bay I A re.a AQ Ity Mnag ,
District, t� _ all new materials for inspection Applicant understands and will comply wnh:.
yf7 Yes -t n l N° all non-point 'source regulations.
1 have"ad the h iardmi,materials Fegavemcros'under Chapter 695 or the
'Califbmia Hevlth 6 S.re1,Ctide:Sehiuns 25505,25533 and 25534.1 underswnd that
--if the building does not ct at,have a tenant:toot it is mY responsibility m nmifY the'-' -"- """" _- -" --'"-"--'" -""'-"-
/•occupem f,he rcqu rc nt which'ma i be m t p or m ix uance f Cenifica,e of
10� °" p `y can[ Dae _
�� ---- - Signature ofAppli _ _ t
-
i. All roof coverings to be Class"B",or'better
T.authorized
gm ,1 '•�wV vire
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