01110095 TINO
CITYBUILDING DI ESiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21593 CASTLETON ST SEARS HOME IMPROVEMENT 01110095
OWNER'S NAME: APPLICATION SUB DATE
JERBIC CHRIS C ET AL 283 E. AIRWAY BLVD. 11/20/2001
HONE: (925) 245-2000 SANITARY NO, CONTROL NO.
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O y RCHITECI'/ENGINEER: BUILDING PERMIT INFO
U CELECT PLUMB MECH
y a i � 'J C-1 L__J L7
•z�; Ihereb �ICFehtEsm�a.,n�aRv��ionsofCaN 9moneadr Job Description
'?yam° wilhsechoc70E.fDi,i,hm3afdmB^anesanndPrtre„mmCod,."namyrerma INSTALL VINYL SIDING ON FRONT BACK RIGHT
y f is In tell force and feet. 7 ,
_ggg Licensee Li`'.. SIDES OF HOUSE ICBG ER3663
3 a y
Data Crxdhxchm
,y C ARCHITECT'S DECLARATION
I undennand my plum,hall he used as Public records
r
3 S O Licensed Professional
OWNERBUILDER DECLARATION
v I hereby affirm that 1 am exempt from the Contractor's License Law for the
(_? following reason.tSarnen 7031 5,Bminc,s and Professions Code:Any city nr county
E F C whorl .q pe -t t c .true It improve,demolish, p ny,truc
ca a. ell Pnort t. also q th PPI' nt for such permit fl signed statement _ - _ ........
tha he I censN p 4m t t th<proa i sof m<Comracrors L nse la (Coapt 9
(commencing the t n7(N1i Division 3onha Busma,,adP r shmCoal _ :''' 1.� .Sq; F[ Floor Area t ,.•y,: ;f r- Valuation
or that he r,exempt mer from and the b,s for the alleged exemption.Any violation .. - .
of Section 7031.5 by any applicant for a permit subjects me applicant to a civil Penalty
umber Occupancy ype
❑1,uz owner of the property,or my employees with wages us their sole compcnmtion.
Will do the work.and the structure is not intended or offered'bur sale(Sec.7046,
Business 'd Professions Cod The c t m License Law does not apply to an 102 - PIERSRe Required Inspections,
..a of popery WhoWilds or motives th ad hod h o k himself
.1 through n. ploy« p m
aat n p e t inintendedm .-. 103... -.-.UFERq P
offirnedfor,ole.ffhawevur.then la' g P cyear - ...._.. . .... -
IJ within o of .- ... _
' omplef theerb'IJ neve men a Tpr gm to doe cut build or 104 REBAR - J
mpr of purpose of 1e1 105 ANCHOR BOLTS J/ O
— -- -- -
❑I,ns wen of the property,am endus vdy
mac
i ng With I cerecor contractors to 106 S EWER & WATER
consumer the project(Sec.7044,Business and Professions Coal The Connors
I ,
License Law does not apply to an caner or property who builds or improve,thereon, 202 - UNDERFLOOR PLUMBING .
:. [ atnw -eonamsuen.poi«r, ma.connections)licanard.purshand to she7 CotranirsLmenscLaw ......_ _ 203 UNDERFLOOR -MECHANICAL-----'
' ❑Iamexempt under See
. e&PCfor this reason 204 - UNDERFLOOR FRAME'`
° n" Dei 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
rnertb . mundcr 301 - ROUGH PLUMBING r ,miltyofPrrinryoneonnermlwmgdeclarttioa.: 302 - TUB & OR SHOWER
I have and WHI'maintnin a Certificate of Consent to self-insure for worker;
y omperemoon. as provided for by Section 37W of me Laher Code. for me 303 - ROUGH MECHANICAL
pcAomnanm or me work for wmcn mis p<rptit is i„uca. 304 - ROUGH ELECTRICAL
.�qf+nave ane win m�mtai�workers cumpcmmmn insurance,a:regaireE nr section 305 - FRAME
J]l16 of th Labor Coee f th perf rma< of m work for cab ch Nna pemut is
isiuW Mywo� aCo pc t Insurance v,dPoEgnambnam 306 HOLDOWNS
c:rsie""f-�G�.x' iicyn�JftlL4Dai4�9azI 307r.'- INSULATION, . — --- - -. _-
' CERTIEMI'TION FROM'WORKERS; t•"•. "' ' '
'� COMPENSATION'INSURANCE"�",,,- - " 308' -'"SHEETROC�K
-'--
' ' 'rl3tia i�iio6�«d not be r'omvleied rr me pcm,it is for one nunmea emlars 1.",.:r�'.. 1 yon:
ulool^tiless.j., „,, 310 - INTERIOR LATH --
-. _ .... ..,... .. ;COAT' _.__._.. ..
I enrrr'tn t m m pert int d f
'he o k f hich this gaining ued l 31.1•'•_ SCRATCH, ••-• _.• _•. - •.�__ ---'-
e ll not employ any proson in any manner so as to become subject to me workers x t
compensation law,otcaliromia.Dare• 313 - ROOF NAIL''l '
.Applicant 50'1'- - FINAL -ELECTRICAL-ENERGY ----
NOTICETOAPPLICANT.If ft making thisC nT amofE aYou —
pt n she Id
0 becnhe bj ttoth wok c mpc aro p sof dieLanb Cumyou mut 502 - FINAL PLUMBING ENERGY
foMx th hply with such p r th pe i shall bed d calked,
z _ _.__ ._.503-. -.._FINAL--MECHANICAL_ENERGY.
Fr 5: t b ffir CONSTRUCTION LENDING AGENCY 504 — FINAL BUILDING ENERGY;' ' '
�i 7 ' 1 hereby Which that there ued(construction]coding agency for the performance ,.
Len a's N for wmrn int peter .issued(sec 3697 em.c.l � _ _ 505.--_F I NAL ELECTR I CAL
d,❑ lender's Name 'e-_, :::. .. t n. :.: _.__ _
PZ Iedaers Aaaraa, 506 GAS TEST .
V O lcertifythinlhavertadmisapplicationantlstainthmtbeaboveinfonnationis 507 - FINAL PLUMBING'
correct.I agree to comply with ell cry and county ordinances adi state laws relating
U toWildinWa mge-mmnsmlcoon,and thereby audhowmPrrunmtivesofmncitytoenterupon 508 - FINAL MECHANICAL
>.. eabuvcanged Property for impectiogpurposes. 509 - FINAL GRADE
y l es,j agree ts sive,indemnify end kap h,may inan City of accrue
d'gainn
-y liabilities,jodgmcnrs,costs and expenses wmgn.m>,y in any way accrue against said 510 - FINA P ING
Ciry in consequence^f m<Smming of mist perms. /
_ APPLIor""uI uctNTAO wILLCOIFLYWITHALLNO'rOlt, S1� — I IC WORKS
SOURCE REGULATION. ':�' ej, l$$Ued by: Date
Signawre of APPlicanUCom re" '. pa¢
" HAZARDOU MATERIALS DISCLOSURE Re-rOOfs
' - Ikll the ispitt not or future Wilding orcupant som or muscle ha adous mmerial .Type of Roof_.- _. .
as deftedb the Cutin Mn - - -- ^-
Y K Py Code. and me Health and Safety .,_.
P P
Codd:S❑ecY 2532O'
B'F I
.All roofs shall be.inspected riot to.any roofing.material being installed..
aim Willtheecrionniharsasd form lnedlb,rupantysse.Air ualityMdevices wm`n If a roof is installed without first obtaining an ins ection;-I agreeaolremove
t heard v udu ants d toed by th BeyA eAt Quality ry M gement g p
'''"" all new materials for inspection. Applicant understands and will coed 1 with
oY �+�.. all non-point source regulations., P Y._.
nt
I ha read Ne hanol materiali regmmments under Chapter 11 fi 95 of the
CsIdi Halm&Safety Cod Sections 25505 25533 and 25534 1 understand that
ifar6bmldingdees not currently have.mount,than it ix my responsibility to notify the
ora a i t f me mem Which i be n p t t. Liao f Ceet fcme of - - -
/
of
nature Si Applicant
-,
gDate
r `, saw"nn '"on== gerp to / All roof coverings to be Class "B" or'be[[er „
OFFICE__ ..