01080001 CITY OPERTNNO
BUILDING PERMIT CONTRACTOR INFORMATION:
RUILpJ if.LL16REBt ANZA BLVD ## C-3 PERMIT No. 01080001
" UU�44��MtENTER ASSOCIATES APOL�Ays81/ 20T01
•PHONE: SANITARY NO. CONTROL NO,
Moi ARCHITECTENGINEER: BUILDING PERMIT INFO
ee m 13 ELECT PLUMB MECH
vFi 6
y Z LICENSED CONTRACTOR'S DECLARATIONj
Ihereby affrmthalamlicensed under mvisionsofClupter9(commencing TENANT IMPROVEMa escription
wFc with Sdelmn 7").f Division 3ohhe Business dProfession,Cddi,.mdmy license
e y y I. Lill forte Lind feel. -y
roc 0 icenu class Li .a 1
33._ ate -- Contract.—,
`I
ARCHITECT DECLARATION
/
LL O 1 undemmnd my plain shall lie.,cd E public TI N. ! /
y C Licensed Pmfcxsional OWNER-BUILDER DECLARATION /O7,
a
E_'a 1 I hereby affirm thin 1 am exempt from the Cm.ti is License Law for the
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z r„nrtwmg re,.r,n.(5.6.n 7031.5.nusines,and Probe......Cmc:Amy shy m<nmmy $27885
,,S o which requires a permit to conswet,alter.improve,demolish.or repair any structure
not, pro to t .also requires the applicant for such Permit file a signed statement
that M x 1 c nscl purses t mine pro s n f m C uact l3<nse W IChept
fess ons Code) ;3,”
3 '4: 7.t0 a•t 5r,4 .6,a
Valuation
or muheA exempt therefrom and the hairs for the alleged
exemption.Any violation '
..pf secaan dons iv any al+pficam rW a permh xabiau me appheant ro a and pemaey I`tt'9ftMAT I ON
.arum mere man r namarea ao0an 1ss60). 101°PN ..�a,r--:o Occupancy Type
i
01,as owner othe property.ormyemployees with wages astheir sale compensation, 102 - PIERS
will do the work;and the structure is not intended or offered far sale IS7614;' - -
pi-
Business and Professions Coda:The Contract.,License Law does nor aply m an 103 - UFER Required Inspections-
ownE
r ofpro,amy Who bodes m improves drent.a,ane no does such work mmsaf 10 4 - REBAR
of mroagh
his own mmpmy«t. buildeq tort inpar ,e,ner,is ro are not intended or f _
bBe.od r f.sme:H,wwtilderte waves e l mmpmveeem is rod within dz year of . . 105 ANCHOR BOLTS-.-__.-- _.-.._. ........ .. ......_. _._ . ..
inprove for the and o sale.) will have the burden of proving Nat he did not wild or' '''' ''
mpmvc rot pnryose of sale). 106 - SEWER & WATER
tri,''isamd�,�wite�d;deny:'omen<insivelycontractin mucens<acnmradersio' 202 -- UNDERFLOOR "PLUMBING
construct the project(Sas,i1W,Business and Professions with Code:)The Contanort 203 - UNDERFLOOR MECHANICAL -
-- - and who
hes tract nm apply man owner of a conty who wilds or improves t mEars 2 0 4 ._—. _UNDERFLOOR FRAME
"ama.who coohocts for such pmjenx wim.e ronuacmr(s)licensed pursuant make, _ __ -
aw
01cina<matL<ense Sec 205 - UNDERFLOOR (INSULATION
❑1 am mammae under Sec. � ,B&P C for tett reason
oscae, Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 TUB Fie OR SHOWER
Ihereby affirm under penalty ofPerjury one ofthe following declarations: 303 - ROUGH MECHANICAL
,• 0 1 have and will maintain a Cer ificnro of Consent In .self-insure for Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3200 of the Labor Code, for the 305 - FRAME
perforwntt of the work ed
for which this permit is issu .
0I have and will maintain Worker's Compensation Insurance,as required by Senior
306 - HOEDOWNS
3200 of the Lnwr Cade.for the performance of the work for which this permit is 307 - INSULATION
iss MyWmkcrsCompction..Insurancecame,and Policicamynumberme:
z�-r 308" ; SHEETROCK- - to
C
- t. t Pah<yNo. r93��oZd-6J - - I „a .,30,9;.' PEXTERSOR"..ATH: .. 'I
F.RTIFICATION OF EXEMFr]ON FROM WORKERS; t.
-COMPENSATION INSURANCE'_'_"; 310;,--,INTERIOR-LATH___...___._..__._."_.____.__-_
e (This vcnion need rot be completed if me permit is for one hundred dollen 311' 'SCRATCH COAT
5100) 1 )
I nirm troth art -rte ' aster mmhthx rsi..� t' -- .... 313 .-. ROOF NAIL
shall not employ any pc n any maria,sin as la became bject,gine Worker, 5 O l - FINAL ELECTRICAL,,ENERGY '
carpe au Ia s.1 California Date I
Appl cat _ _ 502,._=_ FINAL- PLUMBING ENERGY__"_._
.. - - -
. NOTICE TOAPPLICANT If,after kigthis Certificate fExemption.you should, 503 - FINAL MECHANICAL"ENERGY
bee ubjen m the N k .C pe t p ons of m Labor Code,you must
Oz zp rpnhwm<nmplywitn a np vrnonsormr,pemrnsnauxa areookaa. 504 - FINAL BUILDING ENERGY
_ .
' •' t '"''colvsTRucriolyLENDING AGENCY � - 505 - FINAL ELECTRICAL
C. ,].hereby- ,firm that there is a mmtiunion lending agency for the performance 5 0 6 - GAS TEST
armink for which this Permit teased(sin 3097.os c) . .
p, ❑ LendrsN e' _ '.::-. - - 507' FINAL PLUMBING ' ..-......._. ._. _ ....._ _.__.__. _.
U Z Lenders Add- - - 508 - FINAL MECHANICAL" `
Eis I cenif)mat I have read this application and state that the above information is. correct.I agree to comply with all city and county ordinances and.nate laws remteg 509 FINAL GRADE
(, m building construction,and hereby amhorize represenativesor this city mmot,ii on
;m W 'to above-mentioned m
oneappeny forinsppnionpurposes, 510 - FINAL PLANNING
a IWddgmetomost indemnify and keep hmayintheCity ofCion,dup9sast 514 - FINAL PUB IC W013,K-S�
96
liabilities.e)agree to casts and expenses which may in any way accrue against test j
U Z City inconsequence ofthe"minfir, ofinis- t. rr
APPI T'UNDERSTANDSAND 1 AMPLY WITH'ALL NON-POINT I
SRE ATION, i �_ _ Issued by: ate
11- 4 a 1
s�snu , rA n n m ..nine Re-roofs
H OUS MATERIALS DISCLOSURE`,',,
P. .:
Will the Wlicmt a future w ldeg occupy t tore m bumble haamons matEnal Type of Roof _
• .as d fined by,me Cupc no M pal Cods Ch pt 9.12.and the H Ithand Safety _ --
C6aSaxon25532(a) I .' (?rt. Si � '.f •. 'Ij�`*:, "I
oil1All,roofs-shall be inspected priorto,any roofing material being.installed. _ _
•
Will initoommi r rwe b di ed <perequipmenta devices wech If a roof is installed without first obtaining an inspection,II agree to.remove
Emit hazard a c nu is az d fined by the Bay A a A Quality M Management
Dmn tOYfall new materials for inspection. Applicant understands and will comply with
- all non-poinf source regulations. --
61hc.building
read ter waramrs materials regnnEmemta ander Chapter e.9s or the
ahn&Safety Coda Sections 25505.2x533 and 25534,1 unit that
does nut currently have a tenant.Nat it is my responsibility to notify the -" -' - - - -- - ---"-he req irements which must ben 'ortoissuance of a Certificate of
ce
Signature ofApplicant Date
hon Data All roof coverings to be Class"B".or better '
.:.
-:., - -- OFFICE -