01070094 CITY
I BOIL OF
DIIVISSIIONNO ' CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10220 DUBON AV MCS CONSTRUCTION SYSTEMS 01070094
DATE
Abb CHILUKURI BABU 5177 PHARLAP AVE 077202001
PHONE: SANITARY NO, CONTROL NO.
p (408) 225-5151
WOO ARCHITEC MNGINEER: BUILDING PERMIT INFO
Sc w L ELECT PLUMB MECH
m i LICENSED CONTRACTOR'S DECLARATION Job Descrip on
1 hereby affirm that I am licensed under provisions of Chapter 9(c
whhSection 7000)ofDivision 3ofthe Business and Professions Code.HOPATIO COVER.
is full forte edneRe
cense ClassLie.#
a�3 u am Contrao
t O ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records .!
a6 p p Licensed Professional
°'a OWNER-BUILDER DECLARATION
n�m I hemby infirm shm I oat exempt from the Conuanor's License Law for me $10000
t i< Pollowiag rtssan.Section 7031.5,Business end Professionsny Code:Acity or canary,
X F o which q Permit t consumer.alta improve,demolish,or repair any structuresaa3<� _pirimmus issuance,a1m mgaincibe applicant far such permit in file a signed snmmem
that hot.'Slicensed pun6nttothe provisions of the Contractor's License Law(Chapter 9 �,zs �.r �.fnOCsrea �• ' Valuation
(commencing,mpwith_Sev n Al(ID) f Division J of the Business and Professions Code) Q. r;";
ex ';'3 4 Cfi�Y-071. .;V V,,i�-��.s�! 1"q.•
or that he is et therefrom and the basis for the alleged itineration.Any violation
of Secuon7thanva undredicam(orapertitsubjmrsthe applicantmanivilpewlry 1et(; .., Occupancy Type
ar not mote than Ice nanarea donors rssool. l O lA��f�FDAT I ON
❑1,as owner of the property,or my employees with wages as their sale compensation, 102 — PIERS
will do the work;and the structure is not intended or ofered for rale(See.7(3,14,
Business and Professions Code:The Conto crnr's License Law does not 10 3 — UFER Required Inspections
apply to an q p
owner of property Who builds or improves thereon,and who does such work himself 104 — REBAR i
or throwgh his own employees.provided that such irepmvemems ore not intended or -,_..._.".
erzeted ler sale.If:however,me Wilding or imparmincat it mid wiihih-mi yur or 105--— ANCHOR BOLTS"
'rompledan.the owner-builder will have the When of proving that W did not Wild or
improve far purpose or rale.). 106 — SEWER & WATER +
❑Las owner of she property.tan exclusively d Porf ing with fill Th Contractors
o nctom ro — UN
Licensconstrue
the does
nISac.appl to
ownBuser
andProfessionsCndcaThevesO mon. 203 — UNDERFLOOR MECHANICAL�-
u `
License Law does not apply to of owner of property who builds or improves thereon.
..aod-wW.mLicense Low. projects with a contractors)Wuued.parsuant m the. .- -- '-- 204— ---UNDERFLOOR'-'FRAMECia ----.. .-- '----".'"'-- -- —' ----
' 01 ma exempt
License Sec
❑lam exempt under sec. ' ".BR PCfor this rtason 205 — UNDERFLOOR,"INSULATION
Ow ner sr< 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 3O2 — TUB & OR SHOWER
Inertby.rfrt underp<aalty,ofp<r;ury aae,of the rouowiag e«Iamtionr: 303 — ROUGH MECHANICAL
❑ I have and win maintain certificate of Consent to self"mmm tar Worker's 304 — ROUGH ELECTRICAL
Compensation,-as provided for by Section 3700 of the Labr or Code. for the
performance or the'work for which this permit is issued., 305 — FRAME
❑1 have and will mainarm.Woiker's Compensation Insuance,as required by Section 306 — HOLDOWNS
3700 of the Labor Code;for the perfufmance of the work for which this permit is
307
t ...� nsa3 0 7 — INSULATION
'- slued.My Workers Competion Insurance carrier y nu
er and Policy are:..�..--.
Carver
Policy No.:
No.: 'ssSyyHEETROCK
s� CERTIFICATION OF,EXEMPTION FROM WORKERS"' 309TNS '- 'BXTERIOR��LATH
Ttr aLannaanah completedNrmelp mu emranehuna --310 -r7--INTERIOR-'-LATH
1.......... .._ ._..... _....
hundred 311 SCRATCH COAT
(SIWI or 1<ssl _
313' — ROOF-NAIL _ — -
1can
certify
that a the performance f the d k ro h h tit s permit p blued,l t
shall not employ any person m any mo ns io become mbJect to
rte Workers 5 01 — FINAL ELECTRICAL` ENERGY"
'a. motion
t nl.uwr (CII at, ....502 - FINAL- PLUMBING.
"ENERGY ..
.Applcant - . .:
.NOTICETOAPPL(CANT:If;a"rmaking,nCenifcmeafExemption.youshoula 503 — FINAL MECHANICAL;
'
Wcome'subjen to the Wmk<ls Compcnsmom provisions of the",C
Wr C«le,you must
O f«,nwimta'Plywithsuchprevniaasor'ispertmit heaeemmmmhea. . -_..504 __ .FINAL_ BUILDING_ENERGY- _- _.. . .
a CGNSTRUCrION'LENDING AGENCY' 505 — FINAL ELECTRICAL ,, ,. '
F^ - 1 hereby affirm that the aeon.
construction nd'ng fig y for the performantt , `
W of the work bar whi8hthis perinnittrissud(s 3097.Civ.,c1 506 — GAS TEST
__ :_. . ..
"p l.emd<r:Nome--.., . ..._ _... . _.._... _507 — FINAL PLUMBING,.
I<de a Address;
`' UO Ittntfym tisapP.c tna oat the shove inrormmma is 508 — FINAL MECHANICAL .tt
correct.I to comply with all city and county ordinam ad stare laws mating 509 — FINAL GRADE
O.V to mgeonstmciion.and hereby authorizempreiematives o is city menter upon
:j.,rW aMve.menbonedpropertyfor,inspection,putpaes 510 — FINAL PLANNING
(We)agree Fo save,indemnify and keep harmless t of upenino against
liabilities,judgmtents•costs and expemes,which'may' y aecmeagainst —
said 514 FINAL PUBLIC WORKS
"� City in conmquence ofihe'g'rnting of thisyer
A URCAKTUNDERSN 'L HALL NON- INT [slued by: Date
t
iBnamre nfA ontrnaitr_ Dm Re-roofs
AyARDOUB MATE ALRDISCLOSURE "
wi a appli ant or future building pant store or handle havtNanr mat<mW Type Of Roof
u d f d by,the Cupen o M c pal Code Chapter 9.12 and the Health and Safety „• I ,, -, .. - '. „. ,
Code Semmn25572(.1 ( + ,
❑Yes oNo? All roofs shall_be inspected prior to any.roofing material being-installed...-
Will
eing installed_.Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection;I'agree.6 remove
emit hazardous air cc I man' yAma A,r Quality Management
District? all new materials for inspection. Applicant understands and will,comply with
13 Yes oNo _ all non-point source regulations:, ,; ,
ave read doe'Wrallon,materials r dei Chapter 6.95 rime
C omie Himbs&Safety Cod e,Sections 25sJ3 and 574,.1understandthat
the building does not currently have am thin it is Ispommillt tnnotifythe
accts6n,.of the rett quiremam,wh' be met pt rain'su"nce'of Garificate of
"gyp°"`y
Signature of A hcant Date
--71m
orixeaagent All roof coverings to be Class"B" or better .
.. . . ... _�. . . .OFFICE. _ . ... _ . . ._.