01120011 CInuDIGESVO
BUILDING DIIVIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7544 FALLENLEAF LA R A D CONSTRUCTION COyyI yy 01120011
ovN�f'ss,. TY KEVIN P AND ELAYNA 4315 FILLMORE ST AP1L2/ 03s/ 2001
I PHONE: (408) 988-3690 SANITARY NO. CONTROL NO.
c ARCHITECTIENGINEER: BUILDING PERMIT INFO
w G BLDG ELECT PLUMB MF.CH
zL 1 I-1 C7 LJ
LICENSED CONTRACTOR'S DECLARATION
z 5 = Job Description
hereby notion,0.11 am licensed uMer provisions of Ch p r 91co m ncing REPAIR FIRE DAMAGE .
mCs with Section7pA01ufDry>io Jnftne Busin<sn anJ Prylcpsiquyc a<,anamyhrense
yY J If;n rYll
zre< License Clara. ta/ ` Lica �pr"
Date Comm 0 R9 fi`�
'�3�+-� ARCHITECt'S DECL ION
ah
-�O j I undemm�d my plans eM1nll be uaed m puM1lir rcn+rde
oo LicensedProfesafon.l APR 0 8 2002
6 en OWNER BUILDER DECLARATION
v.
1 hereby affirm that I am exempt fmm,he Contractor's License Law for the
E50
3ifollowing (Ser, 70415B ,esaP f county
which requires permit to .th t aper,improve,demolish.ofmy structurecture
- BUILDING _. _ -$__9-00.._0
to t also anionsthe applicantf hummiofl.'i'nm s,n¢mem. _
v licensed ponom, the pro,. s adds,Contractors License Law(Chapter9 ,�;1„,�r.p� r Valuation
acing with Sect 7 BlofDvisionJ rafts,Business acid Prof,ons Code) •a i•,S ' i•(3�� 8,V' .it`tv��,e ''C._i
Or that he is exempt,hercfrom and the two,I.,the alleged eiempuon.Any violation
Of Section 7031.5 by any.,he..for a permit subjects the aadicanu m a civil penalty
morn hot Five hundred dollarscS500). 101ApNPllz 3l;JDATION -' Occupancy Type
01,as owner ofthepropeny,wmyemda,ecs with wagcsas their sale compensation, 102 PIERS
win do the'wmkpand the tmc,c c is no,imendcd in°berm for safe(Sec.7(144, 103 - UFER Required Inspections'
Business and Professions Code.The Contractors License Law aces no,apply,o an - '
owner of progeny%%o Wilds or imposes thereon,and who does such work himself 104 - REBAR
onbrain g r his own empluyecs.provided that illo Improvements are no,intended or _ ._ _ _ _ _
for Sale. wer builinwilldamgchanderoeem<nt is sold he did one rem of 105 —ANCHOR BOLTS
"oRcrrd
iampmaan, he owner-nunaer win nova me numen ar proving 7(,a,he did 7(a,Hood or
mprvscmrpm,ma,.fsele.). 106 - SEWER & WATER
- .. --_- 202 - -UNDERFLOOR PLUMBING'
Cloram as owner of the p(Seeny,am Business a rommning with de:)T ,Corm ma m
Licenser me project tappl7tou,owners and property
whom Cmc:)The venthereon, 203 - UNDERFLOOR MECHANI CAL
License law does not apply,o an owner of property who milds 7(r improves thereon,
-mil who.conuach,for such projeeas with a contractors)licensm.permsmi.to me ...... 204 - UNDERFLOOR -FRAME----- ---- -- ----- - ----. -- .- .
Communists License Law.
ClIain exempt under Sec. ' 'B&PC for this bents. 205 - UNDERFLOOR- INSULATION
Owner nme ' 301 - ROUGH PLUMBING
'WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby arGtm una<rrc9.I,y°f penury one of he following declinations: 303 - ROUGH MECHANICAL
f0 1 have and will malntum a cenific.te or Consent to.eleinsme for workers 3 04 - ROUGH ELECTRICAL
Compcna,iun, m provided for by Section 3100 of the Latour Cade, for me
pefrornmoccofthework for which thin permit isissued. 305 FRAME
01 have and win maintain Worker s camPonsa,imt Imumnre,m fc lumad by section 3 06 - HOLDOWNS
37Bo of in,Labor Cm r 'hpertxo mice of he work r which,ms permit is 3 07 - INSULATION
ismEM wck<reC/��e uP moance career and Policy number ,,,_ '308 ,SHEETROCK -
C am s L '•Policy Nu. i 2 9 316 't . !3`09t='t BXT&RP0R4LATH. -
KTIPICATION O E%EMPDON FROM WORKERS y
COMP
(This season nmd cid be FNSATION INSVRANCP._ ---------. 3'10, ;-':INTERI'OR --LATH--- .---
completed if the permit is fm one hundred dollars 311•` - `SCRATCH COAT
(51007 m leas.)
- 1 nflna,i�tk1. rr ofe,ve work which; 3-1-3• -- '-ROOF-NAI-L--:.'-
r a ct Lis ns�m.1
Compemmio°il°Laws oibay `cifomta Date ° ` become b""' '"`w°rk`a 501 - FINAL ELECTRICAli'-ENERGY
Applicant .502 . FINAL PLUMBING ENERGY.. ..
NOTICETOAPPLICANT.If.after making Mu.vi,i cmeof theL.bp,ion.yaushould
....1 503 - FINAL MECHANICAL ENERGY
z fortbecamembjrcty the Worker's Compeomeon Permit shall he Labor=voka . must
zO man m I 505 - FINAL ELECTRICAL
comply i,7( rhproismmofmispetmi,snanbedeemmasakm 504 FINAL __BUILDING ENERGY
•f, .CONSTRUCTION uctim l G lending
age Y _ u,
as 1 he by atTr.h that the- a conswa on 1<na ng agcr¢y for Mc performance ,I
.B onn nkforwmcnm am;ttsissum(s<c.3o97c. c.) „ 506 - GAS TEST `
:D z Lenders Namc ..••` . ...-•: - ..
. LanaersAap2ss' _. - 507 - .FINAL PLUMBING.
U1ccn,fyma,Ih.vcrc.nmin.ppnra,onadnateMonneabovemrom.ean;. 508 - FINAL MECHANICAL
ta:., . aaiiecB 1 agree to romply with.11 city and county ordinances and state laws relating 509 - FINAL GRADE
O C.1 to Wooing comaueaon:and hereby amhunm heprcsenmuves ottnis city to enter upon
} W to amve-nxntionedpropnyfor insKcl,.npurpgses. 510 - FINAL PLANNING
E.'Is. I c)agree it save:indemnify and keep harmless the City o'Cupenino egilns
7( B.mhhea,jaagm cit:.easm an
e.p<nses which may in my way name raga 7(a, a a 514 - FINAL PUB I C WORKS
V=� City id consequence of me granting of,his permit. '
LICANT O ' ERSTA.' AN'D L(.COMPLY t ALL NON-POINT '
ER r I a . Issued by: Date
a- .ac.
Sigru ofApplca antarmr imp Re-roofs
1=00 MATERIALS DISCLOSURE "' "
W II ca
applicant m fmiire budding occupant 1 a Xam4 hvardods rm,eiiil Type of Roof.
m def m by th CNpcnino Municipal Code Ch Pt 9 12 and the Health am Safety
Codc Section 25533(a) - tit• is y -. -. t'.d. .. .....
❑Yes' ON -,All.roofs shall,bfe inspected prior to.any roofing material being installed. �_
W IImeairconla o
futurebefinedbyt p tweeryAirQuality
u tdevices emrn If a roof 3s installed without first obtaining an ins ection; I a ree.to remove
elan hazard ,a a ,.as defined b)to Bey Amu A Q 1 ry Management g p g
Dist"' _ all new materials for inspection. Applicant understands rstands and will comply with
0Y °No - i all non-point source regulations, ,
Llrdmv�onmn�.Isatl me'haxeNmvs on renals ramremcom,md<r Chapter&45of the
&SafetyCoac,Sections25505,25533and25534.1 undcamnd mmsnmcumcn,l havea1.moot is my mspansibilitymbitdy,heanch mus and Prior m issuance of a CeniGca¢of
acy 6 .1 .1
,0j . Signature ofApplicant Date
:ed.gem IVDate All roof coverings to be Class "B's or better '
.. ., _ . . ..: :' OFFICE