02020096 CI TY OF G DmSION PERMIT
° CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1047 NOVEMBER DR ADAM CHAN 02020096
02/25/2002
PHONE: SANITARY NO. CONTROL N0,
cat 7OF
O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
wF BLDG ELECT PLUMB MECH
S N z LICENSED CONTRACTOR'S DECLARATION Job Descri tion
5 Z_O 1 hereby affirm that[.,it lirensrd adder....min,of Chapter 9(commepncing
r-m isithScnion7000)ofDivision3oftheBusinessandPmfnsionsCede.andmyIiceram ADD 391 SQ. FT.
cm�� is in full force eM cWn. ��9�N A 9 E®
i x < License Class Lic.a N eP'V.L
i 3 O Dam Contractor
u y ARCHITECT'S DE LARATION
1 understand my plan,shall be aced as publ it records MAY 16 2002
r
i i C e Licensed Professional
OWNER-IIUILD17R DECLARATION
uR"LL 1 hereby afftmt that I an exempt from the Contractor's License Law for the �1 ", gig p e�
t?a following reason.(Section 7031.5.Business and Professions Code:Any city or county V Iag 7•V•l,JJyO
2=0
x C which requires a permit to construct.alter,improve,demolish,or repair any structure
1- , ..prior t I u a1: cq - 'tit applicantf such pe nuuo file a signed vamment.. -
com I'c n'JI honn' he,M) w' , fm C ucttrs and Pr Law,(CharterCer9 { $Q, L/p,'1sa�p Arca Valuation
Icon, cseempt Ilmo "1000) TD s J frit lBusinessandilmfAnyvi lade) C.V3� (1�3'fJZ tO-V 1Urt t0 U.S.�-1.Y: l"•,
of mm he 7031.5 b merc0om and the bast. for the alleged mcanpfnd Any violation '
if Section L5 by any applieam fora armil whjttts the applimnl too civil penalty- p, N �n
Of nm more man Bve hundred dalma(s500). 101PNDATION !riOccupancy Type
Q I.as on,net of the pmany,ur my employees with%trips as their sole compensation,
-will do the work.and the shoolum is wt intended or offered for sale(Sec.7044L' - -
Hasiness and Pmfcssians Code:The Comruchm's License Law does not apply m on 103 - UFER Required Inspections
owner of propene Who builds at improves iherttm,and who does such work himself
or Otmagb his own employees,provided that such improvements am not intended ar 10 4 — RE BAR '
_Offered far sale.If,however.the building or improvement Is sola within on,:year of - - - --- - '.. .... . ... . .completion,the owner-budder will have the burden of proving thin he did not build or 105 - ANCHOR BOLTS
mpmvri"a'amommfsme.). 106 - SEWER & WATER
- wnecof lh<pmpeny.am eadusivdy comrxting aim littrnW<onwcmrs to 202 - UNDERFLOOR PLUMBING '
oo.vua the project(Sec.7( ,Busincas and professions Code:)The Cmamcuo i
License law does am apply to an owaer,of pmpeny who build,a,improves thereon, 2 03 - UNDERFLOOR MECHANICAL—
.and who contracts for such pntjccu with a contractors)licensed pursuant in the ... .. ..
CO..,.,',License Law. ., 204 — UNDERFLOOR- FRAME `-- - - "---"
G l am exam Sar. ' B&PC far this march 205 — UNDERFLOOR* INSUliATION
owet5—oZ 301 — ROUGH PLUMBING
WORKER'S COMPENSA 10 DECLARATION
302 - TUB & OR SHOWER
Ihereby afrrmunder Penalty ofPat one ofthe fnBewingdcclaation.: 303 - ROUGH MECHANICAL
\ ❑ 1 have and will maintain a Certificate of Consent to self-insure for worker's 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the tabor Cade, for the
_ arrnrmaece of me work far which this Permit i.issued. 3 05 - FRAME
❑I have and will maintain Worker's Compensation Insurance,as manned by Section 3 06 — HOLDOWNS
_ 37M of the Labor Code,for the arformanec of the work for which this'armit is
issued.My Worker s Compen..ion Insurance carer and P.1a,e number as: 3 07 - INSULATION
CNrer Policy No 3,08.-.. .SHEETROCK,.; t .,
CEIcl'IFICATIONOPEEMI'TIONFItOMWORKERS t- *'' 30'9' vt:"EXTERTOR'LATH
COMPENSATION INSURANCE _ _ ..._._ _. .__.._ ._ .. . ._..__....__.._...
(ods'mniovnFdmatbecompletediftheperznitisforonehundreddollars 310 INTERI R LATH 1,
(SLID) le"')le"') 311 — SCRATCH COAT
I
-certif..y liter in the_pedormance of the work for.vhich this ipewt_is. issued,1 313 — ROOF NAIL.`
'
,hall not employ any arson in any manner so cep to become subject no the Workers' 501 — FINAL E LE CTR I CAL ENERGY
Comammion laws of Cal:fomta.Data '
Apphcam. - -- . 50'2" — -F'INAL PLUMBING' ENERGY
NOTICE TO APPLICANT:If,'aher imklnb this Cenificam of Exemption,you should
become:ubjecttothe Worker'sComanratummonaiaionsothe Labor Code,you must' 503 - FINAL MECHANICAL ENERGY
Op ronnwimeo„tplywimlrn'pmlixvan:ormiaamitanenxaemedrtl. 504 - FINAL BUILDING ENERGY
'r '�^' CONSTRUCTION LENDING AGENCY ' SOS - FINAL ELECTRICAL
f""I hereby aRrm that thea is a Construction lending agency for the perfuimansti
,�. 6r
the work for whichdaisPitman isissued(Sec.3091,Civ,c.)
L _ _. _. 506 - GAS _TEST.
z Lener _ .. ..
rrName ' '
Z i naarcas - 507 .- FINAL PLUMBING
U O I cenify that I have read this application and stale that the above information is 508 — FINAL MECHANICAL
coven.1 agree 1 comply,with all city and county ordinances and state laws relating 509 — FINAL GRADE
m building emousciiin,and hereby inalmoaempresentatims of this city to enter upon
y..� me above-mentioned property for inspection purposes. . 510 — FINAL PLANNING
FC6 (We)agree 1x111,indemnify end keep harmless the City of Ctips against
fn' liabilities,judgments,costs and expenses which may in any way accme against said 514 - F INA P C WORKS
CJ.Z Cityi conscqu<n 1. f hT gaming or this permit. ' ' �1
�SAhPPL . NT UNDER}RMN.DSAND WILL COMPLY WITHALLNON=POINT' ( / V
�m ' �
Siguaureof ApphdanJContrvcmr - Date, RQ-IOOf$
HAZARDOUS MATERIALS DISCLOSURE
Will d¢ pplicam or fatreb lding occupant same a,handl haa5rdous mam'al Type of Roof,.
as defined by the Cularatim,Municipal Code.Claper 9.12,and me Health and Safety
Code Seaon 2553200 - I r nl� a s:.'' ,';a!,• t ' }�. to '
oY �" '` - , .. -All roofs shall be fnspected,prior io,any,roofing,material being installed. _..-.
W 11 the pplicamorfumrtbuildmga p .ysccgapminta a e�awmrn If a roof is installed without first obtaining an inspection, I agree to remove
em t haamd us air cosh mioena as defined by the Bay Arta Air Quality M...gemetn
a all new materials for inspection, Applicant understands and will comply with
No _ ... _ -
Drstna 1!l
a q .
. over .,. all non-point source regulations.
'nn.He lth the xty Codes ectime,2 n uiremen and
Chapter 6.95 of me
ifthe uil building
do&Safcom Cade:S'tions tor.da itis end 35531.I ity to actradnotify
thin
if the building dols not curzcntly have a mnam,mat itis my tsuance Of a to nficio the -
oc- p t of the rcy it rc wM1ich must be,ma piiorna issuance of a Certificate of
at1, All roof coverings to be Class"B„or better '
OFFICE _.