01050043CITY
bDIVONO
CONTRACTOR INFORMATION:
ISSINPERMIT
BUILDING ADDRESS:
10114 VISTA DR BLDG 1
PERMIT NO.
01050043
Oml�xE'CLARA CO
LICq y
AC 03%2001
FIRE DISTRICT
PHONE:
SANITARY NO. CONTROL NO,
Z ARCHITEC'UENGINEER:
BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
E
L7 f—I I—t LJ
i
LICENSED CONTRACTOR'S DECLARATION
lob Descriptio 4
Ihereby affirm that: am licensed under provisions'( Chapter 9:commencing
3ofthe Business.rdPral'esvi'ns Code. license
' 6 UNITS/ UNIT A (4 EACH) 557 SQ. FT. EACH
t9i with Section7(R)mDivision andnsy
n In full far. and effe 2C
UNIT B/ (2 EACH) WITH 609 SQ.FT. EACH
ULicense Class Lic. a
Date
FI N A LE
R HITECT'S DECLtARATICM
g 1 undersmnd my plain mall W used as public rtcnNs
.
MAR 2 4 2003
Licensed Professional
OWNER BUILDER DECLARATION
w 1 hereby affirm that 1 um exempt from the Contractor's License Law for the
following =son. (Section 70315. Business and Professions Cade: Any city or county
0 which requires a Permit o construct, alter, improve, demolish, or repair any structure
p ori°itsissuaugalsortgttimsto,appreant for such permitt0pan signal stmamem-
- that he is.li¢nsed pursb.hl rosin pavilions olthe Contmno(s accrue taw (enapter9
700n) Division Jofthe Business Professions Code)
BUILEH
Sq::F[.F1oor,Area1 ss
i. {; �.'!I,F
Valuation
(commencing with Section of and
or thin lie is exempt th'crtfrom and the basis for the alleged exemption. Any violation
,\ t• 4 s!)' f.-.":1 r•.l.Cr.
of Section 7031.5 by any applimat for u permit stibjeas the npplic.nt m a civil penalty
'of not am Five hundred dollars SW).
re m
APN Number
Occupancy Type
❑l, as owner of the property, or my employees with wages as their sole compensation,
101 - FOUNDATION
_
102 - PIERS Re uired Inspections '
q p
'will dothework. and the structure is nor intended or offered for sale (see. 7844.
' Business and Professions Cale: The Contranor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
103 - UFER
imp ere not intended or
through his own ey provided that such mm
. ;bm Bered for wle If, nompl 11 building or improvcmcm s mid within one year of
. _..
-- ..._.-..l.O 4.- - _.REBAR _.. __._.. _. --------
completion, theowner.Wilder will have the burden of proving that he did not build or
105 ANCHOR BOLTS
impmvefarpurposeofsale.).
-
__,.... -- _e. -. -o .._......
O 1, u owner of the pmpeny, em axe ly commning with licensed commnors m
.._...1-06 .._..'SEWER --&-WATER"
construct the I mjael (sec. 7044. Business and Professions Cmc:) The Contractors
202 - UNDERFLOOR PLUMBING • . -i :.. r' ,
License Law does nm apply io an owner of propcny who Wilds m improve thereon.
and. who conaccts,for.soch pmjccia with, contmetorfs) licensed pursuraus the
.. _._..203 - UNDERFLOOR- --MECHANICAL--'-----=--------------'—'
Contractors License Law; -
Clamexemptunhmsms' `' '.B&PCforamoceaon
204 - UNDERFLOOR'' FRAME..,
owner Piano
205 - UNDERFLOOR INSULATION
' WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
I herebyaffinn under penalty of perjury me of the following declarations:
302 - TUB '& OR SHOWER
❑ 1 have and will maintain . Certificate of Consent t° self-inmre far Worker'.
303 - ROUGH MECHANICAL
Compensation, � as provided for by Section 3700 of the Labor Code; for the
304 - ROUGH ELECTRICAL
performance ohne work far whim this permit is iasaed.
305 - FRAME
C I have cad will malinmin Workers Compensation Imumnce, as lexamal by section
3700 bf the Labor Cme. for the pe'rfomtence of the work for which this Permit is
306 - HOLDOWNS
issued. My Wait C .,colli. Insurance came, and Policy number ase
comer ,(
_ _ - _
307 ..INSULATION
ices ArINOPetemeno�RF�?9'��';,
=sap` (?30'811 3'SHEETROCKtf",'t,
_cDMpENsnnoNwsuanNce'
--- ---30'9, .:EXTERIOR --LATH - ----'"—
` IThissitidunncadsainecampletearrmepe,miiisfaranebundrtddmlars
310' -INTERIOR LATH
aiomanexa,3. .,: .. ...
_..-:
.. _....311.,.-..SCRATCH•COAT.._ .._.- _._.._._�,.....-.. ........�-••°-..,..
1 cenif that in the perfugnanh of the walk for which this permit is is...d. r
a
c nit nanyate' mbec m Subject 1M1e WOE°r�
313 - ROOF NAIL''
a Laws of Calf
' ..:
501_ - ELECTRI CAL....ENERGY
. -'Applicant
.NO"fICETO APPLICANT: If, eller making this Cedificmeof Exemption, you should.
I- .. _. ,FINAL.. .. .... _. ... __. ._..-.
502 - FINAL PLUMBING ENERGY
Z become svbjen to the Workers Compcns.tion prnJisinns of the lsWrCmq yoo mast
fordiwithcomply withsuchp,nvixuarx,mthis permit shall bedecmedrevoked.
503 FINAL MECHANICAL ENERGY_ ..
"''CONSTRUCTIONLENDINGAGENCY.
504 FINAL BUILDING ENERGY _ "• -
' I hereby mEmr that there is e'conxouNot lending agency for the performance
-
505 - FINAL ELECTRICAL
y'"
of the work f r which this pert' t s issued (Sec 3097. Civ. C)
,-.,
.. .. .__ __._. .. ... _..... .- -... . _:. .
'TEST.
0 " Lend rs Nam -- ,. 1,.. -.. ..,
506 - GAS
LandersAdd rPo. -.
507 - FINAL PLUMB I NG '
I certify that I have rem this application and slate manhe above information is
cour t, I agree to comply with all city end county ommonces and nam Iowa relating
508 - FINAL MECHANICAL
no Wilding contraction, and hereby'auborize represcmati4ee by this anym akar upon
509 - FINAL GRADE
�] the above-meniioncd progeny far inspection purposes.,
y(We)ilioaove. indemnify and keep harmlessthe City ofCupeninoagainst
510 - FINAL PL ING
A liabilities, judgments, costs coil expenses which may in any way accrue against said
7J- City in consequence of gmntiag or s petm;t.. ,:. - •' ...
514 N WORKS
APPLICANT STA, AN 11:1. COMPLY WITH' ALL NONPOiNT''
Issued �p Date
SOURC. UI 3
�I
_
SignatG o Ip card on5ror Data f
Re-rooA0 - ROOF BATTENS
I
,"', HAZARDOUS MATE RIALS DISCLOSURE
Will the applicant or future building c palm soon 'r handl h does material
TyP �..(ld ROOF IN -PROGRESS _
e O O f - - -- -
m defnpd by tit Cupcn no Municipal Code Chapter 9.12, and the Health and Safety
Cine Sect a 532 )1 t 3p "
1
,b �t y Ir dtl [l St•tf i,51
s
Al] roofs shall be inspected prior to. any. roofing_matenal.being installed
Will the applicant or In re building occupant use cgmpmcm or dente watch
If a roof is installed -without first obtaining an inspection;J agree -to remove
emit nazaNaeus to, a6mandrionarits radefined' Y Y Area Air Quality Managermn
'
D stoat
all.new materials for inspection. Applicant understands and will coin y with
-.n-
qeR.
CY °
„•
all non=point source regulations , i
t
p6,95the
the hazed c utenals c mrements u der Cha ter b 95 of
-
Cel forma Hnith & Safety Cine. Sections 35505 25533 and 25574. 1 undersmnd met
I Pie bold not cu,rtmlyhmsatenant that n is my. responiblity to fiottfy the
'n . .
- -' - - -- - ��/J �� r62
gid
occupant of the rcquircrvems x h mu t be t poor to ....rice of i Celiificate of
-.
bay
tipksPP.
Signature of Applicant Date
All roof coverings to be Class "B" or better
o er au non d, t seam
g
OFFICE _.. - _ ...