02080071 CI BUILDI c DIVISION
PERMIT CONTRACTOR INFORMATION:
e�ayi4A0DRWALLACE DR MATKOVICH ROBERT B AND RIT PERMIT 02080071
W'f fflYICH ROBERT B AND RITA S APPLICAB(2SUyr72002
HONE: SANITARY NO.
l 4 CONTROL NO,
s
lu ce O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
Ed w BLDG ELECT PLUMB MECH
as
y" LICENSED CONTRACTOR'S DECLARATION
nr o 1 hereby otprm that 1 am licensed under provisions of cb,, x 9(commencing
CONVERT GARAGE TO RI��(AoSq RM
cm 1_w with Section 7t300)of Division 3 ofine Business and Professions Code.and my license
e sc isinToms arw effect. ��A�.,a Q��® NALEM)
c a License Class Lic.x
3 w Date ARCHITECT'S DECLARATION
O 5 1 understand my plans shall be used as public records O C I I j 2002 OCT 13 2002
�Y
6 e,a Licensed Roasiowl
e OWNER-BUILDER DECLARATION
w=m 1 hereby affinnin on 1 am exempt from the Cession, is License taw for she
my A1 x x
Z G following reason.(Section 703 L5.Buainas and Professions Cade:Any city or county wILDI tit 6.y J�.�nIl V tl
wh h ts Permit tt t he -improve.demolish,orerepairSig any structure
prior t t I req pr ppl tf such ileaatgrcd(Chapter
that basf with Se u'thcp provisions Ire Contractors f me s ad cLaw
...Coir9 , 73 g0$CB�3r�tPa. ; , 8 I1 , , Valuation
(comm a ingwMSecfon T00U�of i'mc!tp basis
o mic.1.1elxsmd Rofesst vi Code) �. 1_s. '
or thin he i7 31.5 b tmy applicant
m'and the basis for the subjects
the exemption.Any violation
of Section a than
4,5 iv my applicant fora permit subjecu the applicant to a civil penwry
of not more that five nanareaaoliass($s(r)). 101A[LN 1Cpi1WDATION ,' Occupancy Type
❑Las owner Orme property,Lir mY cmpLyces with wagesaslheirsalecampenution, 102 - PIERS
will do Ne wore.and the structure isnot intended or offered for awe(sec.7044, 103 - UFER
Basiness'una Professions Codc:The Cmmnctor's License Law dues not apply tom Required Inspections '
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
.r through his own employees.provided Nat such improvements am not intended or
o10 5 - ANCHOR BOLTS
ffered for sale:If,however,the building Jr improvement t;Bold within one year or '
completion,the awnet-Wilder will have the burden of proving Jut he did not Wild or 106 - SEWER & WATER
improve far puryme of eale.l.
oi`as owner of ine pmxnr:am�:duoi.elrcontracime with licensed emulations to -- -'UNDERFLOOR--PLUMBING.._.... - . .. -.
construct the project(See.7044,Business and Professions Code:)Tne Contractor s 203 — UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who builds or improves thereon,
_and who.commets.for sum.pmjmm with a.commctons)ncensed.puryuant to the 204- - -UNDERFLOOR..FRAME..-.... ...__.. .... .. _
cpp °tor ieense w. 205 - UNDERFLOOR :INSULATION
r. a
F$) me ruderr:" ',B&Perormis reason 301 — ROUGH PLUMBING
I _
Dae WORKER'S COMP 302 - TUB & OR SHOWER
FN .S�pIJN DECLARATION
I herebyafBrm coder penalty of perjury obeat the following declarations: 303 — ROUGH MECHANICAL
0 I have and will maintain a Certificate of Consent to seleinume for Warker's 304 — ROUGH ELECTRICAL
_ Compensation. as provided for by Section 37w of the Labor Code, for the 305 — FRAME
- _ perfonnance of the work!or which this permit Is issued.
... 01 have and will nummain workers Compensation msuanee,as required by Section 306 - HOEDOWNS
37W of the'LaWr Code.fur the performance of the work fur which this permit is 307 — INSULATION
isitied.My Worker's C -pc alio.Insum ce comer and Policy number am' -
. - 308 SHEETROCK - _.. ..
Carne11�gy 't,CERTlECATIONOFEXEMPolicPTIONnOM,WOR�ERS'\, -') .3
COMPENSATION
p-y�iEXTERIOR�'L"ATHo:
_. . 'cf)MPErvsnn1 .ory lNsuRAvcE. ._. - . ,---'—..__3.10...--..INTER-IOR--LATH._. _._ .. ._ ...- - . .........
(This wwiionaeee not Iw completed if the permit is for one hundred dollars 311' - SCRATCH COAT :.`. .. .
(EI W 1 ar In.aJ
_ 313 .-..ROOF NAIL...._..
tic ri ry.tlwj; m psrr nt a rat kl n nm penryt ed 1 501 - FINAL ELECTRICAL' ENERGY
shall nm emplo any pe y an t bee ,object t theWorkers
�J xU 502 - FINAL_ PLUMBING ENERGY
Compen t If Do
curt n'in . .. .... _ . . . .... -
NOT1 A P.IC NT If Rermakngtti.Cerif t fE p you should 503 — FINAL MECHANICAL ENERGY
Z 4 m 1 t t the Workers Compensation provisions of theLaborCade yo List
0 forthwith comply with,mm provisions. this p lshallb de d .ked 504 — FINAL BUILDING ENERGY
42 CONSTRUCf10N505 FINAL ELECTRICAL _
V] r LENDING AGENCY
I hem6y liffirm that there
mu iss cont a o.lendingCo,agencyf th performance 506 - GAS TEST
a'- which this pcmm s!,,acd(5c.)09], iv.C)
w F Lende.,iadchre, ".Ianan elri`;Yvn, . . _ 507 = FINAL PLUMBING —
of to k
0. ❑ henARs Name /1
' �'Z sA°°"s` 50 — FINAL MECHANICAL
U O ation and orate mat Ned sans laws 0ati e 5 9 — FINAL GRADE
' t+ corren,I a J county ordinances and sate laws relating
O.p tobuilding y m«pre.c mtiv-.of this tymanterupon 5 0 — INAL ANNING
>s.w the b ionedp psnyf inspection purposes.y, Lalgmetoncstsanddpenses ph' In any wayrcupcnm.atsaid 5 - INAL B RKS
Z liabilities.ij dgmenu costs J pence which y n any y ccne against said
U-^ ACity PPLI e4 nee fth g t AND WILL
pe t /
so LA'UN A AADS AND0ILLC MPLYW'ITHALLNONPOINT' Issued by Date
ignatureof ApplicanVContacmr Date Re-roofs
HAZARDOUS MATERIAIS DE CLOSU
Type of Roof
Will the mphcaa future W llding occupant omm or handle hazvdous minimal - .. . .._ -.. . . .'
as defined by the Ctmentim Municipal Code.Chapter 9.12. d the Health aod Safety
Code Secdiim 15532( )
'oyes -' - _ •I t . . All roofs shall-be inspected.prior.to any.roofing.material being installed. _... _.
Will the applicant or future building occupant use egoipmcm or devices which If a roof is installed without first obtaining an inspection, ['agree to remove
t hueadous air conmmin ints as defined by the Ray Area Air Quality Management
Nitric'? all new materials for inspection. Applicant understands and will comply with
.OYea - ' all non-point source regulations: ,
- I have read the hamrdaus materials requirements trader Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533 and 255,U.I understand Nat . .. ..
- ifthe Wilding does not currently have a tenant.that it is my urspnmibility nt notifytba -
occu5' 'mized
r ors which retia W ren prior to issumm of a Cmdricite of
J��y�fj� aSignature of Applicant Date
ANda gent. ovu�2: Date All roof coverings to be Class"B"or better
:, ,,....,--.._. ._. .. ... .. ,. _. . . .., ._,. ... . , ..OFFICE