02070023 CITYBUILDING
G DPERON' PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
11092 BEL AIRE CT MERCER CUSTOM CONSTRUCTION 02070023
WNER'S NAME: APPLICATION S B D T
SOUR DAVID P JR AND DEBRA M T619 HAWTHORNE AVE 07y0 72002
I 's PHONE: (408) 374-8782 SANITARY NO. CONTROL NO.
p
ARCHITECT/ENGINEER! BUILDING PERMIT INFO
z w C BLDG ELECT PLUMB MIRCH
8 v= LICENSED CONTRACTOR'S DECLARATION
i z_C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing eSCr""NM
with section 7")of Division 3 of the Business and Professions Code,and my license REVISION SUBMI NO NEW PERMIT ISSUED
I,in fall,mCIrceanaerc=er O L 401100063)
:..< Lice ns Claes Lic.a
'�a O Dam Comracmr
1 a LL Yi, ARCHITECT'S DECLARATION
N ') 1 understand my plain shall be used as public records
I=O O Licensed Profnsimcd
c i OWNER-BUILDER.11an, DECLARATION
w^_, 1 hereby,st,c shut 1 an,eBunp[from the Con.uat C9 a License Law for the
!' a which
mam..ISenion 7031.5,Business and Professions Code:Anycity or county
tts�-o which q pc ill t rah p do ol.h p' ynmcmre
n 3°' firms oid, als.re,aim,the ,dic.m 1 ch pc,.it flea signed statement -822000
_ _-
deahe'homedp .untmthIProvisions 1JmC t I .Litt uLe (Chapters S -FLsFIoor Area Valuation(commencing i s ( 7000) f Division 3 nn Business d Professions Code) ( •.)'� -f 9' W a.t 1`a, t_e , �{.',`r.
or that he is exempt the f and the ba<. f he alleged eXamplun Any violation "35616055 . 00 '
of5ection 7031.5 by any applicant for a permI,subjects the appbcam m e civil penalty
of not more Ilia.five hundred dit ers(S5f y APN Number Occupancy Type
71 a owner ofthepropefay.urmrempfoyeesw,Ili a,F,astheir.eleeempenseion, 101 — FOUNDATION
win do he work'.and the strat,we is not intended lir offered for sale(Sec.704 , 10 2 — PIERS
Business and pmfessam s Code:The Contractors License Law does not appy to an Required Inspections -
r of pr. W'party i.wilds m unpmon
xea here ,and wno does such work himself 103 — UFER
or through his own employees.izir ded that itch io,mWrmms are not intended or
offend for sides.If.however.he buildingyear. 104 — REBAR
or improvement rio n sold within one f
completion,the o,v rf,lcWilder) will have the wmcn or proving that he did not build or '
imp mse liar p.rm,a=ors.le.>. 105 - ANCHOR BOLTS
0-1,a:.wonr.nha property.am c-actuslcey contracting with licensee contractor,to . . 106- — SEWER & WATER. _.. .. . .._. .-- -
onstmct the Prnjet((See.7044.B.,m,,,,and Profess[...Codi The Centmemr s 202 - UNDERFLOOR PLUMBING
License Law does not apply to an owner of progeny who wilds or improve,(hemon,
and who contracts for such pmiects with a cenlownodd licensed pursuant I.the 203- - UNDERFLOOR MECHANICAL - -
. Commeme,License Law.
- ...... ..
01 am exempt under Set. ,B&P C for this.,on 204 — UNDERFLOORFRAME.':'
Den 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
' 7 1hereby affirm under penapyofperi.yan, f[.he following declaration,: 302 - TUB & OR SHOWER
0 1 have.nes will r i.(ain .CRrtifca(e of Consent in self-imare for.Woker'a 3 03 - ROUGH MECHANICAL
Compemm;on, as presided for by Section 37W of he Lawr Coda for he
perfmmnceoft=workfarwhichI;,permitI,iss.d. 304 - ROUGH ELECTRICAL — �
01 have and will m.mti workers C.mpenmtion mstraMe,a,rty.;me by Section 3 05 - FRAME
37W of he Labor Code,for he performance of the work for which his permit is 3 06 — HOLDOWNS
c _ issued.My Worker's Compensation Insurance carrier and Policy number are:
" -307 . - INSULATION —
Cam Policy No.:
t CERTIFICATION OFEXEMPTION FROM WORKERS tt 308 t*-t`-SHEETROCK
coMPEnsgnov wsuuANCE309'-; — EXTERIOR LATH _
_suss..._
--------
This"sectionne2d notxcompleted lthe permit iafor one hundred dollars 310 — INTERIOR LATH '
tsipo) next)
-1 ccnGy'that in&performance or iha'w.rk fur which his peranit I,issued.1 `. 311 SCRATCH COAT.
sWll'net employ a.y'perms in any manner so as to become subject to he W.r1:er 313 - ROOF NAIL I t
Kal
Compenaatipn Law,.rcmifornm.Dae
Applicant " 501 - FINAL ELECTRICAL ENERGY
.
NOTICE TO APPLICANT.If,after making this Cenlfcme of Esempu.n,you should 502 — FINAL PLUMBING ENERGY -
became subject o he Worker's Compensation prnvislons of the Labor Cole,you must
ZC forthwith comply with such pzoismnzortispermit shall.Wdeemed revoked.. 503 - FINAL MECHANICAL ENERGY
CONSTRUC'r1DNLENDING AGENCY ' 504 - FINAL BUILDING ENERGY. ' ' -
-� I hereby of mohal tem is a construction lending agency forahe performance 505 - FINAL ELECTRICAL '
WW Qof the week for which his permit is issued(Sec.3097,Civ.C.I
Lenders Name' , .,, _ I_
z - 506 GAS TEST
- - .
a' Lender's Add. - - - - '
Lea507 - FINAL PLUMBING
I, 1 eertiry mm 1 have read his application dna state mm to amore himrmtio.n
F comet+I agree to comply with all city and county ordinances and state laws relating 508 - FINAL MECHANICAL
O'V m wilding consuucion,and hereby authorize reprcsenmlivei.fdisciy[center upon a
y y he awn-mentioned progeny for inspection parpmcs. 509 — FINAL GRADE
s (We)agree(oIme,indemn oil keep harmless'he CiyofC.,emnoagainn 510 - FINAL PLANNING
liabilities.judgmCuB.costs and expenses which may in any way ac=me against ilia
,U Z
CityAPPLICANT
UNDuenceERSTANDS
of RSTANDS Ag D his L CO - - 514,';- N WORKS
APPLICANT REGULATIONS,
AND WILL COMPLY N'TfH ALL NONPOINT'
SOURCE RECIILATIONS. ISsued by: DdI
Signature of ApplaanVComnctor DaeRe-roofs /
HAZARDOUS MATERIALS DISCLOSURE
will the ipplitant or future Wilding..In, ,am or handle byaiaw,maedal Type of Roof.
as def ep by h c pen M pa c de Chapter9,12 d the Health and Safety
Code Section 2553211' - -
❑Yea y ❑N 6. 1 ( t ♦• e r :,h
_ All roofs_shall be inspected prior to any-roofing,material being installed.
d u happlicant r n'Ia;egoccupantnitequipment devices weed. If a roof is installed without first obtaining anlins ection;I agree to remove
'mit haaard sat contaminants as defncd by(h Hay Area Air Quality Management g p
xx Dia(nct0 Yea 0N. all new materials for inspection. Applicant understands and will comply with
�y f. - all non-point source regulations. - -
`=� I,htum read the'hazindous material,ox,itemema under Chapter 6.95 of the
Califom;a Health&Safety Code.Seelions 25505,25533 and 8534.1 understand the
if the building docs not currently have a tenant.that it is ny responsibility to notify the
occupant of[M1e requirements which most be me[prior to issuance of a Certificale of
.. y'. Occupancy.
Signature of Applicant Date
-- O ocrora.th.nzedage.( Date , All roof coverings to be Class 'B" or better
OFFICE . .