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02100038 CITY OF CUPEWrINO 'f. .a BUILDING DIVISION PERMIT CONTRACT094NFORMATION:" BUIL Fs ANEY AVE 3B WALDRON CONSTRUCTION COMP ipri-NI021Ay00038 WdsfclFvEBILTMORE APARTMENTS P 0 BOX 598 APPLICAT191rUyg4rJy2002 ZONE: (408) 377-8186 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 (� �00 LICENSED CONTRACTOR'S DECLARATION Ihereby affirm that l am licensed under provisions of Chapter 9(cmbou,ning REMODEL-KITCHENbRhYAOidALL A C UNIT FLOOR with Section AXp)ofDivision 3 ofthe Business and Professions Code.and my license is / r �'��®UNIT, a. FLOOR full to=and effect, AND WASHER DRYER. 0�&I License Class Lic.N Z :a Date Contractor a2 P��, moderation! ARCI IITIiC'S DECLARATION 4 oVgo{ 1 moderation!my plans'hall be used as public records DEC 0 9 2002 :O II- Licensed Professional qv�y OWNER-BUILDER DECLARATION ��IyL�'pI� <f I hereby affirm that 1 am exempt from the Contractor's License Law for the gV ae:p 0 following mason.(Section 7031.5.Business and Professions Code:Any city or county %$ which requires a permit ht construct,alter,improve,demolish.or repair any suracarc $34660 W prior to iu issuance.also requires the applicant formch permiuo file a signed statement �m�m< that he is ficemed pubmarn to the provisions of fire Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation g (commencing with Section 70YU(if Division 3 of the Busincas and Professions Code)or $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36903008 . 00 Section 7031.5byany applicant for aPerera'objects the applicnot to.civil Penalty of APN Number Occupancy Type not more than five hundred dollars(S5110), 101 — FOUNDATION 0 I.as owner of the pmpeny,or my employees with wages as dtcir sole comperom on. will do the work,and the structure,is not intended or offered for sale(Sec.7060 Brad. and Professions Code:Tho Contractor's Liccnae Law does not apply to an owner of 10 3 - UFER Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements are not intended uraffered for We.If, 104 — REBAR however,the building or improvement is sold within one year ofcompletion,the owner- 105 — ANCHOR BOLTS builder will have the harden of proving that M did not build or improve for purpose of sal : 106 - SEWER & WATER 1,as owner of the property,am exclusively contracting with licensed convectors to 2 02 - UNDERFLOOR PLUMBING mutt Ne project(Sec.7060,Business and Professions Colic:)The Contrumrs Li. 'coat,law does not apply to an owner of properly who builds or improves thereon,and. 203 - UNDERFLOOR MECHANICAL whoeontmetan, uchprojectswithaconracloyB)Iiansedpursuanttoftcintracloes 204 - UNDERFLOOR FRAME License L. 0lam e d c:' B&Per thio nano 205 - UNDERFLOOR INSULATION carer yLu.- Date �4 7 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER Iherebyafnmtanda,Penalty adperjury oneofthe following declarations: 303 - ROUGH MECHANICAL I have and will meinain a Cerificur of Consent to self-insure for Workers Compere 3O4 — ROUGH ELECTRICAL sation,as provided for by Section 37M of the Labor Gide,for the performance of the work for which this permit is issued. 305 — FRAME 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS 3700 of the labor Code.for Ne performance of the work for which this permit is issued. My Workels Compensation Insurance carrier and Policy number am: 307 — INSULATION Carver: Pallallo.: 308 - SHEETROCK CERTIFICATE COMPENSATION IINS INSUON FROM RANCE 309 — EXTERIOR LATH Ohisseelirm neednmlocomplemdifthe permit isfnrome hundreddnllan(SIa) 310 - INTERIOR LATH Ica`.) 311 - SCRATCH COAT 1 certify that in the Performance of the work for which this permit is issued,I shall not 313 - ROOF NAIL employ any person in any mannerso ea to become subject to the Workers'Compeaudon Laws of California.Date 501 - FINAL ELECTRICAL ENERGY ApplNOTICE NOTICE TO APPLICANT:If,after making this Ccnificate of Exemption,youshould 502 - FINAL PLUMBING ENERGY became subject to the Worker's Compensation previsions of be Labor Code,you must 503 - FINAL MECHANICAL ENERGY O z forthwith comply with such provisinnv or this Permit shall he deemed revoked. zo 504 - FINAL BUILDING ENERGY MCONSTRUCTION LENDING AGENCY [r Ihereby alErmthatIWb,is.conswctionlending agency for Ncperftmmm.of 505 - FINAL ELECTRICAL G' the work for which this permit is issued(Sec.3097,Co,C.) 506 - GAS TEST uJ Q Lenders Name a LendersAddreu 507 - FINAL PLUMBING UO 1 cenify that I have read this application and mum that the shove information is 506 - FINAL MECHANI CAL Iy Fcorrect.IagreetoComplywithallcityandcountyordinancesandstatelawsrelatingto 5 FINAL GRADE building conswctian,and hereby action.representatives of Nis city m enter upon the UJ above-mentioned(Weagto ertysaw,for inspection mnify an keep hs. l O F INWLANNIAG (Wc) In save,indemnify and keep harmless the City ill CUPcnino againstliabilitR ndexperseswhichmayinanywayaaaeagainstsaidCity 5 F NWORKS V 7 in ng of thispermjjithDSA W L COMPLY WITH 6AL N -POINT Issued by: Date Y'1n,V/l Y/} / v ��'CRe-roofs Signlenor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will this applicant or future building o..part nom or handle ha.mous material as defined by he Caparison Municipal Cole,Chapter 9.12.and the Health end Safety Code,Scniea i5512(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes N, Will the spplicam or sore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove L' havallous air commando nu Bred by the Bay Area Air Quality Management all new materials for inspection. Dmoricl7 ❑Yes I have read lyyc hemrdnusmatcriels myuiremenks under Chapter 6.95 of the Calif.,. nia Health&Safoyfjloda,Seclimss255115,25577 and 25534. unJcrsmnd thaif the building Jttes note J arcate em.Nut it is my respymihilily to Badly thct p of the myuirem Bw� ma 6, t asuutrc/face. ifcareof0 � Signature of Applicant Date owrer or whim'., agent NW//./C�//'1ON/yL ��a°/ ria/re All roof coverings to be Class "B"or better