02060166 CITY of c mvisRiorvNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT N0.
10 23 1
BUBB RD 02060166
OWNER'S N.
APPLICATION SUB DATE
ENDOTEX INTERVENTIONAL SYSTEM 06/25/2002
:HONG: SANITARY NO. CONTROL NO.
C O O ARCHITliCT/ENGINEER: IL N FO
bei MECH
fn<s III
v=mi= LICENSED CONTRACTOR'S DECLARATION Job Description p,pR 2 2003
OZ4G G 1 hereby affirm the I am licensed under provisions or..C.de 9(commencing
m withSec,ioneandefect, on3oftheBus;nessandProfcss;ons Cole.ane my license TENANT IMPROVEMENT.
a y p-'j E at fun mese and err<n.
d z w U Date lass Lick
Contractor BUILDING
Dine
F LLO
to,a � I to�ne my plana shall be Tq as ublic records
w p O-�E'hxnse� d�Profcssmnnl
OWNER-BUILDER DECLARATION
treeso I hardly affirm that I am exempt from the Convaeda",License law for be
a following reason(Section 703).5,Business and Professions Code:Any city or county
Y F o which requ;res a permit to<onswn,alcor,improve,demolish,or repair any swcmm. $3000 OOO
unY73 _Prior to its Extreme.alsorequiresthapplicantf suchp nit to the a signed statement, -
thmh .J cert dpursuanit toed 0'
or,h C t ,hLcense Law(Chapter Y Valuation
(co tone gw th Section
7alq fU iso 3 or
e s <csaad Pro"car Tscode) �;{O'k<'t•3• , V t.•.tI !�'�K)J` '
or Inas he is exempt therefrom and the hairs for the all exempt on.Any v olation j
-of Section 7031.5 by any"pPlicam for u permit subXca the applicant w a civil pnnity-
ornotmo,em anfvehundreddoihrs(S11) 101 APN P'84FEATION ( "''•"•' Occupancy Type
El 1.as ow net of the propery,or my cmploreesu;m wages as their sole compensation. -
Rq
--will-do'the'work:and the swcmre;%notintend<d"or'offered'for sale(sec.70 -
'Business'and Professions Code:The Contractor'%License Law does not apply to an 103 - UFER Required Inspections'` d •'
owner of propeny Who builds or impmscs,hereon,nal who rt.such work himself
or through his own employees,pmiidcd that such improvements am not intended or 104 - REBAR
offeuC mFaale If.howevica.the bum b or,mprnvarrcm is Id in eyear or - ... . . _...._ .. --- ---- ......... . ... .—
inmpinionthe�wnerhulJ<rw 11 M1uvc the buNennl pray ng that he did nw build or 105 - ANCHOR BOLTS "
ntroveforpurpe.umf,me.', 106 - SEWER & WATER
- _ ❑1:paownerof the preperty.finalSed.7a Bu,i.mely<oamftingw,mfcgTre on<totom 202 - UNDERFLOOR-PLUMBING -- ::' c::_-
ocense the pmject(Sec.]DOJ,Business and property
hi.b Code:)The Contractor '
License contracts
does of apply1.
fifn ownw th progeny who bmles se.p rsua thw The 2 03 - UNDERFLOOR MECHANICAL .
r, .-and who commas for.such projea%.w Ili a.commnarts)bcensed.pursuam.,o The. 204-- UNDERFLOOR FRAME _. . ..... ._.-.
-.5✓',TamcxemptunJerSec.' ,B&PCfor This reason 205 - UNDERFLOOR'�''INSULATION
Air 'OA SATION DECLARATION 301 - ROUGH PLUMBING
WORK-
a hemb rim,tnae. - 302 - TUB & OR SHOWER
ra <odery,ofp<rjuryon<<,rmerouowmgaalamti°":: 303 - ROUGH MECHANICAL
r, , ❑ 1 fire and win m inmin'2 cemfcare of Conoco, to tear-Insm<for Worker%
: 3 04 - ROUGH ELECTRICAL
1 ' Compensation. as Provided for by Section 3700 of the labor Code, for ,he
-. - a<,ram,ad�e ar and work rot whim tins p<m,h is Ew<d. 305 - FRAME
❑1 have and will maimain Workers Compensation'Insurancc,as required by Section 306 - HOLDOWNS
37W of the Labor Code,foe the performance of the work for which this permit is
rsued.Mywon<rsCnmpenmtinmmsurancecarierandPolicynumberar: 307 - INSULATION
. _._ ... . ...__..._.
e n s 1 . t r PolicyNo308••__' SHEETROCK ---'._.,.-._..... . ... --_.,.....- .. ,- -_.. .
' .Ii CERTIFICATION OF F.KEMPTION FROM WORKERS'i ! �"i 7 t '1 3 0,(3. ."� I EXTER"I OI LATH,
COMPENSATION INSURANCE '
-' ITh t nttJ tbecomplbmd fthePermitis one 3RI
1"O -INTERIOR--LATH--- Lv
�rsll>nl onea..l 311 SCRATCH COAT -
.`.. . I certify that rhpila eon - okr nchm. pv '.it ..%eel .. .31-3_...-."ROOF...NA3L...•....
.C6. , Pala rP _o T.became.Object toThe Worker, 501 - FINAL ELECTRICAL`"ENERGY
Comps i 1 sof Celilmm are
._Apphcam'-'1.:' n I I ..502 - FINAL"-PLUMBING -.ENERGY--____.-__._.
-Sp clTO PP Ie vl It.e B kmgt C anf Ex ` u -- - - - ----- --
bsJA e s bl a the W ones C Pt you should
z pcmaalo p o.orth L..ofevoked.
v youmta, 503 - FINAL MECHANICAli ENERGY
OO forthwithcomply w;m np serm p thallbed e ke _ 50.4..7... FINAL_..BUILDING-_ENERGY .. ..__ -
E„^ ' ”CONSTRUCTIONLENDING AGENCY
� > '' 'lh by affirm lh tin iconnmi til Jing agency fme performance 505 - FINAL ELECTRICAL '
C
of
m< ek far v%ni<h this perm t is ueucd(Sec.3097:Cie.CJ 506 - GAS TEST
0. -Knee NO.6 _
o z Lent .AJJ _.. . _
v,0 507 - FINAL PLUMBING
1 rrrthat ilt mad this applicationdslate that m n < r uan;c 50$ — FINAL MECHANICAL "
�' E^ to but 1 8 t comply ,h II ally'and county ordinances d state s elm ng 509
- FINAL GRADE
O W soW buildingconstruction,ddh n authorizerepresentativesofm sty, lar upon
}.W 1neaWen r dp pcmyr fy and prppa - 510 - FINAL PLANNING
',,. 0. (Nv)aemetosme,mdemm,d,a,keep hiheemlein the Otay cuperilairst aid
W) famfre%.iuegmeeta;<un%amd expn,aev wmrn may i.,any war a<eme agam�,%qie 514 — FINAL UB C WORKS
U;z City In consequence of the granting of this permit.
/.PPLI-EREGUDE I A. 4NTl WILL COMPLY WITH ALI NON-PpINT
SE R�uLAT1DNs.. CO�P1 /O Issued by: Date
:. ,gra-dmf Apphm0Ucomm<tor, „ date;�— Re-roofs '
HALARI SM TERIALS DISCLDSURL
11ll hepplicam f t r b ildoaeupim store or handle CArdow malarial
'as d<r p by th Cupcn' b1 lbg pal Cole Chapt r 9.12.and the Health and Safety "Type,Of Roof_.__ _...
Code S ct o 2551 ( ( '- ...._. ...
-Allroofs Sfiall,be inspected prior to any roofing material being installed.
DoeN d h applicant future building'g p tuseequipment devices wnd If a roof IS installed without first obtaining an ins esti OT1;I fi reert remove
r 1 a wmr i :dermab>m Brnr<�v QuI'lyArnuBem..n g p g
Di:,r<' all new materials for inspection._Applicant understands and will comply,with
alCnon-point source regulations -
hore indd The h ravines mate Is laq-505,2 533 a d 25534.1 ur 6 st d the '
irthe building
dosSafey CWe.ave ana25505,t itis add 25534. understand That
ocampauileinga res nm currenmenta which addia h met prior myssuancei bf a Co notify irate a
occupant of the requirements which mus,be met prior to issuance of a Ceniticarc of
. 1'. Occupancy. �
y' = _ 0 Signature of Applicant Date_
ctthori:ea age. D,e All roof coverings to be Class "B•'or better
. .OFFICE-- ...__.