02070038O
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-OFFICE
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CITYTINO
etUILDING DiVIiSiONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMff NO.
19480 CALLE DE BARCELONA
KERMIT 0. SKROMME
02070038
OWNER'S NAME:
BRMIT O. SKROMME
19480 CALLE DE BARCELONA
APPLICATION SUB DATE
07/05/2002
NE:
SANITARY NO. CONTROL NO.
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ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Job Description
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with SKllore onJofthe Business and Professions Cole, and myliceau
ADD GARAGE 360 SQ. FT.
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is in full force and effect.
ead effect.
Licenx Class
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Lic.N
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Date Convector
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ARCHITECT 5 DECLARATION
1 understand my plans shall be used as public records
MAR 1 3.2003
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Licensed Professional
OWNER-BUILDER DECLARATION
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1 hereby affmn that 1 am exempt from the Cmmwmr's License Law for the
ream., (Section 9ca,ma Business sad Professions Cade: Any city m county
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which re arcs a mnit to cnnstmct ober improve, demolis
qu pe pray , h, or repair any ssmnurc-
psiorto its issuance. also requires the applicant for muzmfiteas
aPP pe fined susernent
___. .. ., ....
thaitt4idli¢nsed pursupnt to thryee pryNsions of the Consractors Licenx Law lChapter9
(mmrg'ac ingwilh Section 7tp6j of Division Sof the ��tuiness and Professiom Code)
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sx' ", 36,' 3:; 0��°r•B.( ya;i, $ ."i,T� Valuation
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or th0 heis e. as therefrom and th<wsis for the eI1FjW ehempuoa. Any violation
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o( Secsion-1131.5 by any upplicam far n pcmtit subjttts the applicem to a civil penalty
of m.rc,.a 'is.hundred aoEars(ssW).
101AP-N �80MATION I-'':•oto; Occupancy Type
IT 1, as owner of the property, Lir my employees with wages as their sole compensation,
102 PIERS
--will-do-the'work. and 'the structure is nor intendedornRercd for sale (Sec 1614,
'Bus ncav e d Professions code The C ntmciar's Lscem, Law does not apply to an
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103 - UFER Required Inspections't r r• ' '' _:
owner of property, Who builds r improves thereon and who does such work omself
or through his own employess. provided that such improvements are not intended or
104 - REBAR
arc or so e. owevere the building or i n stile
did one geld or
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10 5 - ANCHOR BOLTS ' '
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completion, the ownerwilder will have the burden of proving that he did not build or
Widen he
improvefarpurpa.anf:ale.).
106 - SEWER & WATER
(7---w-r of the pmperty,amexduiwely embracing with licenxdcontmctors to
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2'0'2' = UNDERFLOOR-PLUMBING" _
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construct the project (Sec. 7044, Business and Pmfesslons Cale:) The Contractors
LicenseLaw does not apply to an owner of property who wilds or improves thereon.
203 — UNDERFLOOR MECHANICAL'',,
and oh.,emoracts.for.such, pmjccts.with a couroctor(s) licensed pursuant to the..
ntractors License law.
_._ -._.. -'z 04-----UNDERFLOOR—FRAME--- --------- -'- "' ""`-- -'- "
lemexemptunders .BA,PCfarthisroun^205
wner Dute 7 S OZ
- UNDERFLOOR 'INSUliATION
301 - ROUGH PLUMBING
i0Cmapenvoi.d.
ORKER'S CO!.1PENSATI NDECLARA-
302 - TUB & OR SHOWER
ercby amrm under penalty of perjuryone of the following declarations:
303 - ROUGH MECHANICAL
1 have acid will'montain a Ceiiificote of Consent to Wfusure for Worker's
304 - ROUGH ELECTRICAL
m provided for by Section 37W of the Labor Code, for the
performenen of theiwads far which this permif. is issued.
305 - FRAME
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❑ f have and will maintain Worker's Compensation Insurance, as required by Section
306 - HOLDOWNS
37W or"sbaLsWr code, for mq Neto... of the work far whim that Permit it
issued. My W kers Co pe t Insurance cam er and Pol cy w Lire
307 — INSULATION
cam tad `1 .1 'lroncyNo -
308 SHEETROCK" _"
- ,CERTIFICATION OF PXEMPTION FROhf WORKERS (
tt_ I: I .3 0 9 f- :-E}{Ttft.I'QRI.^:L9A'j`.H1
ENSATION INSURANCE
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Tnsxbuaa.ewn�x
(SI W)or leas) completed permit is for one huodmd dollars
311 - SCRATCH COAT
' '.1 [citify Chain the performance of the work for which this permit is issued, I
" — 3-13--- -ROOF NAIL ��ENERGY'
shall nm employ any person in any manner m as to become subject .,he WredoW
501 - FINAL ELECTRI CA'L' •''
cpplica anon i.a yt n(cmlr.mw. Dq"
-NOT[ ani. '
_ -„- 502____FINAL_PLUMBING ENERGY. -- .. .... .
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Exemption,youshould
this Cisions of of the Later
becos CETOAto the NT:If, after Compensation
become subject to the Workers Compemetion provisions of the Wwr Code, you must
forthwith
503 - FINAL MECHANICAI] ENERGY `
comply with tum provisions or this Permit shell be dcemed revoked.
504._ -. FINAL BUILDING ENERGY_
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' •1 - CONSTRUCTION LENDING AGENCY'
on lend' gag cy fonw Performance
Io or affirm that th mued
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505 - FINAL ELECTRICAL
work for whichth pc ¢uissued l5 .JW]Civ. C.l
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offnder's
SO6 - GAS TEST
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Name
ens Address,
507 - FINAL PLUMBING-
LUMBING508
508- FINAL MECHANICAL '
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c6Wild i .gree to comply with all countysentnances and Hite laws
towalywcgconllorsdn.:mdhemby
509 - FINAL GRADE
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authorize enter upon
oo,ocnrizeseposemativexofthis citymentvrupon
the nba(We)
tar ry dke purposes.
e.,to
510 - FINAL PLANNING
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slto, e. oy
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(Wjudgrdts, costs andepenJke1oh rmlasthe waybd sCope}tiro againstsid
Iiabiiities, judgments, costs and expenses wNch may in any way uccm<agains) said
514 - FINAL UB C WORKS
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Ci inronsiiqucnbe of the granting or this rmit.
APPLIDANTU�DERST.'SAND WILL COMPLY \s'ITHAf}..NON-POYST
sr CE'Redf,TATR
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Issued by: Date
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sig+tare_mnpp,,drocnmratrorir . .ata
Re-roofs
.> :HAZARDOUS MATERIALS DISCLOSURE
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Will ii e appl c t r future building ace pant t re or h ndle h .Nous material
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.Type Of ROOF _ - .. .
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ssdefrcd by the Cuperdit Code Chapter 912...d theHealth and Saf ty
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Cod Sano. Y55J(41 ,
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IN \I,ts ti''I,
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All roofs shall be.mspected prwr_to any roofing material beinginstalled.
Will the applicant orfuture Wilding occupant use aipment or devices which
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If a roof is installed without first obtainingan ins ction', a ree to remove
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emit hazmd°us air conmmident, as defined by the Bey,a Air Quality Management
Diori
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all new materials for inspection. Applicant understands and will comply with
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all non--point source regulations.
have c d�lhe hazardous materials requirements under Chapter 6.95 of the
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California Health & Safety Coda Sectiasrs 25505, 25533 and 25534. 1 understand that
irthe w Idmg does stat curseml hmx a ¢nam th t d* mY rcsponsibil ry m nut fy the
ace pal f th iequiretnents t h must b t prior w iso once f a C¢n fc to of
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner raatho aeaagent, Data
-OFFICE