01110021rF01It
ya BUILDING DIVISION,V PERMIT
CONTRACTOR INFORMATION:
I hereby iRnn tat tinm isis . e Z
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of to w.A fairtiliub this perms is is
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BUILDING ADDRESS:
PERMIT NO.
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W.
10146 CARMEN RD
TERRY BROWN, GEN CONTRAC
ORq 01110021
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o9fVA'�EJOHN A AND HELEN
14510 BIG GASIN WY
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A11G705/2001
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]ONE:
(408)868-1640
SANITARY NO. CONTROL NO.
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ARCHITECTMNGINEER:
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BUILDING PERMIT INFO
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' will the miuliGem of fatme Wil
-507--z--FINAL-PLUMBING'
BLDG ELECT PLUMB MECH
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LICENSED CONTRACrOR'S DECLARATION
Ihereb ffrmthat1amRcamedunder provisions
Prov', p (rammnrm[
Job Description
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with Section andefDiyy��'sionJ of Ne Businns a�npp( Profcuiam Code, and mylicense
is in full lorce end eR1ftJ C— / tl '2—
FINAL
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License Clasx ',', Lie. a JJ J t�
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Data Y9 contractor
ARCHITECT'S DECLARATION
PLANNING
aaprr,mu .,,
keel h armless the C ry of Cupenino'aga nst
I understand my plans shall be used as public records
514 -
Licensed Professional
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which may, in anyway same against said
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OWNER -BUILDER DECLARATION
m
(_ <following
1 hereby affirm Nat I am exempt from the Contractor's License Law for the
(Section 7031.5. Business Professions Code: Any
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reason. and city or county
which requires a permit to consumer, alter, improve, demolish, or repair any structure
60 _
-poor mm issuance, also tequtrestheappliant perturb permit to filea.grwd swtQiwnb
_
r,s,s�g5;�� `` pp��''rr 1 tion '
�(� Q'� "-TC_�S.ri
the,ha R.mrs Li ip asw(Che oar9
(man jlti ilifE it S.tEmm7UR DivisionCade)
(rommvectn(iwithidoemmoch"d
or that the basanortheaBusm.pmpfrpf vi
x7031.5 b therefrom mud the baso Ne Any violation
to
r `- y .v l-" x } t. Ll�.ai
ie, it ct; pplicpmon.
-of not mo a than iv ury, appnam rs a permit subjecu she epplicam to a civil pemlry
of not more than five hundred dollars (tslp).
10 lAPN SAT IONflgcjr pe
❑I, as owner of the property. or my employees with wages as their sole compensation,
102 - PIERS'
-will'dn'he-w6rk,"ead'Elm morture is not harnded-or offered far sale (Sm: 7(E441 ;
Business'and•Pmfessions Code: The Comracmr's License low does not apply to an
10 3 - UFER Required Inspection$ r ' " •' "-
owner of property Wbo builds or improves thereon, and who doax such wark himself
104 - REBAR
--
or throb h his own employees provided th t b improvements ore nm intended
: ofje d or sale. If,'however the bu Id rap r improvement is sold w thm one year -f
_ __ _ _ _ -_ ,
_ __ __ --ANCHOR--
'- 1 O S - ANCHOR BOLTS 1'.11 0 - "
completion, the owner -builder will have Ne harden M proving tat he did not build or
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improve farpurpax.fsal").
106 - SEWER & WATER
'
_._.._..- -- - -- -" - ------...---
O 1, as owner of to property, am exclusively commcting wit licensed commuchon to
-202—UNDERFLOOR . - -----
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construct the project (sec 7044, Business and Professions CoCe) The Contractor's'
2 O3 — UNDERFLOOR MECHANICAL 7 -
=
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Us.. Law does not apply in an owner of property who Wilds or imams. tenon,
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. ertd_who.contracn.for.such projecu.with a.mouncmrts) Ocemed.punttam.w the.
_-._ _ _...._..2.04---2()4-LOOR__F.RAMg
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c1...cop,shoel.w., .
❑ I ...cop, antler Sec. B k P C for this reason
205 - UNDERFLOOR'' I'NSUIlA'TION
Owner " "' Date
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby affirm undecPaalry of perjury one afthe following declarations:
303 - ROUGH MECHANICAL
J 1 have 'ead'oviWro iatain a'Ccmficame of consent to self -insure for Worker'.
3 04 - ROUGH ELECTRICAL
Compensation, -n-provided for by Section 37W -.f -the Labor Code, for the
perfomunce of the work for which this permit is i ... ed.
3 O 5 - FRAME
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❑ 1 have anti will i