01100137 CITY DrESIONO
SINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA BLVD HOWARD WRIGHT CONSTRUCTI N CO. 01100137
OWNER'S NAME: APPLICgTION S B DATE
KIMPTON GROUP PIER 9 , THE EMBARCADERO 10/ 25/ 2001
PHONE: (206) 447-7672 SANITARY NO. CONTROL NO.
OO ZO ARCHITECUENGINEER: BUILDING PERMIT INTO
QU BLDG ELECT PLUMB MECH
N Z LICENSED CONTRACTOR'S DECLARATION Job Description
5 z—o I hereby of rm that I am licensed under provisions of Omp ar 9(commencing
mCra with Section 7()X))afDivision 3 ofthe Businessund Professions Code,and my license TEMP PERMITS . EXPIRE ON 11/28/2001
c a y 5 is in fall forceand eHee,. tG p 1 S
am:Ow6 License CI s Lic,k �D
_a O N Data 10 1 N O Coronae m
ARCHITECr'S DECLARATION
ej 1 understand my plans shall be used as public mends
O O
Licensed Profcssionvl
OWNER-BUILDER DECLARATION
1 herehy affirm that 1 am exempt from this e Crman License Law for the
C z a following mason.(Section 7031.5.Business and Professions Cade:Any city or county 6 Q
E Z O
which ra
q Tes v permit to consct,alta p ,demolish or repair any structure 'J
0 Prior- 'totS also"airri the applicantf such Permit to file asgned statement, - - __ _.
that h licanslind poriarm,w Nc provisions f,ha C t i n License unw(Chapter 9 �2 R9,Sw r,��a T n I Valuation
(commencing 'm Section 7000) fDivisionJ of be B.;m<u and Pmfcysions code) f" .';, £(Y._... 1f.5'Y ,..'t ri.0�+ .
m that he is exempt therefrom and the basis for the alleged caempfon.Any violation -
-of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty
or not them five 101APN IODATION Occupancy Type
❑1,as owner of the pa varty,or my employees with wages as their sole compensation. 302 — PIERS
will do the work,and me structure is not intended or offered for awe(See.70f4; 1 O 3 - UFER n• in
,will
and'Pmfessions Code:Tha Cmdracmi's License Law does not apply ,an Required Inspections,,r
owner or progeny Who Wilds or improves thereon,and who does such work himself 1.0 BAR
or mrou h his own employees.provided that such improvements are not intanded or
-offered l�or sale.If,however Ne W ilain t is sold within one f 10 - ._ LTS �..... .-. _. .. .
gorimen of pro year - -- -
ompive for the inviter-budder will have the burden of proving that he did not build or " '' —•
improve for purpose of sal<J. - 10 S
coLasowner pr me propc.7. ,Business
and contractingwithlicensedhe Contractor',
License,
2 — R O P '—
conswm the project(Sec.7.14,Business and Professions Code:)The Contractor's
— - License Law vas not apply m an owner of progeny who Wilds m improves Neeson, 2 — CAL' f'' • -' I'
and who contmcts.fozsuch projects.wlth a contrector(s).licensed putsuam.to the - - 2 LOO
- - ------
Connote pt ade L w.,, 2 0 5 - UN LOO' S I - -
- lam exempt under Sa. '"'s ,B&P C for this moron
water
time +D�zTlot 301 - ROUGH PLUM NG
. " WO�ENSATIONDECLARATION 302 - TUB & OR SHOWER
Iherehyafrotunder penaltyofiratjurytineoflhaf0l.ingdeciimtimns: 303 - ROUGH MECHANICAL
❑ I have and wiu'malntam a Cbmficalebf consent to self-insum for Workers 304 - ROUGH ELECTRICAL
(-W,a sadgn,es provided for by Section 3700 of the IsWr Code, for me 305 - FRAME
'perfmmance of the work for which this permit is issued. .
❑I bay{and will riai.1a.Worker's Compensation bi'um ina,as inquired by Section 3 06 - HOLDOWNS
17_oo'of Ne Latin,code,for the penmmance or the wan'mrwhich Nis period is 3 0 7 - INSULATION
rss• d My Wo mos Compensation- In um r and Policy - rc
her
Pol'cyb4o. 1 ,7� r. 308-%,-. �SHEETROCK;:":—
y [ n
t t.'CERTIFICATIONOF,E%EMPTIONF'ROMWORI -RS s.t!'v s E3Q'9 :''-11G}LTERIOR. 4LATHe" t
--- coMPBNSATIorvlrvsuRArvcE-::- .__ erre - 3-100;: ..-INTERIOR-'LATH!,- .. ._-
en section need not be completed if the Permit is for um hundred dollars 311 • - SCRATCH COAT 1 ',tease. �:(r.
($1W)or 1 s ) .
_31.3 _.. ROOF, NAIL _---- .
r mfr that mm pen rma,- roe orkrwhichm p<;m_t issued 1
shall t ply any .saytnot rsoasfubecum bjectrothe Woket4 501 - FINAL ELECTRICAL 'ENERGY
Coropc ton LawsofClf Date
Applicant - ' ' " - 502 — F.INAL PLUMBING ENERGY
'NOTICETOAPPLICANT If.after making this Certificate ofEsemption.you should '
Z become subjectt meWorker's C pensat provisions of hLabor Code you must 503 - FINAL MECHANICAL'ENERGY "
ZO forlhasitht 'ply with such pmaisioosorthis Permit shaBxdeemedrevoked. 504 - FINAL BUILDING ENERGY,
CorvsTRucnoNLENmrvcAGENCY 505 - FINAL ELECTRICAL
1 hereby affirm that d re is a construction rending agency fortheperformance ,
onhe work for which this 3092 civ.c.) - 506 - GAS TEST ,
y'o nder'sNsme.-
pertnit s issues(Sec.
U-o der'ac dire"!tlnaveremtMsappboaenn 507 - FINAL; PLUMBING
I 508 - FINAL MECHANICAL ,
k+- and state Nat the above information is
comet.I agree to comply with all city and county ordinances and mate laws relating 509 – FINAL GRADE
O V
to Wilding eonstr0<tion:and hereby aummm representatives of city to enter up.. 510 – FINAL PLANNING
ry the above-mend.redpmpeny for inspection purposes._
F., 0, (Wa,)a'jme to uve,imdemmify and keep harmless.Ne Cdy'of Cuperiiiio igvinsi
m liabilities,judgments,costs sad expenses which may In any way accrue against said 514 – FINAL PUB I C WORKS
' V-z City in'romegocnea of the gaming of oris permit." "•
PPLICANT UNUE
ouRSTANDS'AND WILL COMPLY WITHA LNOINT'' / 2
RN-PO
I EIRE lONDrZ sl Issued by: Date
I V_^ a
i t of Apel canJCo t I _Date;, Re-roofs
's HAZARDOUS MATERIALS DISCLOSURE
W11to pplicam 61 f turc building one.penasin'or handle h'azaraous tommal - Type of Roof .._.,....
as deft pe
ed by the Cun l C
Municipal paode.Chapter 9.12.and he Halm and Safe,, s —'- —
ct, Section_ 25532(.)'^ i. ;j. . .i :'?
All roofs shall be-inspected poor to.any roofing mater a]being-installed.
will the applicanto futureW dm c p ntuu equip d ces which If a roof is installed without firs[obtaining an'ins ec[idri,-'I'ag�ee't0 remove
ous contaminants as d cd by m Bay Area Air Quality Management g p
emit n Distinct?o s, 'ON. . ` - . .„ all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.. .
I have'read the N aardoua matchals requ rein
tits under Chapter 695sof the '
Califomta Health&safety Coda,Sections 25505.25533 and 2553471 understand that
fine building does notcurendy have a tenant.that it is my responsibility to notify the
o'cupaot of the requirement.which muse be.met prior w issuance of.Certificate'of '
<qupancy., ,. ; Signa
0 Z� d ture of Applicant Date _
eto daedag t Data All roof coverings to be Class,"B" or better '
OFFICE ' ..