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CITY OF ERTONNO
BUILDING m
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10760 MORENGO DR
LESLEY
& DAVID SKOWBO
02010084
OWNER'S NAME:
APPLICATION SUB DATE
LESLEY & DAVID SKOWBO
10760 MORENGO DR
01/22/2002
PHONE:
SANITARY NO. CONTROL NO.
0 ARCHITEC MNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
I_I L J LJ
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby aF(m that 1 am licensed under provisions of Chapter 9 (commencing
mwithScnion]WO) of Division3oftheBusinessandProfeseionsCode.andmylicense
HALL
BATHROM REMODEL.
is in full force and eflmm
a License Class Li, a
"i Dole SDECLA
ARCHITECT"S DECLARATION
/� C
FINALED
g 1 undemmad my plans shall M used on puhlic records
FEB
0 6 2002
7 Licensed Pralea>irwl
OWNER -BUILDER DECLARATION
1 hereby a!<nn that 1 am exempt farm the Contmnor's License law herdic
a following reason. (Section 7031.5. Business and Professions Code: Any city or county
$11000
= which requires a permit to construct. Beer. improve. denmllxh, or repair any s0mOme
prior to its issuance also requires me applicant for .such permit file a signed statement
_._._._..._ _ _...__ _......__.._.... _. __._..__.._ ...
- boat be is licensed pu smjWt 16 C W provisions of the Convactola License law (Chapter 9
(commencing Scened 7000 of Division 3 of the Business and Professions Code)
µµ
�" A �;3
41a Valuation
7 s�
with
or that he is exma,1 thueY m and the basis for the alleged exemption. Any violation
,,
„r - sV a'•, .
-of Section 7031.5 by any applicant for a pecout subjects the applicant to a civil penalty
:ofnet mam than fivehundred dollars (s5m).
1014PL'4T (DATION ''" Occupancy Type
❑1, as owner of the propeey,u my employees with wages as their sale mmpetnmion,
-will do the work, and the structure is not intended-or'offered'four sale (See: 7011,'
'Business and Professioms Code: The contractors License Law d«a ma apply to an
103
- UFER Required Inspections-,
owner of prop<ry Who builds or improves thereon, and who does such work himself
or charge his own employees. provided that such improactiondssold arc not Intended of
r through
104
- REBAR
-orreied for Site. If. nrwavee the Wading erim within one yea: or
ng
10 5
_
- ANCHOR BOLTS '
en of pont
that
completion, m<owner-n.Ja<r will have the burden ar provins tom nc aid not bails oat
improve for pumoverfmle.)'
106
- SEWER & WATER
ry o erof(heParp<ny,amexcleiweiyemnii etingwitnrcens<Jeontacto-aio
202
- UNDERFLOOR- PLUMBING
Us,..me it. 1. Business and Professionda,whob eine:) orhe crnnacm,a
License Law does not apply noon owner of property who Wilds Improves thereon,
203
- UNDERFLOOR MECHANICAL
se
for men pmjecu with a cmtractortaj licensed. pers.am.to.me..
' . and winces
204--
UNDERFLOOR- FRAME... --- --
kens
Committees License Littnx Law.
" �
❑l am exempt one tis c. ';'13&Pc ronb,rcmen
205
- UNDERFLOOR INSULATION
Owner Date ... .'I -2n.
301
- ROUGH PLUMBING
ORKER'SCOMPENSATION DECLARATION
302
— TUB & OR SHOWER
Ihereby aRtmunder .pioffea}r.yoneofthefollowingdeclamations:
303
- ROUGH MECHANICAL
❑ l have aad will maint.ia a Certificate of Conserl t. sdbir,rre far Workers
3 04
- ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Curie. for the
pefrmtmc<arthe weak surwhichmi� .it isiamed..
305
- FRAME
❑ 1 have and will andr itim Worker's Compensation Insurance, as respond by Section
306
- HOLDOWNS
37M of the tabor Code, for me performance of to wmk for which flus pcerm, is
307
- INSULATION
issued, My Worker's Ca pe . t n 1 x once artier and Pol icy a Wr arc .,
•
f 1
._.... 308,;.._
SJJEETROCK;
Cit Policy Nic.
'ret .'CERTIFICADONOFEXEMPTIONFROMWORKERS'
•369
11EXTER-IOR'-LATH"
COMPENSATION INSURANCE
" ...:....._::,., ..
_..._.._.__310.,
_,.._INTER'IOR- LATH:_.
l,,l•.,
'.(IhismeiiodneednotWmmpieted'ifthePermitisforrzhundreddollars
311
- SCRATCH COAT s -L .
(SI(10) les.)
1
I cgmry that .he p<'ritmtma ran work r 'n m to I=; t
eau bccomi bl Warkeml
. '. 3'13"'-
'ROOF "NAI'L ' '........'- ....-' ..,., , .....•., . _ •,...
t employ any permm in any manner so its, 16 t m the
Comperew on Low. of California Date
Apphaam' ""' ---'-
501
502-
- FINAL ELECTRICAI]FtNERGY
- FINAL PLUMBING -ENERGY --
NOTICE TOAPEucANTIf,aOer making this, Certificate of Exemption. you should
503
- FINAL MECHANICAL •ENERGY
lissome abjccna the Worker's Com'rwraion provisions of the Labor Code, yoo must
5 forthwith c.nplywitn.teen,rrvisimrrrrmispmitshaRnedeemearevrked.
504
-. FINAL BUILDING ENERGY......
O CONSTRUCTION LENDING AGENCY'
505
- FINAL ELECTRICAL. '
w I hcrcty F'tn that nh r a cnnswcf leading agency 4 the p rkirtnance
of the work for x Inch Nos permtns sued (see 3097. civ. Cd
506
- GAS TEST
Lenders Name _. _ - .. ....�._.. ... _....._ �.. __.
__507
- FINAL PLUMBING,,
- FINAL MECHANICAL
1 certify that 1 have nail this.,,Icos. aad state mat the above id...it.. is508
cornot. l agree to comply with en city and county ordinance: and.stem laws relating
509
- FINAL GRADE
to building construction. and hereby authorize representatives ofthis city to enter upon
Q meamuse"mentionedpmpenyforinspectionpurposes...
510
- FINAL PLANNING
t7,
6 (Wel agree to save. indemnify and keep M1armlcssme City ofCupenino againstn liabilities. judgment., cost. and expenses which may in any way accme against paid
514
- FINALPUB IC WORKS
City in rnnxyucnce of the &mining of ihik permit. "'
ALL NON
r
PI.ICANT URDER TANIyS AND N'ILLCOMPLYN'ITH -POINT'
'•' -' " •"
!
Issued by:
Date
ouliGE7 Er. 1, m�NS., _ Z
`.:
�ggatr ,pficantrcrnmWmr .'� :. ", pate,r,t"
'
Re -roofs
r , HAZARDOUS MATERIALS DISCLOSURE •'
Win me apphcmt future bu(ding occupant Mori or handlebaead6m material
Type.of Roof _-
asdefneAb the Cupem MunicipalChpi 9.12. and theHealth and Safety
CWe
Code S❑yo 255320) t, 6YNo •1 • , tp
r .. •-,
All.roofs shall
„ . s
be"inspected prior to any-roofing.material being installed.. . __.. .
_
Will that pphgamt future building p e equi, t de ' witch
If a roof is installed
without first obtaining an inspection', T agree to remove
emit h aril a content t d ed by me Bay Arca A Quality M gc m
' str<7
all new materials for inspection. Applicant understands and will comply with .
11 Yes N .... '
all non -point source
regulanons-
1 hi, mad the hajoemms'mamnils a uirements under Cha'm6.95 6i. he
_
California Health & Safety Code, Sections 25505. 25533 and 25534. 1 undersmnd that
' ifthe bolldingdees not eminently have amnann. then it is myrcsprnsibility to notify the
occupant of the requirements %hick must be met prior to issuance ofia Certificate of
Occupant . ,. ... :. ..
•-
Signature of Applicant
Date
All roof coverings to be Class "B " or better
rte r mrrizea agent . Date .
OFFICE'_ .... .... .. ..