07060103CITY OF CUFEKI INV
BUILDING DIVISION PERMIT
BUILDITq WlEs�k,ORRE AVE
OWNER'S NAME:
SYMANTEC
,NE:
ARCHITECT/ENGINEER:
Cd G
LICENSED CONTRACTOR'S DECLARAI tutu
iV p i hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z w with Section 7000) of Di 'sion 3 of the Business and Prof 'ons C my license is
u m in full force a eft t.
v� 2 Licensc Cl s Lle- IC
'• Contractor
Date ARCHITECTS DECLARA IO
i < I undc nd y plans shall be used as public records
>yU
u H Licensed Professional
O < OWNER -BUILDER DECLARATION
aI hereby affirm that 1 am exempt from the Contractor s License Law for the
p O following reason. (Section 7031.5, Business and Professions Calc: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
t " y prior to its issuance, also requires the applicant for such permit to rile a signed statement
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hat: is liccnsc I pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation o!
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuactoes License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a comracter(s) licensed pursuant to the Contractor's
LicCOu Law' B & P C for this reason
❑ I am exempt under Sec
Owner Date —
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ ] have and will maintain aCertificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 37oo of the Labor Code, for the performance of the
CI
for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
of the Labor Code, for the performance of the work for which thispermit is issued.
My Workg dory ns ria Insuran a carrier and Policy number�attc(r�)^]n�(�',i�L'^
Carrier: �✓f�` vQ Policy No.:��i.� a.ax
CERT] A OFEXEMP17oNFROMWORKERS'
COMPENSATION INSURANCE
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('chis section need riot be completed if the permit is for one hundred dollars (S 100)
MEADE CONSTRUCTION GROUP
645 RIVER OAKS PKWY
T.I-RESTROOM UPGRADES.
Z
S a. Ft. Floor Area
or less.)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the WOrkcrs' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building con
d hereby authorise rcprescntativcs of this city to enter upon the
above-menti(We)tlttiCW-and expo s whicmananyc an�cr'a ND WILL CtlMPL WITH ALL ION- OINT Issued by
HAZ DOU MADISCLOSURE
Will applicant o future ildTUTS
ocant store or handle hat us m terial
as deft the Cupenin Muni palc,aptcr 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes o
Will the applicant or future buildipgJaccupanl use equipment or devices which
emit hares air comamin is as defined by the Bay Area Air Quality Management
District0 ,\ No
\ I hav d the h res u atcrials ylequircm is undcrChaptcr 6.95 of the Califor-
I afet a oqs 25505, 2 533 anJ 34. I undcrstarhd jjhhat iCtft� building
docs n l trendy have a t nt, that it isy respons ility to notify die occudant of the
=L.d which must t priaLCiNssss!!llppppancc of Certificate of an it tel_
Re -roofs
Number
PERMIT NO.
07060103
PERMIT ISSUE DATE
06/13/2007
SANITARY NO. CONTROL NO.
Job Description
Required Inspections
BUILDING PERMIT INFO
ELECT PLUMB
va►uauon
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new riaterials for inspection.
Signature; of Applicant
All roof coverings to be Class "B" or better
Date