02010067 CITY UILDING DMSIONSINOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6301 ATHERWOOD AVE 02010067
OWNER'S NAME: APPLICATION SUB DATE
DANIEL HO 01/16/2002
"ONE: SANITARY NO. CONTROL d,0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
se FOF BLDG ELECT PLUMB MECH
6
_ LICENSED CONTRACTOR'S DECLARATION
5 Job Description
En"� I hereby ammo the i ant licensed under provisions mf nsChapterCode,
and
mmenei se p
:Cu9 is infllforcean efect. nn3ohheBusinessandPmfcssionsCade,andmylicense TEMP POWER FOR REMODEL
is in full force and efien.
Oa License Class Lic.X
i,O,
Date SDECLA
ARCH ll be.w DECLARATION
us
,g I undemmnd my plans shall he used as public rccoms
i p O Licensed Professional
K OWNER-BUILDER DECLARATION
I I hereby affirm that I am exempt from the Contractor's License Law for the
(_? following reason.(Section]031 s,Business and Professions Code:Any city or county $10 0
ne D which resin.a .it to r.nswn..lmr.improve,demolish,or repair any nmnurt '7
3 prior..its issuance,also minors theapplicant for such Pewit to file.sigeed....at
that he is licensed puValuation
to the provisions of,ha Contractors License Law 9 pro 1�q�qs- aluation
(commencing with seetionl]W)of Division 3 of the Business and Professions Code) ti. az j
or that be is exempt therefrom and the basis for the alleged exemption.Any violation
of section 7031.5 by any applicant for a pewit subjecu the applicant to a civil Penalty
of nm more than eve hundred content($500). PN P{gl •. Occupancy Type
°1,as owner of the prupeny,or my employees with wages as their sole compensmion, ELECTR CAT,
'will do the work,and the awemrt if not intended or offered for sale(See ]fNX,
B.dro i m ul Profrems,Code:The Contractor'.,License Law does not apply m un ed Inspections t
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.Provided.that such improvements sre not intended or _
oRer2d for sale If,however,the building or improvement 7s sold w t none year of ---- - -- '- --- - _ -----"' _--' '
ompleion,the owner-bullder will have the burden of proving that he did not build or
improve for purpose of sale.).
as owner of the pmpeny,am exclusively convecting with licensed contractors to _--
o struct the project(Sec.]044,Business and Professions Code)The Contractor's
License law does not apply m an owner of property who builds or improves thercao,
Com cense W uch projects with a.cmarancluni licemed.p..."t.the
.and 'ho contracts(ors u _
°1 nexcm t cry ,B&PCfonhis mason
se
OnvaDate'II I
J! ER'$ROMPENSAT ON LARATION
a 1 hereby /f n/der Penalty of perjun,one ofthe following declarations: •F��j s
Il ,] I have and will maintsin'a Certificate of Consent to self-insure for Worker's ( _ -
v� Compensation, as Provided for by Senior 37W of the Labor Code, for Ne
peenwance of the work for which this pewit is issued. //�
_ ❑1 have and'will mainiein Workers Compensation hi.sumntt,as iequirtd by Section - d
31W'.f the Labor Code.far Ne performance of the work for which this petmlt is - - -
- T issued.My Workers Compensation houmncc carter,and Policy number arc:"
Cart art
policy P`DOF W'O„RKERS i
COMPENSATION INSURANCE
(This genion need nm tie completed if the permit is for atm hundred dollars _ _. - --�' - '
shall
,len)
a 4Gt/3.1/1 _
,t . . Vyym" fro y __.., t. ...
'I c n l Nut in the in any ants the work for which thpeon t is issued,1 __ ---------
all amt di to Person nen manner ao ox m becamesubject m the Workers - ----' - 'l , -1 0�
Comicant on laws of C.Lfwnirt.Do¢
ApplNOTICE TO APPLeWtiil If,Cmanarsagthts Cenifim<of Exemption, —
becomesubject to ytheWorker'sCisions or
his provisionsof the lamed Code;you must
Q 0 forthwith comply with such provisions or Nis pewiuhall be decmetl rooked.
._
fa "CONSTRUCTION LENDING AGENCY .-- -
a,' 1 herttiy sRrni that Neje is o construction Iending agecy fo the perfowence' f
{r7-� mf then rotor hick Nis permnniasued(S 3W] Crv.C)
Cis Lenderp Name-"
Q'Z Lender's Addreasl'
I certify that 1 have read this application raiment Ihauhe above informed..is
W Py coirem.I agree to comply with all city and county,eminences and nate taws relating
Q.V mbalarvegconstrsnion,and ny forIamhoriz purposes,
of this city..enter upon
W
one sbo(We)time
1.pmpeny indemnify
e d roe p he nses., ,
.ps el. agree to save;indemnify and keep harmless the City of Copeni m against
CA liabilities,judgments.cots end expenses which may in any way accrue against acid
race
f.hd gran
PLICA .RONSN.' , WILL COMPLY WITH ALI.N N-PgINT
Issued b 116- 7-,,
ouk`E.,Ecu oN l�b -L Y Date
sign• vpbaamd Man Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '.
. Will the applicant o future building vecupant store orh Idle haoirdous material Type of Roof.. _ .. - _ - .. - .. _..
as dcd ef by-the Cupert Municipal Code Chapter 912,and the Heald,and Safety s
Codes ms.2553200 r ,.�•,v t
❑rea -,f a a.;• -., All roofs shall..be inspected,prior to-any_roofing.material_being..installed.
:I Will the applicarnorfuture buildingoccupantuseequipment- device.which If a roof is installed'withoutfirstobtaining an'inspection; Iagree:toremove
emit Intonations-ao mmts conmanas defined by the Bay Ate.Air Quality Management
District^ all new materials for inspection. Applicant understands.and will comply-with
❑Y,a -- I all non-point source regulations.,.
1 1 ha t read the bar dou material require is under cimpter 695 of the
Calihimi s Health A Safety Code.Sections 25505 25533 and 25534 1 understand the
ifthebuildingdoesnot cuncnil avert letter,thatil is mymsp.n,fInity to notify the -
pan q am a is w most be itiet prior to issuance of a Cenificete of
a an
mer — " "'I I •.u2 Signature of Applicant _ Date
Owner., naeartgect Dam All roof coverings to be Class `B"or better'
'... ...:J; . - -.._. .. ... .. .. OFFICE ._ _ .. .... .-