02030116 CITYBUILDING
c prvERTON PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18851 BARNHART AVE. NICK JAFFE 02030116
OWNER'S NAME: APPLICATION SUB DATE
+ TICK JAFFE 03/21/2002
.
HONEv SANITARY NO. CONTROL NO.
E+re0,Z0 ARCHITECTIENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
<d C I C._) I_._1
h 2LICENSED CONTRACTOR'S DECLARATION Job Description
.,to-
1:' 1 hereby sfRrn thin 1 am licensed under provisions of Chapter 9lcommencing
so with
with SwtionM00)of Division 3 of the Business and Professions Code,and my car. ELECT SERVICE.
is in full force and affect.
0 2 a License Class Us.M
S a o h Dom ve
- Contractor
ARCHITECT'S DECLARATION
g 1 understand my plans shall be used as public records
3 „
O O Licensed Professional
o _ OWNER-BUILDER DECLARATION
m I hereby.(firm that 11. exempt from the Conmotions Coc eA License taw for the
$500
C < following reason.(Section]OJLS,Business unJ Prnfeaxinns Code:Any city or county
E D whi h requires person to conswct alcor,impros e,demohsh,m repel,any swct.x
ig Prior tots iscounce,.1.requires Rte applicant for such permuo file a signed sumroem
enol hamslam dpumimnti Na pin ions of the Convenoh License Uw(Chapter9
(ocr.Naams hntec b gewith
ptSection
fr7om'eqnof
thDivision
f3arotfh(be
alBusiness equit Pibrdo.fzniy.na Code) _ y
Valuation
nolenon '
-of Sminn]031.5 by vny applicant for a permit subjms rhe eppliam m e evil penvlry
off not nimethan fivehundred dollars(s5W). 304ANVMPSR E L E C T R I AL Occupancy Occupancy Type
561.4s owner of the property,in my employees with wages as their sole compensation,
will-do'the work,and Ne"atmome is not intended br"offered for'sale'tass.7044,-
Busimesiand Professions Code:The Contractor's License Law does not apply to an 505 - FINAL EIIBQM(T[ig&ctions
owner of Property Who builds or improves thereon,and who does such work himself
or throw h his awn employees.provided Nat such improvements art not intended or
offertd r-sold.If,w however the bit ave the
p proving
Id rh n one-year t of
edmpleifo the Purpose bit lilt lino sine M1urden ofpov ngthmh ddnut huild or
improvesmft-hepeOf sale) -
°n'as n f rhe proParty m asci ly w ung with I ceased coin tors to
co st t the Project(Sec.7046 Business and Profess in,,Code')no C ucacmr's .� G
License Law dace notopply to en mer of Property who builds a p vas Narcan '
_end who a ants for such lam.with a contractsms)licensed pursuent.m the ..._ _.. _
Contractor's Licenx.La
❑lam nd c crept a �/• .` ,B&P C for this reason tWv'•`" �,l ! '
O"al, Date 0?!2 1.6Z' t,
WORKER S COMPENSATION DECLARATION
1 bercby affirm under pev, of perjury one of Ne following dechrotiamv:
}� ° 1 hove oitd will'mnaimoin a Cenificbm of Conxem to aelGinsum for Worker's ,wsw^r
Compensation.as provided for by gection 3]00 of thr labor Code, for the
performance'of Ne work for which his, r is issued.
°1 have and will maintain Worker's Comansmion insurance,as required by Section
3700 of the Lnbor'Card.for Ne performance of the work for which this permit is
issaed.My Warkcrs Compensation Inxumnce canter tird Paltry number
.. _ n,._
C_in!;
ir1 r s. t-s . . )..'. PolicyN -
' CERTIFICATION OF EXEMPTION PROMPRO,WORK2R "' 1:�, 7 • Y t. 1., L. a `.i it ( ``. i t 1r j,, ,, 'd..,,, . .
_COMPENSATION INS AN_I
i4 b''fThll i ltion suM'nnr he'complded if the pmmu is for one hundred dollars r .1
;
($100)orless.)
1 cenlfy that in the performance of the will(or whichNis perm t issuedi.'I
shell not employ any person in any manner so as io become aub)eet m the Worker' '
Crisis usetion laws of California.Date•" '
Applicant
become subject
APPLICANT:kIf,r's Compensation
this Cisions to of Exemption,you should , .. s ..
z become subject to the scrh po Comas ouiion permit sha of rhe labor Code,you must
. . .L_._._._
Q 0 forth M co ply with itch prov¢ions or Nia permit hell be rimmed revoked
s'• CONSTRUCTION LENOING AGENCY I _t
1 hereby affirm N t N. t9a 16nswctmn lending g cy f N Performance _ t
tQ ofthewrkf which Nis Permit is issued'(Sec 309] CI C)
Lender N me - .. - - ..' - . ._ _. _ __ ___ _ _.
�.Z I<ad r Add e ;
•j, t..
C:1-� I cem(y that I have mad dm application and state that the shove information is
(a¢[ti Farrect.I agree ro cpmplywith all city and county ordinances and sum laws minting
CA to bit lit g nt n
and h by uNorfze pre.tmives oft city tos t rupun
y w Ne ebo t o edCu p pony fo rp
pection puoses
(W)agree s mdem (y and keep hannaleribe City of Cupen no agamv .�
h )tabs)r ,lodgment [s and expc s w cony ny w ysic me egm st said a t/
U 7a.
City mbonarquenPe'f the Bunting o `Perini' �O
APPLICANT UNDERSTANDS' W LY WTTH ALL NON POINT'
SOURCE REGULATION D 2 y oz-
Dl
� Issued by: Date
• >,
Signetuie of -' candConmenbr "'S' --!'. "° " '�- r Dat. " Re-roofs
' HAZARDOUS'MATERIALs DISCLOSURE '
" Will thea applicant or future buldid occu .Type of Roof _ .. .. -
PP g haptesomo till the
Ha.Ith amatfety ., . .
u defined by the Cupen n Municipal Cotle Chapter 9 12 end the Health ontl Safety
CalaSection
°Yat 2$532(.)° t > Na m '1].'t l t'P.`'a
. ,r All roofs.shall be inspected prior to roofingmaterial being installed.-.
Will the applicant calcium building occupant use equipment ordevices which If a roof is installed;without first obtaining an ins ection; Ila see toriemove
an hazardous err conumm is as defined by the Bay Arca Air Quality Management g P g
Dmecul] / all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have rad the hazardous onnermt,requirements under Chap¢.6.95 of the
Califo Ha" &Safety Code,Se' 'ons 25505,25533 and 25534.3 understand the,
ifthebuiltling does mol coram ve atenan i[ss.%miponiibility to notify the
«cupem of the require which i«t prior to issuance of a Cenificam a(
'''" . 0'3, 21l.0 2 Signature of Applicant Date
mer ar.asbadaee.sent " Dam All roof coverings to be Class "B" or better
OFFICE ..
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