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CONTRACTOR INFORMATION:
OFOPF.RONO
IPERMIT
BUILDING ADDRESS.
PERMIT NO.
10170 N BLANEY AV
01030014
OWN17R'S NAMII;
APPLICATION STIR DA'N
HUANG, ANDREW
03/02
ONE
SANITARY NO CONF RUL NO,
ARCI 11 TEC'fl1?NGINEIR:
BUILDING PERMITINFO
BLDG EI.IiC'I' 'LU MECII
1=1 1.I "1 I_J
IACENSED CONI iAO'I'OR'S DI!CI.ARA TION
Job Description
1 htreby Dili....,hat I am licmmal nn Il pmvisil) I, of Oil 1) (mmmcncin,
p
w.L S. on lot the flLic.I and Pmfe..mm Cn,le,tmJ my lion
Off]BUB)ofDlvi,
11 inlall force and clfcc1.
leems,
WATER REGIF'E.
C III
Dili, r
iii,
..�
AIiCIII'I bDECLADECLARATION
11 1e toS
YPI :.I rl it, 11 II
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O
Lie IP I.. I
OWNER-BUILDERrtIorplr DECLARATION
IO
I I bY'( 1,11 111 0 C I -: r lo-lhe
folie eg,,..0 I )oli ,ndl os oreornmy
�C,deArye
(bolo,
whichI nreif....000., allegnim rmVc,l)l lr 1, ore M.... 111 fn
..... l
1:rrnny
it, i... tire
Prior m fin is,Ilanleo, nlnn Ixspdr�. ❑Io am,lieal,l rl)r,Ilch pemdl m rAa t .Ignnd ..tutu» oil)
Sq. Ft. Floor Area
Valuation
IhlaIll I leclillel'nnll�mer,~,,,mor, otire eonbn„mrsLi"o'sc bay, (C,a,",1)
(Iriiiiii ing wish Section 7000) ofDivl,inu 30 the Iiusire, and Pro@,sion, Cade)
or dre he is exomp, It nod Iho bn.it lithe alleged cocmplfon, Any leoll ion
ofSaclinn 70115 by any,pb rol for if plennil salJects,he orPlillrl to o Ill'] renally
l)1 not Ina" marl mi
e 11 o d dolmas (x500).
APN Number
Occupancy Type
❑ I, h, owner al the pmpeny, or Illy employees with wages m flleir-le onmpeto,nliou.
71162102:i
will do the walk, and 111. 4n¢lurc is Dol inleml,,d ar oID-1 for 'Lit' (S,,, 7(94.
Required Inspections
Bnane„ and Pmrc.. or, Codi, Hic Contractor's Lieen.c [.It" docs Del apply to ;Lit
r of'i"I who Il o . odo, work hlmsel
I), i to,ro lkire I. and w hesuch r
�drotigh his wlunploycle,pra„dmmerInd. impn,vrmenl. are,Il)l inlcod"Iar
202 — UNDERFLOOR PLUMBINGanered
lisp selu. If, however. the "1111111r, ,, ilnpmvonhenl I, Hold wilhire ane ycarnf
6a.-baildcr,vill lbavc l he bllraenol ill, fee hnl)l edidhoi1d o i
Lnq,Ilpm„h...ir
-'
301 ROUGH rrl_UIrIBING
,ravle m, prlmaa l)r,a1,).
502 — FINAL PLUMBING ENERGY
❑I.:I„l)wIlcrof lir,,npnrly,a„ee.cw,1,wyel)nln,flog Miffliccn.edconlractaiIit)
mle r¢,'llenl 1 mad, Blome., lbnd Ramssion, COI,:) ' he Coroaell)i,
507 — FINAL PLUMBING
L,fe,lrIlc1
icense Lit, doe, Iu I uPI In a, owner ofprnpeny who held, nr ir"'ro”, ,Iii
and will) ronllncl, for inch tojecls wit, u ,nal ram...(,) licensed rIl r,f I 1l) ten
Cl)nlrnelnr, Ikv„se Lax.
❑ I amcselnpt nndci ,Ii& P C for lhi, ren,00
O,o,r Dam
WORKI?R'S COMPENSATION INICLARA'TION
I hcrchy aEmn, order pcmlry A erjory ono of lho following decloradon,:
. I hell And will orionlaill a Cmificaw of Comers h, e inswc for Wi
Cmurmnatio , provided for by Section 9700 of the Lahnr Codc, far to
rcrrom,anrn of the ,cork fl)r which this ran,ll i, „acd.
❑ 1 hevnuul will maioloin Worker', Compensalloo Itooraoco, r„ rotluimd by Section
3700 of the Wbar Cod, L, the perkorranm of ,he work for witch Ihi, permil k
issued, Myy Wodc1's Campcn/'oLrIoll lroollo",n nand Policy nl, obey arc'.
iIlllly N(lN�2O2�)f
�1 CIiR�1 C IIJN O,jii
OMPENSATION INSURANCE
(Thiscti m nu:d tool he annple ed if Ne per cif i., lupine hlmdmd dollen,
SH) or Ics.)
I renily fiat in dm for ormw¢v of the work for which Iii, pemeil ,Issued, I
shall tow vmpiny flay Pemol'1l) any 1l)„toner sl) h,,, l,ceo,na by, to the Works:
Compcnsn,lon Luw, of Celilbmta, Call
Applicator
NO'rlGli'I O API'LICAN'I': Il; after making NI, Ca, lifiaac of Exemption, yon ,horrid
tire( ,snbjcd m the Work",Comren,trionpro, ision.s of the Lahnr' Cod, Yoe,ml),
fordlwhh comply wit, stcl, ...... tooloorth l, ..... it sled l Im dremed mvek,i
CONs'IRUC'rION L[NDINC AGENCY
I hcicly afrrelthm tlhcmi,u oto -lo ion lending trolley to the porloroorm
of IIIc wok by whirl, Ili, pennil i, Ihsucd (se, 3097. Ci, C.)
Leadur',, Nunn
Londa', Addle„
IIrod, for I Love read 1111' Ill and slam teal the above infonnalime h
'eel. I agme 1a comply will, all or, and manly oroolieras and .lets law, rckidog
14,huilding mnIII, .... or, andIII aid.... rc ¢Rcn2nlulivhw or Ill lily to an,crupon
thi, clyoc,oc,neoredl I tYIII ,wi I,if Ile
(All) to r,c, roc fy ind ker,1 - I... Illy City IfCr,, I a, nN
Tahill )rd,oc,i, ord ,Olorl III roolv or I'll, Ily alrl,.yi 1,1 .aid
"
City illee) cCfe,rem tell gol ofthnpemnl
APPLICANTUNDERSTANDS AND WILL CON LY WITHALL NON�POINT
7
Issued by: Date
SOURCE REGULATIONS. --�� -_
Dale `—
Re -roofs
Signature of AppN,mCnnlnlCll
HAZARD S MATERIALS DISCLOSURE
Will lheapphcanl or Ill( o io,v,pWrtion, or I, If,lmmrzloo,ntot"I'l
Type ofRoof
U, defined by,l,e Cnpcnino Mnaicipal Code, Chapler 9.12, nod the Hcalll, and Safely
Code, See, 25532(x)'1
°Yes °No
All roofs shall be inspected prior to any roofing material being installed.
wal me:,ppde,Im or fit yl.bnddln,rclexpanl to ehlIlipricol °'domes, whale
If a roof is installed without first obtaining an inspection, 1 agree to remove
,,it 11"I'dnu, air cI olowant, , dell by the le, Asea Air Q oil, li f,nrcnl
i.Iri„^
all new materials for inspection. Applicant understands and
❑Yes El No
will comply with
all non -point source regulations.
I have read fho htmrdo,, ,ruler ill, rapolxmem, coda Chl,i 699 of Iho
Caldomia I let hl, & Safely Colic, elections 25505, 25533 and 25534, I „ndcoolnd drat
If Able hoild,ng docs nal cu,'Ianl1, Iti a Icrlanh Ilial Itis toy rtsponsill Ir lily the
ccupanl of the rryuior rr,s ,chvol, ,III', r cl ,for to i,stanee 'If a Ccnificnfc of
o„
Signature of Applicant Date
4>-t0 1
All roof coverings to be Class "Br' or better
)I% net oratill - r1 Dote
OFFICE