02090067 CI saDINGDIVISION
PERTNO
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
876 S BLANEY AV K & M DEVELOPMENT INC 02090067
GLcANG C
W'ER's NAME APPLICATION SUB DATE
HOU 1060 WEST HILL CT 09/11/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 253-9787
e z z ARCHMC tENGINEER: r BUILDING PERMIT INFO
)u O O BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z 5 H? Job Description
O Z y o 1 hereby alarm that I am licensed under pmvisions of Chnpmr 9(commencing p
F,mt_-tu seam Sectioq`")of Division J of the Businen��%���my license DEMO
QYfJ fu e J L Jam'
z 6 Q Licc se As
Q en Lic b
X 3 u.u Contp�to
G fc H ll he u e As pub RATION
1 on/
crsmnd y plans shall be used n public rccoN.t
so
Licensed Pmfeszional
ta
OWNER-BUILDER DECLARATION 1 hereby.(Seco that
Iam tat Bxannt from she Contractor's Cod License Law for the
F_z a following Mason.(Session]va,m Basions and improve.
demolish,
Code:Any city tacounty $13500
a
wo x O which requires a permit ro ntmwn.alcor,improve,demolish,or repair any.ttmmurt
i3$ prior to its ismance,also reclaims theapplicausf ch permiuo(less coed statement
tM1at M1f IfenseJ purse mtA sh pmemon of the Coneamas Ucenx Law(Chaµcr9 prr��1nnr,p�a 1 ,. f.,. Valuation
or
he
cAmni Sect ](Alp„(Divi.' J ftM1eBminessond PmfAnonsCode)- v'Itti',`3.6 2A'/VlYJ-.SPI'Cl"15�, 1t Y�a 5�3 5:
or that he h cubl theafmm and she basis for the allege)ucicant t.Any l pennon
-of Section 7031.5 by airy applicam for a permit subjects the Applicant so a civil penalty, '
otnnlmnrctwnr handredeenmrssou). NO AMnl0s INSPECT ONS"" '” Occupancy Type
❑1,do
owner of the and
the s,ra to employees with wages fe their sole le(See cttion.
-'wilfdo'lhe Pmfiand'lheThe Contractor's
intendedorse La doe tale Vidly to an
(comer ss:anopen, v Who
Wild,
Code:Tha Contractor's License Law s..not apply m an Required Inspections'
r of through his o y who loge s or impmvn at such imp µha dam such work nor
.111medfor his awn employees. K ildetl that such improvements arc not intended ye. or
lf
-bR1id f Ie.lChuweveg5he hd Idm rbvemen(i Id th n otic -fit '-"-"'---
g nr imp Year o ,•Il
completion.the owneobuilJer,will have the burden of pmvmg Chas he did not huJd or "" -
improve for pumoce of salc.l
co 1.u consumer
the of the�(SmnX tat exclusively y commcting with licensed cnneaso s - -- - „ ",.I, f t
Li swa th project(Sm.7044 ownerBusinessJ P f iota Code')The Contractor'sdisemon. tC0�p h� P' - T l I
License L Jas not apply man owner f p pony whobuildslice orimproves
.... themth 1ll�— B gh�
_.
and.who s License
for such prolens.tv tM1 t wr(s)licensed pursuam to.she ...___ _ _.._.. ..... _"'°. ®_.._ ___ _.___....------_ _ _ .. ........._.
CoI mcto pc 'Sqq
❑1 pt dbr5 Love,. "'\ B'&PCfor this reawn NOV 2 {( 2'-� i,y;;:' •:{„•.;,
'Owni4j '1 - 6ar oa�
WORKERS COMPENSATION DECLARATION
BUILDING/�
Ih by alBmunderpe Penalty of pel ry (the hll gd I tions BUILDING
❑ 1 hove and will mmntam'a Cendicme of Conunl to self-mune for Worker's
Compensation, as Provided-fur-by Section 37Mof she Lahr .G,tle. for the
padminu nh of thv work fa Which this pmmit is issued...
❑I have Arm illma min Wo kds Compe t Inzuiaa aquimd by Scciinn
37W of to L b C vl f ih performance f th,work fee which this permit
'ict ed'MyW k/..C� tic {n an)J Polc hn �/'
_�.I u., .f Pnl(y N•a0e. /.. / OZ. A r:_.�_ 1 11.1, _ _
.. _ .-..
x n
1vlCATION OF EXEM FROM WORKERS, - 1.� k i i. r ' �' q ..3121 Y ; v n s.
nt/ COMPENSATION INSURANCE ' -
( is
eon need not be camplemd if the permit is for one hundred dollars -
(gl0olorlca.)r
I1mot shit in the pertl-mtWlh rkf which
- d T t
shs all anon Lay person u any manner sit become subject p t' see
to the.Workerk 1•t .] Ir c In,t,L:(..'.
'Cit p n tLaws ofC IT mta:'Dmc' ""
NOTICETOAPPLICINT.is Ci)rmek ionp CemficatenE N,,Co , .o should,
Qz fro sdompytheeachIsCirmpenr tics pmvisionsofthe LaMv omoko. main
O 7dnhwith comply with such'prorisionsmthis pctmis shall be deemed revoked. j
H
W' , -------
CONSTRUCTION LENDING AGENCY
L L
I nby f(tmth uhmaisA'ot t lending age yf the Pet tt _b�
ofsh work for h h th petro .. a
s d(See 3097 Civ C)
.0..❑ 'Le dors Name
V 0 1 mitil,that 1 hmvvm,A1 this application d state that bite information is
moVmgd agree to comply,with all city,and county ordinances d state laws relating
:Cjf,J imhuiWmgconstruction:and hemby huthnnu representatives ofthis city to enter upon
.D” W .the abnvs-omn immny d pMpeor ngxnion pognxs.t a. _- .
(We) lire t dmnfy Md keep C_pherml .lite t ofC pct .against
.li.bilitwi,)udgm t. t Re pen es which may any_ y u ...Inst said
V Z City n N';r UNDER th gg t got th ptmm - �
'API LICA\T UNDER TA'4DN A.ND WILL Ctl\IPLYµ'ITN ALL ,�- pT
SOURCE RE . I Z�D Issued by; Date
I rot ontract + . .Dam' .
USMATERI LSDISCLOSUREt 1- .i Re-roofs
vru roe pvt noetic bddding ponce is is nazuJoaa matcnal Type.of Roof_
sdefndby sh C iohl 'cplC Couple,913 and th Health And Safety a -
Cudc Section255J21a
t 1 F:'•
°Y
ha
Al] roofs sll be inspected pnor_to any roofing.material being installed..
r ill the applicant or(mare bu lJmg rcvapantazeoGu patent or victims which Ifaroof I$ installed-4VIIHOIII first Oblalnlll an itis eCt10It; Ila see rQ refROVe
m-th aard m 'ant .J f-ed bysh Bay AMAA Quality M tag eat g P g
1°oY - N '_ • _,all new materials for inspection Applicant understands and will comply with
all non-point source regulations
I h vc antl the hazardous ¢nal requimmcnrs under Chapter 6.95 of she t "'
Capfomia Health&Safety Code,Sections 25505,25533 and 25534.I understand that
ifthe building does ons currently have a tenant,that his my responsibt ay to notify the -
' vuance o a Ccmficate of
.occyp s
Line require e t h ch "
p set to Signature of Applicant Dale
p
- 9 _. -. _ ._.._ - -
Dw - m I Date All roof coverings to be.Class B"or,betteri
�—
a! _._OFFICE...--- " -�"
2.