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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
CCK CONSTRUCTION INC
PERMIT NO03 10 0 17 9
R'S NAME:
12204 PLUMAS DR
PERMIT ISSUE DATE
JANG LEVER AND NINA TRUSTEE
10/24/2003
F"ONE'
(408)863-0648
SANITARY NO. CONTROL NO.
ARCHITEC"VENGINEER:
BUILDING PERMIT INFO
ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Charier 9 (commencing
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with Section 7") of Division 3 of Ne Business was Profession Cade, and my Itcense u
in fall force and affect.
REVISION --IN HOUSE USE ONLY
License clue Lic. is
-
Daler
Contractor
NO NEW PERMIT ISSUED/ORIG. 403030025/03080173
ARCHITECTS DECLARATION
I understand my plass shall W used As public records
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Licensed ProfessionM
OWNER -BUILDER DECLARATION
I hereby ofron Net 1 em exempt from the Contrae La
ctor's Licensw for IW
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following mono. (Secdun 7131.5, Business and Pfofuninns Cade: Any city or county
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which requires a permit to construct, alter. improve, demolish, or repair my structure
.
prior to as issuance, also require the applicant for such permit M file a signed statement
that he is licensed pursuant to Me provisions or Me Contractors Lipanse LAW (Chapter 9
Sq. Ft. Floor Area
Valuatic$107
(commencing with Section 7") of Division 3 of the Business and Profession Code) or
that he is exempt Mersfrom and Ne basis for the alleged exemption. Any violation of
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Occupancy Type
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Scellw 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not more roan five hundred dollars ($500).
❑ I,As"net of the property, an my employees with wages u their Ale compensation.
Required Inspections
wtlldothemed, and themocmmisnot intended oroffered for sale (Sec.7044,Business
and Professions Code: The Contractor's License Law Maes not apply to an owner of
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property who builds or improves thereon, and who doesamh wank himself or through his
own employees, provided that such improvements are not Intended or offered for suite. If.
however, Ne building or improvement Is gold within aro year of completion. Ne owner -
builder will have the burden of proving that he did not Wild or Improve for purpose of
tile.).
❑ I. As comer of the property, em exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Convenor's Li.
cense law does not apply to an owner of property who ballots or improv Merton. and
who contracts for such projects with a conuacmr(s) licensed pursuant to the Conuscrots
License law.
❑ I. exempt under Sso B A, P for ..On
_
/C /this
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ENVY RKFR'S CTPENSATION DECLAkAS
1 hereby effum under penal, of perjury one of the fyt ni dedamiou:
Q I Inward! will maintain • Cenifinre ofConsemto till -issue: for Wmkeri Compm-
utlon, u provided far by Section 37W of Ne labor Code. (or the performance of the
work for which this permit is issued.
Q 1 hale and will maintain WeAces Comp rmation Insurance. u required by Section
37M of the labor Cade, for Ne performance of Ne work forwhich this permit is issued.
My Wmker'a Compensation Inumme artier and Policy number am:
Carrier. Policy No.: t
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITB section exact not ecompicted if the Fund, lsforeae hundmddollars(51110)
or less)
1 certify Net in he per(ormancc of Nc for which this permit Ishmael, I shall not
tw�ork
emPlnyanype ni Ymanncrmgbc orme�jemmNewarkcn'Compenulion
Lava o(Califor am 6 mom_
Applieaed �,s-iii /�.�.
,
N077CE APPLICANT: If. star making this Certificate of Exemption, you should
bttom Jxct m the Workers Compensation provisions of the labor Code, you mut
forthwith comply with such provisions m this Permit shall W deemed revoked.
CONSTRUCnON LENDING AGENCY
I hereby affirm that More is a convection lending agency for Me performance or
the work sur which this permit a Wood (Sec. 3197, Civ, C.)
Under's Name
Lenders Address
I partly Mat I have read this applic ,ion arW state Mat Me above information is
Correct. l.&rte to comply with all city and county ordinances and state laws mleting to
building convection, and hereby amhori , mpresenutiv of Nis city to enter Mann Me
shove-memtonod progeny for Inspection purposes.
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(We) agree Id save, indemnify and loop harmless the City of C.Pcnino against
liablldicajudgmenu, costa and expenses which may in any way seems &&stns, cid City
in offfic grunting of his permit.
APPLICANTeUNDERSTANDStAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
RCE REGULATIO S.
9
Re -roofs
of Roof
rtof Applicant Con_,_, Oe
H ARDOUS MATERIALS DISCLOSURE,"'Type
Will the applicant or future building occupant Mom m handle hazardous material
Recd by the Capetian Municipal, Cvde, Chapter 9.11, and the Health and Safety
. Semen 25532(a/? JJJCCC
C] yes p NM
All roofs shall be inspected prior to an roofing material beim installed.
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' If a roof is installed without first obtaining an inspection, I agree to remove
Will Me applicant or future building occupant tic equipment or devices which
emit haurdous air contaminants as dxfncd by the Bay Area Air Quality Management
all new materials for inspection.
Daniel?
❑Yes �No
I have road the hexallous materials requirements under Chapter G95 of the Califon
ria Heald M Safety Code, Sansom 25505,25533 and 25534.1 undiesund thin if thx Wilding
dors not currently haw a tenant. MM It is my rupomihility m nod ry the occupant or Me
requirements whim Wmetommtssuamnc,"Crni0cateor cMpanry.
�$ignature of Applicant Date
Gam
/ All roof coverings to be Class "B" or better
Ow
sal eri.ed &sem