01050142 CITY
OF GDIVISION
PERTNO
UIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
21170 CANYON OAK WAY 01050142
I6NF,('AN1stv1E_ GROUP APPLIc 015/16/2001
ON SUB DATE
r PHHONttESS: 11��..LLVV SANITARY NO. CONTROL NO.
CW ret¢° ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E to C BLDG ELECT PLUMB MECH
A
LICENSED CONTRACTOR'S DECLARATION
S y 1 hereby ffin, hat I am licensed under of Chat 9(comm<ncin .lob Description
"`ndProf� "de a SFDWL: LIVING SPACE 4039 S FT. GARAGE :
P-Im with Senion]I>v0l of Division3 of the Business ane Professions Coae.and my license Q.
6 Y f j is in full force and effect. T
6V License Class Contractor
Data S DECLARATION
®
3 u fi ARCHITECuse DECLARATION
�='°5 I understood my plans shall be used as public iaords
wli�p C Licensed Professional AUG 2 p
X f! OWNER-BUILDER DECLARATION 2002
,x-o,- 1 herby affirm that I am exempt from the Committers License Law for the
fallming ns
tzc
which requires mapconstruct,alter, ana se,deirlihoar:Anrcityorrcture V $409082
whicM1 rcyuircs a permit reossthealter,improve,demolish,or repair any om ant
aE. pn tl ce.al y mapplicant fur....h peimtto Tl signed sate t -..
has he Ta ficarsof pursuant te Clic provisions of the Conbanor Liese.Law(Chapter 9 �`,�wps pis T Valuation
(c me g.,imS to 1103) f Divom,3 of the Businessad Profession,Cod) (,t_i.N ( 3�4'PTA V` . a.Fyl tit,A f�''1:
or that he is aempt therNronarad the basis for the alleged ekempm n.Any violation '" - '
of Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty
.ofnot room than five handrail dollars(s500). l0lAPNPb9Jr9ATION ml Occupancy Type
01•as owner of the propery.o my employees w hh wages as their sole compensation, 102 - PIERS
will do the.,it.and the simularls a.,intended or offend par.]a(see:70447 103 - UFER Required Inspecti6ns""" "'•
Buss viii Contractor's
Business Professions Code:The License Law docs no,apply to an "
weer of property Who builds or improves thereon,and who dues soon work himself 104 - REBAR _
or d mugh his own employees.provided that tech improvements are not intended or _
otiered'for sale...If.howevei,the buildinT or iinprovemem is sold within one ycai of ------ - -- - - - ----'"-'-------- -"-"--- -----
fomvini°n.me owner-buimer will have m<burden or pro.ing that lie aid not wua or
105 - ANCHOR BOLTS a u
improve for purpose of sale.). 106 - SEWER & WATER
.am exclusively^ontraccssionitCode�ed Commoomsto -- ---- - ---- ----------'
o"i:as wnerufh pmpnycontracting with -zPAD ='..:.:.pc.
aonmmct the pmjat(Sat TP4r.Business a d Prof ) c Contractor', 113 - SLAB +`'Cat'• -Ltd :
License Law does not apply to as owner of propeny who builds or improves thereon.
and who p jec s.wi .a.commearwr(s)liceicud Pursuant-to the. `
..:, commas.fur.darn t th
114 ---PLUMBING-UNDERGROUND- ----
conuacmr'sLicenaelaw:... .. , .,:-..; --- ---..--
-. 01 am exempt underSec.' B&PCforthismson 115 - ELECTRICAL"iUNDERGROUND
o < 'lit 202 - UNDERFLOOR PLUMBING
WORKER SCOMPENSATION DECLARATION 203 - UNDERFLOOR MECHANICAL
In by «n d rK, hyorpe3 yn nnem ga Imeena 204 UNDERFLOOR FRAME
❑ I n and wvdl' i tenihet t o 'ai't° esr .r lire rk
far Weer's 2 05 - UNDERFLOOR INSULATION
Compensation: as provided for by Section 37M of the LaboCode, for the
parr°m,ana°aic'vok for which his sm,isissued. 301 - ROUGH PLUMBING
❑Ih - dwill'ma i wbk ',Cumpe t -b 'rand rdgaifedbySxoda 302 - TUB & OR SHOWER
1. '37M nthe LalwjCoa firr the Performance fthe work r hch-thispetintis 303 - ROUGH MECHANICAL
issued.MyW kersCompensation I s'u cr aJP I y be
s w....
ps } .
115100t1'(oThrleussu.Iet on naJ s r • •
- ----------304 ,-306 .-:;•HROOUEGDH
Cbat No.:.
05' TEXEMPTION FROM WORKERS `3 �RMEOWJ.-t
COMPENSATION INSURANCE NE•.LS+—sE,jCaTAR�1Ij_
—_y
It nf'
-'- ------
ot bcote cedd thepermit is for one hundred dollars 307 �- sINSULATION
T , . .. _ SHEETROCK'F mx 308-:
I exp�nii m p<timi kr
h 309
II t e ploy any pc n any a u to become bf t t the W rkcrs 3 0 9 - EXTERIOR"LATH
'c x ton"''.1aws bf clr 'a,n..ate - ._,_..- . ....3.1.0._ 7_INTERIOR._LATH._ __-
NOTICE TO APPLICANT It,after makingthis Cenf ate ofE mpt y ;should 311 - SCRATCH COAT
Z ;becomes n the Worker C pe ton pm - the Lina Code.you must
00 forthwith o ply 'iin rnprovisions srm fiction shall
nna eJ revoked. I -
___ 313___.--__ROOF-.NAIL
CONSTRUCTION LENDING AGENCY 315 - EXT SHEAR t,,•'b x' Pi ' '!
as > I hereby form that there - n t in on lending agency,f the perfoimance
�. fth<work for nchthsFarmt '. nd(sr309TCIr.C) _ 402 - TEMPORARYPOWER
°b 404
. . ._. ._. _._._
a _. .
Aad x..+" - ELECTRIC METER RELEASE
'U � I ccnify that l havemadthis application and state that the above mfom,aten is 50 FINAL ELECTRICAL'�ENERGY
circa.I agre ro,cumply.with all city and county ordinances end.state laws relating 5 - /INALPUM I NG ENERGY
2_0•U ,tri ding canst
ction.and hemby bu,horir'reprc entatives of tris city to eater upon
,theangve-maannpdpmpnymrmspmm.puposey,-• 5 3 - H ICAL ENERGY
M ) g eto lie mnify andk ph role. thecty fC pera gains, -
vat liab I t j dgments t: ne expense n n y n any y ar against said 5 0 ENERGY
U.Z Cityl q ceofthg tigofthispairmia' 5O5APPLICA\2WDERSTAND$A\DWILLCO?IPLY WITH gLLOc-P01.Yf LSOURCE REGULATIONS.:`,s.1C'; "'P". '7 Issued�y Date
Slgwmre of Applicw✓Commctoo, , ,", :Dam-,,i;i Re-roa[Y7 - MBINGHAZARDOUS MATERIALS DISCLOSURE � 'wrath ppbr r re b ming pant lore rat Jlehaaado methal T e of- FHANICALAsdfnJbytheCuperoMncplCW Chpt 912,ed the Health and Safetyyp 'FDEono C , ats, t l
All ro`8f�shall.b�i� d re
a i WJlthe ppl t or for rebuldi ga p t x<q p ro d p,,�,q,
emtn vies contaminant.,asdefinedbyth ayAmaA Q I,y FI s b ; Ifarodfli` Installeb� t�(si ki f pecttonb agree to remove
°i'"' - all need` ten-alsFfb u
�7' n
❑yes tiN , �ec�bV int understands and will comply with
,. all no oo3nts6LRQQ�gul&adWO0D NAIli'
I have ad the haratdo s mamnaPo q rem t e r Chapr 695 of the 3 - ROOF BATTENS
Califoomit Health$Safety Code.Sen' 5505 25531 and 25534 understand that
if theM ld' gdoe.not c nyn tenant, -that is e.p bltym ,if,the __ ..6.04 ROOF--IN--PROGRESS,
oc
pant bf the miIiamounno,which muse be met prior to issuance of Cenifiesie of -
an
.', Signature of Applicant Date
owner ora ino.rdag at p„e All roof coverings to be Class 'B”or better
_. .
' OFFICE ' .. . ..... .. .. . . ._._ . ...... . - -- -. .. ._ ..
CIBULEBONO
BUILDING m NPERMIT CONTRACTOR INVORMATION:,
BUILDING ADDRESS: PERMIT NO
21170 CANYON OAK WAY 010501��uu42
INWTEN GROUP ASPg7lg / �0Ay1
PHONE: SANITARY NO. CONTROL NO.
y
GOO ARCHITECT/ENGINEER: BUILDING PEL3�gRIMIITINFO
Ed
w DG ELECT \ MECH
1n<n
LICENSED CONTRACTOR'S DECLARATION
m H 1 hereby aRrm that 1 am licensed under JOb D seription
o�"-o provisions ofCM1apar9(comm Ging SFDWL: LIVING SPACE 4039 SQ. FT. GARAGE :
F:l_w wuh 5 ction 7m h omDiv" 3 rf thb Business is a '�s Code,and my license
¢m 2� Ill force and effeet.
be rtp d V t Icruse Cl" Lic.a
c Cons,
RCHITELT'S DECLARATION
org 1 u Jeman y plans shall be.suit as public records
da o Licensed Professional
n 5 OWNER-BUILDER DECLARATION
ic 1 hereby nlRrm rant I sin exempt foam the Contra....'.Lissnso Law for the
F Z following reason(Sectio,7031.5.Boom...and Yrom,oiuct Qde:Any city in croon, $409082
EZO wl h q pentmcoxnuct inter in prose de uLM1 to any.,unnre
LO3 prior to itsq the pplcant for such pennit totile a signed statement rIA�•�f e
that he s l ceps d pursuant t'me-provisions of me Contractor L La (Chapter 9 - �3�519CM�r.Oaa . • t , r , Valuation
(c mens ng 'ins s 70f1i1r rD Division hof the.Isms d Professions Cale) (';1Y', t ,..� ,. ,,. „ ,t. .. Ls,� J;\,
or that he s exempt therefrom and the bass for the alleged esemptron Any v olich o i
of Section 7031.5 by any applicant fora prnm...ncc¢the applicant to a civil penalty
rotor,mire man five Inundated dmlas DOM), 101APN POU#DATION
It, i. , Occupancy Type
❑1,asowner ofthe property.Ormyempl.yeeswith wages ustheir sole compenxation, 102 - PIERS i
'will-do'me work;and the simenum is not intended'or'Offered'for sale'(Sec.700.5, 103 - UFER Required Inspections '
Business and Prokssions Code:The Contractor's License Law does not apply to en '
owner of proPersy Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided that.such improvements are not intended o. -.TOS' ANCHOR' BOLTS - - -' -
"complle for sale:IE however,the building e t dden oemem n sold within otic year or - -'
comoseforum,motthe e.-bund).will nage me brmen rr proving that he aid not Haim r. 106 - SEWER & WATER
improve for purpose of sale.).
202--- UNDERFLOOR--PLUMBING
_ . .
❑1 as of me propcny 4.esclu. sly contracting with licensed contractors to
---'
ennawct me pro)...ISec.70.W ens Leas aPrareasmna cnde)rne cit ametors 203 - UNDERFLOOR MECHANICAL'. .::.t
License Law does not apply to on owner or property who builds or improves thereon,
and nit ommme or,such project,with a contractors) l;cen.ed pursuam.to the .___ __ 2 04 UNDERFLOOR FRAME...__
.--
Commnors License
law.
❑I am exempt under Sea' ',B'&PC formic reason 205 - UNDERFLOOR INSULATION
.c." Owner .. ..
Date' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER '
I hereby afrsm order sena❑y of MrjurY one of the following declaration.: 303 - ROUGH MECHANICAL
0 1 have and will maintain a cenif.ne bfLCbnsent to self-insure for Worker'. 3 04 - ROUGH ELECTRICAL
Ccumsmotimit, as provided for by Section 37W of the Labor Cade, for me
N,fibmance fineweekforwhichthispe - FRAME
111 have alit' 1 thban Workers Compensation Inaurarce,a,required by Section 3 06 - HOLDOWNS -
37 she r adc,for me pedormane, mek for which this permit
is 3 0 7 - INSULATION ,
is a Mr nit c m n tool am or ya rot' re 308 -;SHEETROCK- -
boar
Poll ION FROM WORKBRS'l t x3.09. ! '-EXTERIOR.'SLATHsf
._soot_ , cokjPEesm msuR cE_ .. . --- - .--
INTERIOR- -LATH--.—.. -
__.. ... ...3.1.0.,.
rn m a a dinars 311 ` SCRATCH COAT
/ ISIWI( le; ) -
313- .. .: ROOF:-NAIL-
a, -
rl e t fy,that th pe I mn6e t f t k I ,ch thi s pe t' '.seed I
all not employ any pe ny manner so as to become subject to the Workers 501 - FINAL ELECTRI CAli'' ENERGY
Car son Laws o
502 - FINAL PLUMBING ,ENERGYAppIle t - omae
ucANT 3 after m, si its rt .a m 503 - FINAL MECHANICAL' ENERGY
theta k Compensv provisions of th WM Codeyo us
u q suchnPPwitnp visions. t pertdtshanbea aked. 504 - FINAL BUILDING ENERGY
Z rr
forthwith comply
.. .. ... ... _._. ... ..... _.. . . . . .._ .... ._ .
becomesubject to
CONSTRUC1ON'LENDING AGENCY,' 505 — FINAL ELECTRICAL
Le there Name that et aronsi t aled'nf th
I h oeby-loom
yet-> 6eg cY pc.(ormatas � � \::••
rnM1 kr wnenm dem r. a.aeles«v)97 Civ.c) 506 - GAS TEST
w Q507 _ FINALPLUMBING. ...... ..
z Lane its Address
. U'O Icerslrymmlhavartaemhapplicatir.andsurtemattheah.vcinfaminioois 508 FINAL MECHANICAL `
w,F corse..1 zgrce to comply with all city and court,onlitances and note laws relating 509 - FINAL GRADE
_ O U to building comtroctirn;andhereby amhonzereprcsemativesrfmiicitytoen¢.upon 510 - FINAL PLANNING
>a W theah.ve-mentioned property for .,,vel on.purposes._ .„ ,
P. (r,) otos dn,nifyarlkpnptlessthectyrfC'ptfno.,am' 514 - FINAL PUBLIC WO
V] liab Iii es j IS tsu is J cxpc M1 ch may in anY Y gainst said
UZ City nc e ft Brats F th pe 't
APPLe NDfRSTAN I, W LCOMPLYW POL . 602 - OF D NA �ZQ�a�
sol m ns Issued g}p Date
"cat r vc tractor D u Re-roo - -
Y IIAZARDOUS MA'ILRIALS DISCLOSURE '
- -. I wily the a scam a more baildid,ae.,ant store or handle harmdnas mater al . Type of Roof.
' as defined b the Cupem Mp ¢ipal Cole Chapter9.12, d theHealth and Safety
ena s nt ss532n All roof is installed i I j t o a n y a
N
ClY- u. °N ) t e _ _shall be.mspec[ed pnor,to any roofing material being installed. . . ._._...
wornt,coapplicant ft Wilding tudbytoccupant eco poem odeic.wnan without first obtaining ninspection; Faoree.toremove.
eat Willi earcitauton:ut.as Bel Bed by Bay AreaAir O a rtyevices which
Di"'ireall-pew materials for inspection.,,Applicant understands and comply with
oyes ONO
P PP P Y
all non-point source regulations:,
1 h' b read the hatoidons materials mquireirmol tinder Chapter 6.95 of the
Cal ammf th&Snfny CWe.Sections25505,25533and 25534.I und,oaznim., _
bu- ng ce -otc ne tly hos at -an,Out uIs my rts tbltyt oufy the
pa Ft q vh�h tp bum iso e t ulic.to of
c �— /J�D(/? Signature of Applicant Date
COO a mrr;aed ag t All roof coverings to be Class `B"or better
't. .. .. ... nt. .- OFFICE . . .. .- ..