01120097 CITYL'
BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20045 CEDAR TREE LA 01120097
,li .VNER'S NAME: APPLICATION SUB DATE
SANG PAUL AND TRAN TRACY H 12/27/2001
PHONE: SANITARY NO. CONTROL NO.
00 ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Z f
ss.. LICENSED CONTRACTOR'S DECLARATION
O so- I hereby of irm that l am licensed under Job Description
:4- y provisions of Chapter ADDITION AND KITCHEN REMODEL
wiin fection7 )of Division3of Ne Business end Pm(cxsiom Ca�le.an`d�mYjlicenm
i
UA: is Lic full( e tic t. � V V
OW.U U'cepse Cl Li V p� p Cpm
130 D a L Conte F'BVALED
ARCHITECT'S DEC A N
D g I understand An,plans shall he used As public mcodx
1 6 p O Licensed Professional
doh
JOWNER"BUILDER DECLARATION AN 03 .
2.' 20
=u, 1 hereby affirm that 1 am exempt from the Contractor's License Low for,he
C < following reson.(Section 7031.5.Business and Professions Cade:Any city or county
000
O which requites A pennit to construct..1ter.improve,demolish,or repair Any Autocrats,
° 3$ _pried m u uuuica dwrtq i ,he applicant forwcnpemuuofile aligned cutemen, BUILDING _ _ _ ___ ..____ -_
E thIetb ill enxeap rsk iudmfhs,provhichs.fthe Contrutm'a License Law(Chapter9 * n p; Valuation
(commcmcmg will,Sectron,700))OfDivivon3ofthe Bu{mesc and Protrfa ons Code) f••1)Aas + [{i: y,rJ,jJ'L�,•U'U tt�4 ty [[,fw't 57
or Na,he Is exam i therermd aid the,basis for the.1 ed ea t'a`'`�g'l,L R.
p et emgmd.My l penalty-
-of Seaton 70313 by anyapplicant fors permit subjects the Applicant to a civil penal,y- A
mf not more than five hundred dollars($500). 10 i'pN AT ION '' Occupancy Type
01,u owner of Ne pm,cy,ur my c.ploytts with wages As inch sole compensation.
-will do the and the smactum isnotintended or aRered'for'sale(Sec:70".
`H.Ammutid predications Curie:The Cmmuctor'a License Law does not apply to An 103 - UFER Required Inspections'` '
owner of property Who builds or improves thereon,and who docs such work himself 10 4 - REBAR _
or throw h nix own employees.provided that such improvements are not inle dr l or
-;co� onshe.ILHowevere ilia building ar wpm of prove sole within otic Wild
or 105 — ANCHOR BOLTS }`,�IT�V y,t
'completion,the owner-Wilder ilder will have the burden of proving that he did no,build or
improve forpumoreofsale.). 106 - SEWER & WATER t
❑L- wee _----_ .. .-e_ .. - contracting—. ._ _. ._"... _ - -
eowhe ofthe p(Sec.7amexdaxPosNdPofens Code:)
de Connector'.
onnorsm 2.0.2. — UNDERFLOOR—PLUMBING-
construct
- ic,cs. aw project(Sec. Rotuma end Professions h.ns Code:)The ContradoM1
License Low apex no,Apply'...owner o(propeny who lwild,or impmvex thereon, 203 — UNDERFLOOR MECHAN'I CAL''"
`. ' ..and..whocontracts for-such.pojecu-with a comrscau(s)licensed.Pursuant m.the
Contractors License Law. , 204 —UNDERFLOOR- __..._........_....._.... _..-__.-,'' -
0 l am exempt under Sec. '' ,B&PCfor this reason 205 - UNDERFLOOR- ''INSULATION
- weer "Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 3OZ - TUB & OR SHOWER
Inereby aRrm sneer pcmeltr olp<yuryM edsena following declarations: 302
- ROUGH MECHANICAL
0 I have sid'sdill`nsuinuin a CeriiOcax,of Conon,an self-insum for Worker'. 304 - ROUGH ELECTRICAL
r- Campenastmex es provided for by Section 3700 of the LAWr Cade, for the
performance of the work for which Nis permit is issued.
305 — FRAME
01 have and'will'malnuin Worker's Compensation Ibiurence,as required by Section 306 - HOLDOWNS
3700 of the Cibor Code.far the pciromunce of die work for which this penult is 307 - INSULATION
issued My Worker's Compensation Insurance carrier and Policy mi be r e,,... .R
carver I;, , , a:Pdi[yN6 - . .308" - SHEETROCK.,_
CEmmlcnnONOFEXEMPnONFROM-wpRKERs I t e ' 'Y 309- f-a�EXTRRIOR tiLATH'
' COMPENSATIONINSURANCE _ - _-_ _... .. _ _ .-..._._._
(A00)or 1e ) p Penne is for ane hunerce doR.rs 3 11 i- SCRATCH
I OR LATH
ect o
nbed t he' o
Axel
leted f th 1 Q ,:- I'
TECRATCH COAT
1 ret tAetmth rrm,�ebnnrwnarnrwmmm,x 313 ROOF'-NAIL ^- •` -r : - -:..
p p m aixxaea I 501 - FINAL EIiBCTRICAL 'ENERGY_
shell ra t em I n n m r coa bf(��gQnu u��yyact to the Workers
Com i ren LAslayof
-ApplpcalR�' -- - 502 — FINAL -PLUMBING ENERGY - _
N(yOCE'TtY�PP (CANT If eller making)hsC nfi[neaf Exempt on'y nannme 503 — FINAL MECHANI CAL 'ENERGY -
become object m the Wdrk is C mpenxouon Prov s o(the Labor Csid you mus,
0z fohhw th c reply with such provisions or tit a poem t hell be decreed rcv ked. _ ENERGY,_.
.. _ . . _ ... ELECTRICAL v� rIColusraurnoNLENgINcnGENcr 505 FINAL ELEL "
y BUILDING '
tb 1heforwhichthe,!bareIsscsued(SonledCinj agencyfedthePerformance 506 - _GAS TEST _
W i..i of ire ark for which tit s perm t issued(S c X097 Ci.C) '
A �Genders theme �. . . ..' '-. ... .... .. .. ..-
z I,AderaAAses 507 - FINAL PLUMBING
O ,I ceNfy di i I have Rad this application and state that the above information is 508 - FINAL MECHAN I CAL
ks'.Ey cortecul agree to comply with all city and coynty,ordmances and stem laws renting 509 - FINAL GRADE
.OAU ,o buildingconsuuctinn,and fiereby authodee mprescauunice of this city to enter upon
the abovenu toned property m,inspection purpose 510 - FINAL PLANNING
Uea pt (W)ishre.to save and Mini fy and keep harr"leu the Cny of Cupenirid.gainer
TA liabilwea judgments,coals And.pent.whicI.h may m my way.cent.ayunst said 514 FINAL PU I C WORKS
U ,�$ City n consequence of the gent ng of thla pemdL - .
APPLICANT UNDERSTANDS AND W ILL COMPLY W11TH ALL N0 POINT"
of EREGUL. NS. " 'I" "r"`' -'� G 2 Issued by: Date
Signamfeof ApplicAWLbmrknor .. r- ^
"I;` I"' HA7ARDOUSMATERIALS DISCLOSURE'" dem Re-roofs ^
. -. .'.
v,�' Williriie"applicant or futuk,building'mcivponi stoic of Handle Heurdous materiel Type.Of:ROOf:.
ode CNp,er913 end the Health and Safety .. ..... ._ u:_.. c., .. ._ - ..
Code ect on 25533(x 1 ip F F s . ,: tr •f`t: _ r a f ,a a, '•l3 t •.ti u'
eeefinOWYeSth ca menMpmmi c \ t - All rgof$,shall be mspected.prior tq any roofing matenal being.mstalled.
r a w
' t
W II the p, t building oc pant a equipment red which If a roof Is Installed without first obtaining an Inspection I'agiee to remove
,buudo s ur conurmn t d fined by the Bay Arte A ry Qual Management
-
may all new materials for inspection Applicant understands and will comply with
OY f ea " -T' alCnon-poibt's'ouice regulatlon9 -- -
' 1 hove rtad,the haurdous.maierial requirements Chapter 6.95'of the
California Health&Safety Code,Section,35505,35533 wed 25536.1 understand the,
'if the ,Ioftng eoenot
rrintslyhaveatenae et pd6i my W,Aancsiofa I.notifythe -
occupsm dT the rtquiremenuwhidi'rnun be mei prior to iuuan[e of a Certificate of
q VP' `y Signature of ApplicantAll Date
0.3 az i,
Amer o rn need all A it I!% .,e. . roof coverings to be Class B or better
7.
a OFFICE