02050166 CITY
oiEROxo
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20045 CEDAR TREE LA MAI ' S CONSTRUCTION 02050166
OWNER'S NAME: APPLICATION SUB DATE
ANG PAUL AND TRAM TRACY H 359 N. PARK VICTORIA 05/28/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 202-4875
�O O ARCHffECI]ENGINEER: BUILDING PERMIT INFO
as- BLDG ELECT PLUMB MECH
to<so
Z i LICENSED CONTRACTOR'S DECLARATION Job Description
0 Z_ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P
po,tw with Section 7")of Division 3ofthe Bmi and Professions Code.andmylicense UNGRADE ELECT SERVICE/200 AMP
Q Y _i is In
z C 6 Dai Lic.
0 n L' Doc Cut. Q(8[jg�
3��i ARCHITECT'S DECL�'�J(�}DION
u'0 g 1 understand my plans shall W used m public recoNz
�N
adi O O Licensed Professional
OWNER-BUILDER DECLARATION
I hereby offirm that I am exempt from The Contractor's License Law for the
s-i a following¢aw n.(Section 7031.5,Business and Professionsde:CoAny city or county'
add z p which requires a pem,it m construct,aline improve,demolish,or repair any dstructures., $500
6Cm .Pct m¢ summrequucslheapplcanl fo s Contractors
License
Law(suspon-9 _--
thmM1 #d purslmm76tsof visionthe t tractusLicenselaw(Chapter9 ' t SFp,�I+Q Valuation
(co c,tima Secuo ]0110) (Divi.is Sof e B ne{sznd Prof�ions Cods) :.13_� S B,1Cb34.0'Opl;SV U:12:,5.'� FT1.3L1:
or Sem he 7 ex6mpt thercfmm and the basis for rhe allegro uempn t io Any l un on I
-of Serrano 90365 by any applicanj for v permit subjects the applicant to a civil penulty-
.of not somo d an five hundred do]).(s500). 103 APN�'tri,Vr Occupancy Type
❑T m owner of the property,.,my employees with wages m their sole compensation.
will do'the'work,-and the'swnurc is not intended offered for sale(Sec.]fiJJ,' - - - ---394 R1
- - - -
�Busincss'andPinfessions Code:rise Contractor's License law does not apply to an 505 - FINAL EL k� sections'
owner of property Who builds or improves themon,and who does such work himself
r Ice ti employers,provided Ice[ h'improvements tintended ar
,offered fo fo sale If h N Wilding p is ory sola within me yc5r of
completion.The owder-builder willh the burden f purving that he tld notbu lJ or
improve for purpose of sal ) / 1
OI' ow fth p pcnY,ampxcloawly-,mruidi widuld contractors to
construct the project(See 70ai Business and Professions CMc:)The Contractor's so Cl 0
License Law
_ Owner of
apply towner
) net of property ho builds&t
PCpfonhs sth«eraewonn,
and ho conPuazls for such projects-with co racto(')I<nsdp rs ant to the-
Co t r cit ttLe •,'h [l,at � lm s"l',
//O
OI t ndScDal
_ -
,;t "WORKER'S COMPENSATION DECLARATION
•`'``f 1 hereby a(fimn under penally of perjury one ofthe following declarations.
.: i..' _1 ❑ 1 have and will'mainuin a'Cernficme of Consent to self-insure for Worker s
k' Compensation:as provided for by Section J]W of the Labor Code, for the
performance of the work far which his permit is issued.
❑1 have and will mainiain Workers Compensation Insumnce,'as required by Section
37W of the labor Code.for The performance of The work for which this .I,I,
isWM.My Worker's Compensation Insurance carier and Policy number are:
Y
Came j}. -,,st[ 1,.iT Policy N . - '
!CERTIFICAIONOFEXEMPTIONFROMWORKER 7 i _]V;h\ ..s.15_ C s n1i 1'S,f5 I(a,�
COMPENSATION INSURANCE
. . ELLE _ .. .. ...__-... . ............. ._.......... .._._.. _
"
Mil sen oo'oee l nor he completed if the permit is for one hundred dollars _.� '- J`'' �_3-,._v...-•+�_.
•($100)orless.) '
a
Icertify that me perfo a of Ice rk'f h,h th y^perm t s d I'
Cd 1pad tovoy any fC lforti a"m in Uteoua° /'s'/f as �j�t_ �he_�`
aayy991f �grrnG
Nrdi fthfOA0the Worker's
romak ngth¢..Won,e ofE Labor
you ould t_•, sin
lwcome su cm,ly the Workers Compensation peritshaofthe Lab or in mkesL must '
Q Q forthwhh romply with such provisions or this permit shall be deemed revoked.
Zr -.. _. _.. .-.
1 hereby wSerm that N consurlending agency for See perfoimance ICONSTRUCfIONLENDING AGENCY
of the work for hchSe permit 'issued Sel I
v
_
JW],Civ C) -
D_Z Lende, Add
V 1 cemily that I have mad this application d state that thEo -information is
I- can
Wil
n 16 omply Ice' II lY J y J adxtt l relating
0:U the bo 7 g ca st' and h by authorizeprt t t of th s ly t enter upon
;as:i:0. above mentioned urei 16 p live:
ma morn and keep
purposes. '
E._q1 (Wgdgme t,Tax.indanmfymdkehihamay in Jany isit o(eme age against
"fA liabilities.judgments,or the
and expelvms which may in any way acerae ogalnst said
U.Z City Consequence orSe gratitinguf lh p t
'APPLICANT UNDER$TA S AND WILL COMPLY W'ITHAI.LNON:POINT ' !
S gE UIT n - z Issued by: Date
1
✓"g f ppucanve cur, 1„ Date Re-roofs /
.HAZARDOUS h1ATERIALS DISCLC
'.' WlI to appheanio,fuI "buthingaupant store or handle hazinhow mmenxl .Type Of ROOT___
`o.d f d by the C pen tit 'p I Cod Chapter 9A2.and the Health and Safety. t• - ""' "'- ^'•�'
•Code S ton
IOP , 11 �N ' '1i1 t I' 1.0. 1 ' Iw Ti .� 10 41�LI1 ISa . t(l '
., All roofs all be inspected poor to.any-roofing,material being installed. •_ •,__
Ninth ppplba t future Wilding cupn tmeloc 1 ma s, hch If a roof is ihstalled without first obtainingan inspection-�I'a ree,to remove
Toth ammo acontortionat efnedbyth ByAreaA-QalityM gement g
Dram°' all new materials for inspection. Applicant understands and will comply_with
❑Y N
1 all non-porus source regulations. - '
read the hazardous m Icri Is requ rcmems'u der Chapter 6.95 of the '
Cal fomu HwIN&Safcry Coda,Sect on 25505.25533 and 25534 1 undersmnd That
apsum dingdcesnolcuecndyhhormitmm,Mardis mYrsuance of
ticcupam o!the requirements which inusi Ed met prior m issuance of a Certificate of '
I'
Occupancy, .'.':..
ryy, Signature of Applicant Date
Vwncr or amthont,ola& 1 Dale All roof coverings to be Class"B" or better
O
-• .. 't--' ELLE, " FFICE