010700091
CIDCSONO
CONTRACTOR INFORMATION:
BUILDING IIVINPERMIT
BUILDING ADDRESS:
PERMIT N0,
21681 COLUMBUS AV
01070009
OIIlgHsfaimYUSUKE AND YUMIKO
APPLICATION §UB DATE
07/05/2001
'HONE:
SANITARY NO. CONTROL NO.
: ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG 5ECT PLUMB MECH
- LJ IJ LJ
LICENSED CON TRACTOR'S DECLARATION
lob Description
1 hereby office that 1 am licensed under provisions of Chapter 9 (commencing
with Search 7000)of Division 3ofine Businessand Prof=ssions Cale. and my homes,
BDRM.
,
WINDOWS &
is m full force and effect.
License Class Loc. 4
LIGHT
FRAME RF.ON GARAGE.
Data Contractor
ARCHITECT'S DECLARATION
I undersand my plans shall be used as public records
Licensed Professional
j OWNER -BUILDER
I hereby (Sam that I irm he RATION
License Law for the
from ,h= Co,ions
l
! �/
. I.S.=Bump,
: following reason. (Section Cods:
]a3LBusiness and Professions Calc: Any city or county
t resit any ewaurc
: which requires salvo re uirnwct. alms improve, demolish, file
,. Pro i issuance. 1 9 for .L d statement
- -
.. .. ..
S Ft
�•!. tl'
FloorArea)
-�1.1 .I
Valuation
Conpermuofl
e p isionso
thathe sr withwd r, thep smnsn3o ceBusir �e L onsCor9
(c with Sava Division J of the and Profess ass Codc)
`s
I, a
or runt he is exempt thcrtfrom and the basis for ,M1e a11egN exemption. Any violation
mon in l allied
,
-� y ry ;, }
- - -'
of Section ]031.5 by any applicant for a permit subjects the applicant to a civil penalty
or act more than Face hundred calla", (s500).
APN Number
l: Occupancy Type
01, asownesofthe propony.ormyemployees with wages as their sale campansetfon.
101 -
FOUNDATION
will do the work, and the structure is not intended or offered I.,sale(Sec7,u4:
Business and'Frofcsaln., Cale: The Cmamiamr's License Law does not apply t° an
1 O 2 —
PIERS Required Inspections
owner of property Who builds or Improves thereon, and who does such work himself
103 -
UFER
orthrough his own employees, provided that such improvements are not intended or
-,offered for sale. I .however. the Wilding or improvement is sold within one year of
- 104 "-
REBAR-
eompletoon nwnervbuilde"will have the burden of proving that the aid not Will or
improv rparposeorsaley
105 -
I'
ANCHOR BOLTS :
1. "asowner.1di Prooeny��m�xd�ri:•elreo�i:�rni,gwuhu�=�aee�o�tr�.r�iotsln
._
-..• .-106--
1__ ._.. .. ....__... __..... __..
SEWER_ & WATER
from the projeet (Sec. A14J, Business and Professions cod=:) The Contractor's
License Law does not apply so as owner of property who Wiles or improves thereon,
2 02 -
UNDERFLOOR PLUMBING ' '
and who amit.a. for. such.p"aje<ts with ct
a commm(s) licensed pursuant .,the
..... 2 03 -.....UNDERFLOOR-
MECHANICAL' _....._ ....---
CnmmctarsucenaeLmn'
❑lam esu , B & P C mnhis mason
204 -
UNDERFLOOR --'FRAME i : %
o Date' •% — Tj
205 -
UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301 -
ROUGH PLUMBING
Ibeacbyafrm, under penaltyofpea,myone ofinefollowing declarations: -
302 -
TUB & OR SHOWER
0 I hco( and will malmdin a CeniR<nle of Censer, ,n saff asure for worker's
303 -
ROUGH MECHANICAL
Comsma:ign, as, provided far by section 37W of me Labor Code. for the
perrorman<danneworkmrauchthispematsi„ued
304 -
ROUGH ELECTRICAL
01 have and will mainuin Wakes Compensation Insurance, as ma uirc l by Section
3 05 -
FRAME
I]W of the Labor Code: for the performance of the work for which this Permit is
3 0 6 -
HOEDOWNS
issued My Workers Ca pe f In.ui e, and Policy number arc'.
Pai <r Na
Curt•I.r 3CERTIFICATION
-307,,•'-;_'
k 308 `•SHEBTROCK.
IN_SU_LATION - - - -=
+ '� ~
OF EXEMPTION MOM WORKERS',
COMPENSATIONINSURANCEa
_._-_.. 3O9--i,;-EXTERIOR--LATH-'
(This section need not be complctea if the permn ,s for one hundred dollars
ISIW)o leu.)
310' —
INTERIOR LATH
_ •
" see
311--
SCRATCH COAT
1 err ihi ,he per c "the k for whichto p' it''Is 1
shall not employ any piarcars'in any man as to become subject to the Workers
`°
313 -
ROOF NAIL'; "
Comp
Com a ns
ensation on Laws arCalifornia. Date
. 501 - _FINAL.ELECTRICAL...ENERGY
502 -
FINAL PLUMBING ENERGY
NOTICE TO APPLICANT, If, after anaking ams C=nircn,a of E.ampnaa. yaa snov1°
M: come subject to the Wurkcr4 Ctin,pensa,ion pmvi inns ofihc Lima, Code, you must
forthwith comply with such provisions or this Permit shall bedcemed revoked.
_ 503 _-
FINAL MECHANICAL ENERGY
' 1 hereby affirm that Inde is'a'cond
Ib'cOn•sTRUCriONLENDING AGENCY the
lending agency for the Paronnance
504 -
FINAL BUILDING ENERGY - ••` - -
.. . ,
(Sfm.
tm,permitLsinsurefsrc.x. cm. ca
505 -
FINAL ELECTRICAL
Lmbworkrnr -1
Lender's Name .. .. ..: ... .. .... _... ._.. .._...
loader's Address
I .. 506 n--
GAS TEST
have
507 —
FINAL PLUMBING
I cattily that l "cad mi, appEcatms and viae that me aeave mm,manan is
<oradt: 1 agree to emnply with .all city and county ordinances and state law, relaamg
508 -
FINAL MECHANICAL
,o W ilding cismrractich. and hereby autbono, representatives of this city to enter upon
theabone-memimmil pmpaty farmspca,mn Parposcs.
509 -
FINAL GRADE
(We) agrce1.mve; indemnify wad keep harmless, he City of C.pe-mossmamst
ease
jadg�n=nts.rosta a wad, maym any war <cmc again„ said
-
510 -
FINAL PLANNING
in cane=yuenee o ,mating
is perm'u,'I§ M, 'ILL COMPLY WITH ALL NON -PONT
-
-
NA U C WO
klaabiliov,.
R .UI
Issued by:4
_ G 1
_Date
.. ppl'manvcm :a �� .• Date
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will,he applicant or is. Wilding otcupanuroie or handlehazvdaos material,
:Type Of ROOT.. •.
.:. ,... .. .. -
as defined by ,he Cimen Municipal Cal Chap, 9.12. J th Health end Snfe,y
';
' r e '- - -^ ^•
.3 _,, :..
Cad Section 2s53'O -
11 Yes I
i • N rt
, ..• + ,
--
_._.All roofsshall be inspected prior_to any. roofing. material being installed.
Will mepplier toff m Waldi gwas-Prim aseetu pai, m1delier, which
ani IM1 z' d . a t m t. -, detimd by ,h Nsy AreaA Quality Masncmmcm
-
If a roof is installed
without first obtaining, an inspection; I agtee.6 remove
o
°i "e' ❑Y. 11 No'
all
all new materials
for inspection, Applicant understands and will comply with.
PPP PY
...
non-point source
regulations_',.:. "- I :
u. mmenals reyu{25533smnder Chapter ti.95 the
I have read the hly
Cd
California Health k Safety C We. Sections 25505; 25533 and 255?4. 1 unJcra,and thm
d
1111 a building d cnaa1, thm h is my raspo...mility m nntifY,hc
-
- -" - - - a-- - - -
ace v , of m mq ,z arms e, prior ro iuonna of a Camps.. of
u
.. .... 6 3 .
-. Signature of Applicant
Date
w "aumsnz=seas=nt '�' _ Date
r
All roof coverings to be Class "B•' or better
OFFICE