02050018 OF
TINO
CI BUILDI c DPEa
siONPERMIT CONTRACTOR INFORMATION:
li ff lgllg IgDRF,$$:,- IG CT PERMIT NO. 02050018
L11b l..2u1AND YAO TING-Y '8fgc/TJJn D2
�rff.'PlftG-CHIH
PHONE: SANITARY NO. CONTROL NO.
M-O ARCHITECDENGINEER: BUILDING PERMIT INFO
F to
BLDG ELECT PLUMB MECH
P,z u LICENSED CONTRACTOR'S DECLARATION
Ihereb-affirmmatIamlicensedander of Job Description
s=-o prowPmfiea p € ADD 417 SQ. FT.
is in fall force
ore0nd effect. 3of the Business dna Profession.Cwc.and my license
:ex ce< in ran l.,,and errect.
;Oyu Date Clasz Lic.a
Dom Comma:or
1=O G ARCHITECT'S DECLARATION
5 1 understood my plans shall be used as public retards
Ac
p O Licensed Professional
OWNER BUILDER DECLARATION
mm� W 2 y 1 hereby affirm that 1 am exempt from the Cutthroats License Law,for the SEP
Id L q LOO gL y $45000
L i a following mason.(Section]031.5.Businessand Professions Cade:Any city or county S
E".� which rtquiree a permits m mnstrvet,al¢rJCI-impvwe,demolish,or repair any suucm e
y3� priorto its issuance,alsorequirestheapplicant for such Permit File ignedstatement .._._ .._.-._- _ ........ _
slash glttudp nthop_ is:onsoftheContmnorsLtt La (Chapter A� r �]p��p/, /�a+�Y Valuation
(.lith g the t ]8881 fD "ontnf the Bus nes- dP fs sC Je) 1 wt 2 f"..- s i 1.:L I.1°1f x, 1.JILDI it A
or mai he Is exempt therefrom and the bass for the alleged exemption.Any violation
1
-of Section 1031.5 by any applicant Tor a permit subjects the applicant to a civil penalty
of..,mune than me hundred dollars($S00). APN I Occupancy Type
❑1,as ouncrofthc norm employees with ua 102 - PIERS
proper y ye p 5 of offered
their sol.to
to sec.lion.
will Business the work,and anion=nraure is no, moticCommerce's
License
(Law does
snot(Secy 0044: -
owme,of and eroreasi.b cad<:The Contrcmra,Md w Law a«.net apply to an Required Inspections
owner of h his o y em builds or imprmes thereon,dad who does such work himself or 10 4 - REBAR
or through his own employes,provided that such improvements are not intended or
afreaa Toro,alerlr,-However.the building driltprovemwt is Cold avenin one>'ea:aro . . _.--_ 105----ANCHOR -BOLTS `---. -----..- � - - ---- -_ ..
completion,the ownerbuimer will nage the burden of proving that he did not build or 106 - SEWER & WATER ` V.
improve fm purpose or sale.).
y.a.°whe,arneprefootame;flux i,elycoidwBrswiihii&io,-dc�t;Itoo,to 202_.-._-UNDERFLOOR.. PLUMBING. .._....
°nahaet the project(Sec.7044.Business and Professions cmc:)The Contractors 203 - UNDERFLOOR MECHANICAL ',
- - license Law does not apply to an owner of propcny who builds or improves thereon, -
`. and who contracts for such projects wi h a commmngs)licensed parauant tame. __. _._ ..2 04._-. UNDERFLOOR FRAME
Contractors License
Low. 205 - UNDERFLOOR'.INSULATION-
0
I am exempt under S ,B&PCT tM1s Aiar.
��/y�a i 301 - ROUGH PLUMBING
O ERS. DNSATIONDEC RA N 302 - TUB & OR SHOWER
n«In=reby unmet penmty orp<yaiy one onnq snow ng a«laruona. 303 - ROUGH MECHANICAL
F ❑ 1 have and will maint5in Cerurcme of 6mort to,elf-insure Tor Worker. 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of he labor Cade, far he 305 - FRAME
performance of the work for which this permit is issued.
306 - HOLDOWNS
01 have and will maintain Worker's Coinparroodov Insurance,as requited by Section 307 - INSULATION
3108 of the Labor Care,for the performance of the work for which this permit is
issued My Worker's Compensan°n lnsumnced carrier and Policy ..ad are: _30.8SHEETROCK..-_.
m. ._.. ... _ ...av' .- ._
c�.,t t +" , "t : I EM No ' '� .' ;'x309 .:,EXTERIOR' LATH'.
CERTIFICACOMPENTION OF E TION INSURANCN MOME
WORKERS s- i s1 — I '
. 'r - _. 3.10__..- ..INTERI,QR.-LATH__...
• r(rbf.3eFroh'Jeea'rmMedmpi<;eaifthepe.i,iaroronehundreddnnars 311• SCRATCH COAT
313 - ROOF NAIL_
_. . _. .
I rfry'tnt m ,perr of the work nenm perms . nem 1 501 - FINAL ELECTRICAL''.:ENERGY
niCompensation p1L y�x{ ` nj7, 7'�-`n Worker,'
°`k ra 502 - FINAL PLUMBING ENERGY
APPI s1-E `I^� ! ..
s pt Id 503 FINAL MECHANICAL ENERGY
NOTI DAPPLI ANT t, B k th C rcmc of ynus m - t,
Z becamej n thew k C pe Betio p x Fisher Labo Cm<.you mds
,Oz forthdthcomplywitAsuchprovisionsooh Permit shall he deemed revoked. 504 - FINAL BUILDING ENERGY
505 FINAL- ELECTRICAL -
F,: .�.: ' .(� '. CONSTRUCTION LENDING AGENCY
CC<i y I Is by (firm that the- a coarct rs lending agency for the performance 506 - GAS TEST 's
of the k r° h'h th pc 't sued(Sec 309] Civ C) -
LendrINm< _ . --507 - - -FINAL-PLUMBING .. ._
D%z
Lend q'naere 508 - FINAL MECHANICALL, .. -.-_--
U O •I esoify that 1 have rend this application and state that the above inforznetion is 509 - FINAL GRADE
�+ F correaa agree m comply with ell city dna county ordinances mtl state laws enter
upon /
.O�U the above-mering oumion:pertyand fri inspection -uposes.ItivesofNiscitym<merupon 510 - FINAL PLANNING
t,,:,fa] the aba(We)agree
16oned property for inspection p karmic.
^A (WejigmemsaoUmdcmrtlfyand keep hihamayinthe
MYwa6Aefxemnoa9dint 514 - FINAL PUBLIC WORKS
h liabilities,judgments,costs and ing of thi which mayin any way carve against said
V.y City in consequence of the granting of this permit.' Y
APPLICANT ONDERSTAN SAND WILL OhIPLY,WITH gLL'NON-PDINT' 1
OURCERF I.ATIO �r:. t o Issued by: Dale
_ - .ig:aureof APPlic Cnnrador '• "" "'. '^ Dae" j'
y pe p Code Chapter 9 I2 and the Health d RC-COOTS
A DOUS MATERIAIS DNCLOSUR
defined
e
Will the pp t future bidding e, pa list -ha die Heallou naafety Type Of Roof
sdef tli the C n M P Safety yP - -
Code Section 25532(e)? � - -
DY<sr' .r ❑N ..' t
_All roofs shall.be inspected poor to.any roofing.ma[enal being installed.,
W B the ppl canto f t lit fi sec e B t e. P as ae nim If a roof is installed without first obtaining am inspection', I agree to remove
mh'hn d contaminantssdef a by th Bay p a AirQuality M gemem
-'"i1 all new materials for inspection Applicant understands and will comply with
❑Y - - U.Fa ... P Y.... _.
all non-point source regulations:.
1 Ilha e.read.thf K..udMx mate mals regmremrnts under Chaim r 6.95 of rhe
Glifom a Hwith&Safety Cade.Sections 25M5:25533 And 8534.1 understand them
if the budding does not currently have a tenam,that it is myrespo iNt ility to notify}he
occupant of the requircmems which must be'met prior to issuance of a Certircate of
Occupanc3'.r• .. ..
" • ' " Signature of Applicant
o .- - Date _
Tamm od=was Date All roof coverings to be Class "B"or'better"
OFFICE .._. . . ..
- ' .. ._ . . . . .,. '