02060131 OF
CI BUILDING!DIVCfISIOsNNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10106 CRESCENT RD PATERSON STEVEN W AND LA RA L 02060131
OWNER'S NAME: APPLICATION SUB DATE
PATERSON STEVEN W AND LAURA L 06/20/2002
PHONE: rte, SANITARY N0. CONTROL NO.
ARCH ITECT/E1NGINEER: BUILDING PERMIT INFO
�— NIvBLDG ELECT PLUMB MECH
I_7 17 1-1 LJ
Z nZ LICENSED CONTRACTOR'S DECLARATION Job Description
O z—O I hereby a1Rrm Nat 1 am licensed under provisions of Chapter 9(commencing p
F_s_w with Section]0130)ofDivision3o(theBusinessandPromsionsCale,eadmylicense TEMP POWER POLE
ce m^� is in full fORe and efittt.
z
License Cl...
ctorKDate Contra
O Lis.M
to a.u.�', ARCHITECTS DECLARATION
L''—`
0.5 1 understand my plans shall IN,used as public records
f�so
ii p O Licensed Professional
OWNER BUILDER DECLARATION
ee� 1 hereby aRrm that I am exempl from the Comment's License Law,(a,the
mZ G following reason.(Section]031.5.Business and Professions Cade:Any city or county $500 O 0
S 2 D which requires a permit to construct,alter,improve,demolish,or repair any structure.
so 3 m"'prior m its issuance,also requires the applicant for such permit to file a signed sommeut.
that hq A ficeetsw pinvout to the pmvlsjons of the Contractors License Law(Chapter 9 S Ft.Floor-Area. + Valuation
(commericm with Section,]00o)of Division 3 of the Business and Professions Code +�• 't'-' 1 'A s'
or that M R eiempi therefrom moulds,basis for be allegd ckemption.Any violation �' ir.\'1�???�i;\7
-of Section 7031.5 by any aPdicom finite panni]!subjects the applicant ro a civil penalty N
rofnotmomthanFivehundreddollara(ssn)s 304APNR��}GgH ELECTRICAL
'L' '"' Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
—will do'the'work:and'the str eatim is'nor intended or offered far s ile(Sec.'70-M; -— ' -
'Business end Prdfcssions Cods:The Commnor'z License taw does nut apply to en 505 — FINAL EL �ecuons'
caner of property Win builds or improves thereon,and who does such work himself
r through his own employeesp Jdmt chimprovements e notintended o
,dificied f- 1 If however,da,bailditig o p 1 IJ -within- ._.... - ...__ ._ .. ..
ipl i
imp
o nb Id 'lIM1 the burden at praying that did not
m \s
P to,Fainpoic arrda.)1;oi�rar .
fePrtY I lY t t g thlc tl oro t t
__
1K1 e
consume,th proje,nt(Sec.➢W Business and Pr fits.ons Coda:)The Cmaractansi
License Law does not apply to an owner of property who builds or improves thereon,
and who.cmaranx.fm.suchproles.with a contmetogq licensed pursuant to the ..._.
Contractors License law. . - ... _2 ...____
.. ...
01 n xempt under Sea �A�,B,,&n P,C(or mis reason �' �o. `
OW ti .. ' 3BEV "map
W RKER S COMPENSATION LARATION
_ I hereby affirm under penalty ofpc'joryone,of the following declarations:
C I have and will maintain a Caaificate it Consent to self-insure for Worker's
Compensation, as provided for by Section 3400 of the Labor Cole, far the
'perfurmanec of tfie work far which mis p:rmil is issued.
01 have and will maintain Worker's Compen.selion Insurance,as required by Section
3700 of the Labor Coda for the performance of the lock for which Nis permit is
issued,My Worker Compensation Insurance cancer and Policy number are:
Cartier: 1_:, CATI N ,l Policy Na.: . . .. t . . .. ..
Ip,ii!CERTIFICATIOOF N IINSURANC WORKERS'+_ �'t,t'ac't�.��q`r g',ser L,\*-,1.)�.'.g:;*
COMPENSATION INSURANCE'"'r c ' - �_
" -`(This uction'Beed not W completed if the permit is for one hundred Jallan -. '' )J'^ .. I' ,.
(SIIX))a(less) '
,. 1c nfY that he PK a 'fth walk for th' t
shal cot employ any Person n any man al m become se bi m the W vkervl
Campen.salion Law's of California.Date
.Applicant -
N01'IGC TO APPLICANT:IF,after mak ng Nes Certificate of—Exemption,you.vhoulJ --'--- .
bccaine subject to the Workers Compenvhon provisions of Ne labor Code you mst
u '
Q fonhwithcomply'with such provisionsarlhispennit shall be Jamedrevokcd.
N ,r.,1•, .; ."..CONSTRUCTION LENDING AGENCY
I heieby affirm that there is a construction lending agency for the performance
C.,a ofNer-saDmrwhich mai permit is issued(Scc..]09).Cie C.) " ' "
n+
Icenif mmihnv ..•
Lender's Address
U Q Y read application ndstt that[he W f io isto s e
G+ F. torr t I g t omplr th b c ry rid pr
� U buildingtno c 't fo ,baba th p eta es fin qt Pon
[mss
P6 (We)(W)dg t,P a Jf xpen nJkephaml aany ty ofC pen' id
V) Citlialines 3 Jg ace s ,expenses which y any y me against said
U Z City cq ND of T g g of th pc a /� 7 n
SOURCE
NT REGUL TIONSf.DS AND WILL COMPLY tI'ITH SLL UON-POINT Issued by: i✓' Date 6 �/t/
SOURCE REGULATIONS 't-
&ga m of AppbcanuCoatraa n + Data' '�
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
Will the applicam or.fuwre building occupam snort or handle haraedous material
�a ser dab di c —_.T}'pe of Roof_._.
y porn N "pICW Chapl 912 and the Heahh and Safety - - -• �•-�-- ......
CWe S to
Cyst. m � t i inn �1 i'4��`li "-. )f�. .?,'ll p� tils
..— - All roofs shall be inspected prior to any roofing material being installed.
Will theirt -buildingefoccupant S use A equ p t devices ar -wmrn If a roof is installed without first obtaining an inspection,'I+agree'to remove
amort rel renin .a<dernW by me Bar Are Q rty Manage em
District? _ all new materials for inspection._Applicant understands and will comply with
Y.. p
all non-pointsource regulations.
Jh he ztedals yu nems and Chaprer 695 or the
Calif.mes Health&Safery Code,Sealons 25505,35533 and 25536.1 understand that
if,mbwldin Jcesnot curzendy have araan6 that it is my responsibility to notify the "-- -
'oc,u ant t e requircmenes which. be prior to]oaten o Certificate of -- - - -
- Oce a y. - ..
_ ignature of Applicant Date
( Owner oramho zW ager-
Data All roof coverings to be Class"B" or better
.. ._ _ OFFICE'