03010044 CI'PY OF CUPEW11NO ' °•�"' �' > �'<
BUILDING DIVISION PERMITUWC,ONN.,T•RACTORANFORMAT,ION
BUILDING ADDRESS: PERM]F NO,
10051 S DE ANZA BLVD 03010044
OWNER'S NAME: APPLICATION SUB DATE
id BEST FINANCIAL 01/08/2003
ZONE: SANITARY NO. CONTROL NO.
ARCIIITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�.pi00 LICENSEDCONTRACfOR'S DECLARATION
rc p I herchy affirm Nal 1 am lamed under provisions of Chapter 9(commencing Job Description
�<� widhSecuon7MBuf Di snn Sof thce ccs and] dnsinns en i,�ndmyraensciv
int run meyrte errem. z TENANT IMPROVEMENT
FNF'nZ Licen.4�llss��� ,L c.N
f,p f-TCo�ntr�Bc/�a CONTRACTOR: C W HANSEN CONS
Y� I undc�rsrun�d my plans shall be used as public records TFINA��
aCpwV
FLicensed
LLO^ LiuccePrnlcsxinnal OWNER-BUILDER DECLARATION FEB 0 44 2003
ex
a S 1 hereby from that 1 am exempt from the Contractors License Law for the
OO following reason.(Section 7031.5.Business and ProCode:We:Any city or county
to to mfi which requites a permit in construct,alte,improve,demolish,or repair any structure
in nihir.
—'^ poor In iU issumce.alxorequim.x the applicant lorxuch pfrruiuo III casignegsmtern,at
fSCOat Nisliceocdpursuant olhcprovisiamoflheContractorsLicenseLawlChapter9 Sq. Ft. Floor Area alua ion
is, (commencing wish Section 71XX1)of Division 3ofthe Business and Profession.,Core)Or $30000
w�S that hN
e is exempt themfrum and the basis for e alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy amt mom Orion five hundred dollars(ssfn). 35908018 . 00
Type
❑ Las owner of the pmpery.or my employs wish wagaushcir sole compcwtion,
will do the work,and Bre strumure is not intended of offered for sale(Sec.7044,Business
.it Professions Codc:The Comuemors License law does mol apply m an owner of 101 - FOUNDAJlf�ed Inspections
property who wildsor improves thereon,and whaccesxuch work himself orthrough his
own employeesprovided that such improvements am not intended oroRemd forsale.If. 102 — PIERS
however Ne building or improvement is sold within aloe year of completion.the owner-
builder will haul dre burden of proving this her did not Wild or improve for purpose of 103 — UFER
s''`) 104 — REBAR
D I.as envier of the property,am exclmi arty contracting wish lim tic d contractors to 105 — ANCHOR BOLTS
convect the project(Sec.71144,Business and Professions Code:)The Contractor's Li-
wrreLaw ibe:not appy to an owner of pr"pery who Wilds or impross Hereon.and. 106 — SEWER & WATER
who contracts for such projects with a roll senoth 1 licensed pursuant o the Contractor's
License law. 202 — UNDERFLOOR PLUMBING
❑Iamexempt under see. B&PC for thisrason 203 — UNDERFLOOR MECHANICAL
13700.f
m`r Dam 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby affirm under penally of perjury one of the following declarations: 301 — ROUGH PLUMBING
I have and will maintain a Ceriftcam of Consent to sel6iasum for Worker's Camper.
nd.as provided for by Sccuou 371X1 of the labor Cuk,for the performance of the 3 02 — TUB & OR SHOWER
k for which this permit is issued. 303 — ROUGH MECHANICAL
I have and will maintain Worker's Compensation Insurance,as required by Sectio" 304 — ROUGH ELECTRICAL
Ne Labor QWe.for Ne perrormanu of the work for which Nis permit iz issued.Workers o saromlms cec 'er and Pub nam re: 305 — FRAME
rier: m Poke .M 306 — HOLDOWNS
CERTIFICA OF E%EMP I & WO ERS'
COMPENSATION INSURANCE 307 — INSULATION
fTfiis section need mol he completed it to Permit is for one hundred dollars PS l W) 308 — SHEETROCK
aro) 309 — EXTERIOR LATH
employ certify Nat er the in anymance ar the work rmr which Nis Penn it is iamcd,l shaa mm
Lawsoanyikrum in any manner sen as to Mcomc suM1jmun the Wmrkcri Compensation 310 — INTERIOR LATH
Laws umia.vent 311 — SCRATCH COAT
Applicant
NOTICE TO APPLICANT.11,after making this Ccrton.%of of Labor Cod youshould 313 - ROOF NAIL
Oz Mwethcmplywhhsuchp'oCompeorthison pmvitihalofNemedmyoked, mtral 501 — FINAL ELECTRICAL ENERGY
provision:monis Permit snag rte deemed mvukm.
z CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
FI herchy affirm that there is a convection lending agency lir the performance of 503 — FINAL MECHANICAL ENERGY
Ix Ne work for which this permit is issued(Sec.3017.Civ.C.)
u] p LeneerxName 504 — FINAL BUILDING ENERGY
U0Icndcr1readressdyd 505 — FINAL ELECTRICAL
U O I unify Nal 1 have mW Nis application and]some Thal the above information is 506 — GAS TEST
ty F correct.I agree to comply with all city and county nNinanees and role laws relating to
0U building convection,and healthy auN"rim mpmsentatives of this city to cmterupon the 5 FINAL PLUMBING
abnvm-mentioned Property for inspection purposes. Q$ FIN C L
p}s� ggr (We)agree m save,Inde nifY and keep harmless the City of CUMnsts against a.a. /�
i—r 0 liabilitics.judgmcnn,cos¢and which may in any way accrue against said City C, N D l�(/([/
V z in conscyuenc of the gran"m f spermit.
APP IC
NDERSTAN ND WILL COMPLY WITH gLL N -P INT Issued by51 — NG Date
SO RCE ULATIONS. Y
signmutWORKS
naf icanUCo 1 \V 3 Re-roofs
I(AZAR)OUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future building mcupamt store or handle hvardous mnerial
',definer by the Cup)jmar Municipal Core,Chapter 9.12,and the Health and Safety
code,odor zs53z(ay! /� All roofs shall be inspected prior to any roofing material being installed.
Yee p7pJu
Will the applicant or Iuture buildingrxcupanl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hasasdous air contaminants in derined by she Bay Arca Air Quality Management all new materials for inspection.
Diudct7io p
Dvs
Thaw read]the harardas ii-ialsalquircmcnuumk,Chapterfi95ofNcCilifor-
nialicalthASal�lyCtaC,See r 25th)5.n533and25534.lunhrstamllhmifec Wilding
doesn't idly hate a te at it is my resry nsibility m notify the mcupanl N
rewire Lwhichmust 'e'Pnarl of.CerufneiWeavupancy. Signature of Applicant Date
authad.ed agers, D e All roof coverings to be Class "B" or better