02020045 OF
CI BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
6UILDING ADDRESS: PERMIT NO.
02020045
NER'S NAME: APPLICATION SUB DATE
OW
ALI REAL ESTATE PARTNERSHIP 02/12/2002
M PF.IONE: SANITARY NO. CONTROL NO.
O¢Z ARCHITE.CT/ENGINEER:
bise O LNG NFO
m BLDG ELECT PLUMB MECH
U
u u cn u
z y 2 LICENSED CONTRACTOR'S DECLARATION Job Description
z-�, 1 hereby affiem that 1 am licensed under yyr visions of CM1apmr 9l commencing P
rot_u w1 'CCi ]IIOfI)ofDivision3 flbcBusirrtvVandPmfcssionsCWeandmylicense INSTALL ONE ILLUMINATED WALL LETTERS .
¢ce S� is in full fo and cHcn. ✓ / 1
,,-5-
z e< LicenS<CI ss C-'1v Lic,u 1D1� �` �p y /� p
°oI l0 B IA tonna • I B`y7 Psi Bao E
O ARCHITECr'5 DECLARAT
I understand my plans than be used as public record,
y,aXa o L¢cnsd Professional AUG 0 7 2002
uwi o U OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
ria followinguiassn. ermitotocomm,Businersandve,deolihodeAny�inyorccture
BUIL DIN.G_- $4000
E tz-Oo xM1i<h requires a permit m conslmct,alter,improve,demolish,or repair any structure
3 m Pdo lot - als e9 ,h ppl'cant for such perm uo fileangnW sm¢rrrent __ -... -. __ _ _
Nath EIcewd pr-ant to the pray s of the Connectors License Ww(Chapter 9 - -- --'-'-
(cn mg Q Secf 7800) f D on 3 none B"rmerr dna rrqret.onr coam f 'c" Sq FP:Floor Area a M a i. ,.k;ti, Valuation
or mut he s exempt therefrom and,he bass for the allidgcd cxemptlnd Any violation - ''1 ' i�`3 5 917'01-9?'0'0&.. x
-a Section 7031.5 by any applicant for a permit subjects the applicam m a civil penalty
Tor not more man five hundred dollars S5Bn). APN Number :, - Occupancy Type
oLarown«ohne 101 — FOUNDATION I
progeny.ru my employees wits wages az e for
role le(S a.7044.
-will do the work;and'(he'snucture'is'not'imrnded or oHercdfor'sule'(Sec.7044, - ----- _--
Business and-Professions Code:The Contractor's License Law does nor apply,o an Required Inspections'
owner of property who nand,or improves thereon,and who a«r re a wink himself or 10 4 - REBAR
m Throughfor Ms nwf.employee.. Wilding
ildin that stuck improvements are not intended or ANCHOR.--BOLTS----
- ofrcied foi sale:If.however,int diildin-r""�"vemeni is sold within onc- --'-- -"'"-105-- --
'completion,theowner Wimerwfn have theburd not that redid not b'u`imar 304 - ROUGH ELECTRICAli"r'" �•' '' "
improve for pmpc,e of,alc). proving
— — -- —.... ---•--- -..FINAL._ELECTRICAL
❑I;as owner of the progeny,am Business a t I g with I'cenu❑co Contractor
- . .._. ..._...._... ..
nes>wm me project(sea ]Baan Barmen d P r.: lir cone)The commmor a 514 - FINAL PUBLIC WORKS -
License law does not apply to an owner of property who builds or improves Neneon. - <I.
_and who.rontmas for.such pmjees with a commcor(s)liccnsed.purxuam,o Ne. __ - .. .. ._................. ....... .._._ .-
' :. Comwho.c License Law. .. .. ._..._....._..__._._.. ._. . ....... ..... .
Olamexemprurider Ste. ",B&PCfardes..
ae•
WORKER'S COMPENSATION DECLARATION-
_ -1 hereby affirm under penalty of perjury one of the following dedamions:
❑ 1 have and will maintain a Certificae of Consent in self inane for Workers
Compensation, as provided for by Section 37W of the Labor Code, for ,he
- performance of,he work for which this permit is issued
O 1 have and will'mainmin Worker's Compensation'Insurance,as required by Section- .
W f th perfomw 2 f Ne week for which this permit
is
u
ct FI d Policynumber
!
� JCERqTIFlT �/ PolicyN�
rs yf CATIONOE EKEMPINS FROM WORKERS
COMPENSATION INSURANCE" ( l fs2ry`e' •p1 y i.22`G.'�l i.�i •,'
00)orIts scctinri need not be completed if the permit in for one hundred dollars ^r•' ^" -
(SIfiO)or less.) I ' '
1 n fy that,to'hep ffomnarra T Nt wo iicwhich N tis "red l ..._... ..
shall t -PI Y Y pe.t n y m' to to 1.athsubject
t to rhe Workers' c� ,
ComPensi on Lars of Cabforom.Da¢ '
_Applicant
,N01ICE TO APPLICANT If Be k ng,hCenftofExe -
Z become subjecuo the Worker's Compcnedtion Provisions of the Labor Code,ydu must it
ZG forthwith comply with such provisions lir this permit shall be deemed revoked.
r ..
''CONSTRUCTION LENAGENCY•' - ' -' i:.I
CC>> I h ny Frm that them .a' construction lending agency for the performance , It
i..•, of,he o k!r h ch N s a -i issued lS 309] Civ.C) i- `
f2nd riN tar : ..� - .., _ ..,..��.. .... ..... . . ....... . .. .... ._.. I ..
.U'Z Lenders Address - _ .. ..- ..... .♦ . h_. ..-. _.. .. .._. _ _ ... ..
,-I rend,Nat I have read Nis application and std
;a- ¢Net the above information is
['r wren.d agree to comply with all city'ana county each
rances and state laws relating
O;V to building construction.and hembti cathodic reprexnta,ives of this city me mer upon
y-W Ne abose-memionrel property for inspection purpose,
IW agree) am 'if,and kph IesNeCty'fCpenno against
-Vj llabilf jdg is L ❑ pc xs ahch,rrwy' anywy rue.egainxl said
C,2 Z Airy s 9 ice th g of g f Nis Pc , " ^
Ape (CANT UND "TANDS W'Lf COMPLY WTTH'ALL N N:POINT '' 1 V
S Itce'RecuL I - Issued by: Date
Z OZ
•gnat fAppl can(A- t I .. ,' Da_ Re-roofs
,, HAZARDOUS MATERIALS DISCLOSUREr j-
wuth ppplcant 61 future buildirgce pearaidert
handle.1 def ed by the Captions.M1CoeCp9.12 hioM us ¢naL Type of Roof .
- • +- - - - .....Cade 5532(a), a d H d Safety
- --
- [ •)' - 1 N!rr - •- -- -
0 Yet,
t I +r r+p? ( 1
-- , . ` ' ° All_roofs shall be mspec[eI prior[o.any roofing.matenal being Installed. _ _
wnmsapplicant
irt � tat rcwla g p,, AcoAise equipment or devices meIf a roof is installed without first obtaining an inspection,-I agree to'remove
minnazartlous tormentors as df ed byN ByA q Quality Management
':matloyinio _ _ all new materials for inspection. Applicant understands and will comply with
i{!dL "al] non-point sourcetegulations,:,, :; ,
1 h elread ihe'haiaN m to Is req mmenis and Chap,r 695 of the '
California Health&Safen Code Sections 25505 25533 and 25534.I understand than
ocamG1 building❑ces mol currently navcaren'vnl.Nat ii is my rcspgnsibilirymnfir eche _
Occulit Rh regdi m , hah mtysi be mCi p to'ssua c of Ca an of --- - -
W y
fD oZ Signature of Applicant Date
...man or ., Dula„ All roof coverings to be Class "B"or better
,i y _ _. . OFFICE .. ._... . . .. . .. .._-.. .... ._