02040050CI BUILDI
CONTRACTOR INFORMATION:
G DIVIISIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
•
10601 DE ANZA BLVD
02040050
OWNER'S NAME:
APPLICATION SUB DATE
ORVICK MGT. GROUP
04/11/2002
PHONE:
SANITARY NO. CONTROL NO.
M O
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MF.CH
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LICENSED CONTRACTOR'S DECLARATION
Job Descri Elia
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1 hereby affirm that 1 ata licensctl under provisions or Chaprer 9l commencing
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wiIhScxnka700C)ofomixmr3.fheBvxiaxanaPmt�fexxmnxcod. amrhanxe
in full fo a and elf
REROOF.
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License ( ysr O O
iLLy
Dv`, ,�F „7 Course
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FO p`pp A 9+aE 93
l� ARCHITECT'Sourse I .
1 understand my plain shall be used as public records
En o
MAY 0 9 2002
Licensed Professional
OWNER -BUILDER DECLARATION
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I hereby oRnn that 1 am exempt from the Crnoeam's License Law tontine
foll031.5. ss nd
whohrequiisa(saction]omaraBusiter,mprove.demolih.orAnycityincrease
which requires a pemut otter, improves demolish, repay any stmmure
$41000
BUILDING
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peso mssa req file
ex count due
e Permit mimna twlwtemem
Fa -p>, f -f
t_41 t Vi3.S�1t#'C���.�lgr
Valuation
pass
6 pmeisiscantfhc Cohmctoe
that he slnnxdp nue a shop s sof the Commnols Llecnu law (Chapode)
amm enc g 'm=eet ]oaf) rD
.trn3rrmel;v=ines:�ndnor�xtonxerae)
or that he is exempt iherermm v ul the basis far the alleged eegnismil. Any violation
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-ofSection 7031.5 by any applicant for v permit subjects the applicant v civil penalty
of not mom than five hundred dollars S500).
3 0 APN I�ir l elE
�; . �;.m '..t Occupancy Type
0I, as owner of the progeny, or my employees with wages as their sole compensation,
ATTQN
will do the world'and the stmcture'is not ntenaed-or offered'for -sale (Sec: -9W4;'
- -
601 - ROOF TEA EZgk iF Inspections-
'Busials and'Prom,,ions Code: The Contractor's Licensee Law does aro apply to an
or r of propcny who builds or improves nceaon, and who does such work himself
through
rraredfbaaown gmmdorsuch sure act on-iycdpr
NAIL
haweveemployees. rimprovements
scoured for sale' If howe a the building ave mpro t Id 'amain one yea of
compleuon,Ih<owneobuilJerwillhmeth burden rrprovingthat lredid artbuild or
_ _____6.0.2_.-_ROOF._PLYWOOD. - - - -' - -- - -
603 - ROOF BATTENS ' " •''-"''
impmee farpurpnxafxale).
—
604 - ROOF IN -PROGRESS
_ _ -_ - __... .- - - - ---..
CLax oxner rfrhe PropcnY•amadusivdy commcting with licrnsWcontmnors to
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construct tM1c pmjea (Sec. 70a4, Business and Professions Code) The Contractor's
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-
License Law does not apply to an owner of pmpcny who builds or improves thereon,
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_and.who.crnlructs for -such projectx.with.a summations) licensed.pursvant. to. the
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Conotomi's LicenseLaw.. .. -,
❑ I am exempt under Sed.'"',"s"''I`b" B& P C for this mason
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O'ner baa"' '
- WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perully or perjury one of the. fallowing declarations:
❑ 1 have and will maintain v'Ccnificate'of Conant to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Izbor Code, for the
'performance
_
of the work for which this permit is issued.
-
❑ 1 have andwillmaintain Workers Comperivtion Insurance, as required by Section
3700 of the tabor Code, for the perfoiisunce of the work for which this Permit is
-
O a Co pc t Insurance carrier and Pul ry n be '
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Yl CLR :IC ]ON OF PTANO ,
WORKERS.. -r .,. _...-_.
" _ _NSR" '
f... _ATIONIINSURANCE
_.....-'COMPE(this
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icndo need not Ee completed if the permit is for one hundred dollars
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($100)or less)
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I n fy.th in the ycrfo a f the k'f hich th pc t s ixsu d 1'
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Cashorn nest employany
n person m any manner, w as m become xublen to Ne Workers'
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Compensation tawsws o(Califdmiv: Drum a.'
NOAppcant
I ICE 10 APPLICANT. IP after makingtM1 Cerfificam ofExemption yo should
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'' ' e you took,
forth
nh ply with such pions or thispermit t shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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1 h shy Rrm th s =here x a cowa on Icnding'agcncy! rhe perfdrriunce
'ooteonde
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kf hath th p u' ued (S 309] C¢C)
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- LName . ,.., .. .. ' ... ,...:,. :.:. .
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Lender'I Addrcsx -.
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s I cenify that I have read this application and state that the above information is
coven. I.agae to and
comply with all city county, ordinances and state laws relining
m building comarvnian, and heniby autliodi.e'repritmidatives of tbii city to corer upon
the abovementioned property for inspection purposes.
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(We) egae t'o save; indemnify and kttp harmless the City of Cdpeniho against
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liabilities, judgments. ca=rs and expenses which may in any way we against said
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ucn
Cityconsequence/�(th gam g p nIt
AP3'LICA tDE)P
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ANDS T CO PLY WITH ALLNO `01 "'
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Issued by: Date
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AZ RDOUS MATERIALS DISCLOSURE I
Re -roofs
:' ` Will the -cam f raild g occ pat or handle hazardou mvre'al
re W51tv
- Type of Roof
m def ed by th penO n Municipal CodeCb pie 9.12. and th Health d Safety
.
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Code S t 2551 t `�"
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-All roofs shall.be inspected prior io any roofing material being Installed.
Y H'douall itapplicant future ibuilding bytheoccupant eequipmentaAard vet
n hazard coin I defined b) the Bay A A Q I ty management
If a roof is installed without first obtaining Ira inspect3om'IlagreetOr remove
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all new materials for'nspection. Applicant understands and will comply, with
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all non -point sou r gulations —
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I have read the h..Mo a materials requ remend and Ch.pacer 6.95 of Ne,
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CaliPomla Health &safer Code Seolons 25505: 25533 and 25534. 1 understand that
tort' rem hi h p rte( usua�
if the hald chat tly h' a ¢n ha t rryy resp biF'�"
evve,
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_ Signature of App ant Date
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All roof coverings to be Class "B" or, better
1 note en '