02060002 CI BUILDI G D1V�'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
1451 S DE ANZA BLVD TONY CONSTRUCTION CO 02060002
OWNER'S NAME: APPLICATION SUB DATE
r.ISIA CHOU INC/JACK IN THE BOX 444 LAUREL ST 06/03/2002'
r J-
PHONE: SANITARY NO. CONTROL NO.
(415) 345-8881
00 ARCHITECDENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
y i LICENSED CONTRACTOR'S DECLARATION
00
Z�n I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing .lob Description
with Section 0000)of Division J of the Business and Professions Code.and my license REMODEL RESTROOM/ADA REQ
Mis in full force and effect.
dou License Class Lic. REMODEL DINING AREA
Date Contractor
a 0 ARCHITECI"S DECLARATION
r g I un icround my plans shall be used as public reoords
as
O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby a8iw that 1 am exempt from theContractor's License Law for the
(_?C following reason.(Section]OJ 1.5,Business and Professions Code:Any city a county
which requires a permit to conawm,War,improve,demolish,or repab any swemm
prior se its issuance,also requires the applicant for touch pemut to file,a signed statement - -__-- - .-.-_.-- -_-- -
tlYt Ik is li¢nbd punwnt to the pmvixwm of the Contrxwls Littnx law IChepta 9
S :Ft Floor Q�aa a nation
onampancingivit Sectiae�]Wlll;uf Division Jof the Busyte�eed Pwfwions Code) ���``A (•, Sq Ft
in.7.a'l 1t1 VF{9r lit 1f .�
or Nal h le eiesu t the rtdtem aha the basis for Ne alliged preemption.My violation
-of Serums 7031:3 by arty applicans for a permit subjects the applicant his civil pesdty-
Wnon.mmRthan five hundred dollars(S5B0). umber ;rmmr\'n Occupancy Type
111.as owner of the property,or my employees with wages as their role compensation,
-wilydi th ud I'm:'and the structure Is not Intended easeorofferedLaw doessale'(S lily to 4;' -
rBhslnes ro arty Who
Code The Contractor'sthereon.
License Law d«°h work utility m an 501 - FINAL EL Q1Y2SGt$ RGY+" °
owner ofproperty buildsormprovaNeuchIandwhod«stechwinkhimself 505 - FINAL ELECTRICAL
or through h' own however,
employees,provided that such improvements.not attended r
;9Qere0 fo '1:IC ho oval,the Wilding-or imPiovemenl a smlJ wuh n'oney er of--�-""` -------_... ------- .. _ __._ __.--------
'completion,the owner-bWild will have the burden of proving that he did not Id or
imp a for purpsne of sale.).
__......_.__._p____.__.__—_eontow_._..._..__..____.._-m-to- _.___._...___.__....._._._._._._...-�...____.._.._.._____
as gwner m(Ne PropenY.am exduxivelY contsaciing with licensed cmntiutors to W.my�A�Hi++!`a6II':
v
construct the project(Sac.]1144,Business and Professions Code:)The Comncwr'a
Licenu law d«s no apply to an owner of property who builds or improves thereon. '
-and_who.canwcu.for such projau.wiN.e.contxacws(sj licanded.purswm.w.th--_.__.--_..._._._._.._____. ...___._.._.__.__.____L_ -
"' s Consomme.License Law.. ('n\t r.�!.n� A
'p under sce:— ''rri(t `?•'B'A PC for is reason IOI7 VC�CCI_pl ,T
Glom aacmi
WORKtR'S COMP N DECLARATION
BUILDING
I hub affirm under
Y prat:*!!ofperjuryoiie,ofsllafollowing dalamtiom:'
`L •- �` ❑ I hove add will'ivmaidi e'C�nificaie'bFCon4ns'io self-imuR for Worker's
=i Compenaetian;-.a„Providedfor by Section 3700 of the labor Code,-f« she
- _ _ performaece'ef the woh for y�hich Nis peRmLL is tuned..i i
❑1 have Led will time'to Worker's Campos non 1 survnce al tequiRE by imion
3]00 Pifie'Lebor'Cde for th peifoim ce df the'work f"' h¢h this pendit^is
sued My Wo kh s'Cmmpen ni qn 1 ranee tamer end Polley numh arcT':.v
Camertl i}n f '.n{'YP}•r Pol ay Nor -..`:: s `, r ) y J F 1 Ji-(1 NI 9 Y i ffl llrtt 011
hIt°rIi+CHRTI ATION OP BXBMPf10N ROM.WOR �- 'l L.k� 3- ,',. I �.�_Id. Y.5M11 31.2111 n.T,Y is lti'I.
t<'LlI17hu udibn need not be edmplmd iRhe permit is for one hundred doll. I71nl,;, NI'A; i7C�li�JaC� iVih:
(1100)orlas.)
'Ion o'1'ttn( slut l'n Ne perfAml9iiSe or she woh foiwhich thio peenpus laud,l I(.(;, Iii ,i).(+l y `st, ,.'.I +i-— - _ _—
shall linl amp oy my parse in nny manner d as is bi<osne sub)ai to the'Woheta -'
Com nation -
Baxrd
NOTICB TO APPLICANT:es Cox making this C tuir cm te of Exemption,you ihould 3•.i T iia: +v::
Ob&umehearittythe suchpi Groans rt his perimitiomll Ne Lebon Cade,d. tens
fontiwith'mmply with such provisions or this permit shall h dated Rvokd.
Z • .__._.__
Lt❑L•i:f4 '1 '..InT" e 0. "CONSTRUCTION LENDING AGENCY ,i.l t('`pgl is I`:Pe
xl hkrcby of ost that the i c on nstxua, tending agency for the perfomwlce 1. I I f'i •0 \I\1
G�il• 4the work forwhich tho perms is issued(Ser 3097 C
nder a Addrca' ., „T Il
cis 1 candy ilii 1 have teed 41 s applicat o and stem Nat the above information is
Tbuil 1 agree tq comply he all iryand ounassir n vas;-and state laws relating
io above-mentioned
bove- entionedThIpndhercbYauthmnmuposeetAtives of Nie city to enter upon
(� ihopbove n e hie,o p pony rte inspectionake purposes.,
0:1 (We)ugmetaxsate indemnify roil kehihma lionweofcruengainst aid
F•I'fA
liabilities,in c .q.a nu, «u and expenses which may n any ay accrue against t said
U � Cit m conseq nee of the gra t ng of thispe It ”
I.I�NT U{YUBRSf�Y )ND W(LL DMPLY tHIALL.I.r[WSPGNT
A uNC RCOULAT1oN5t // Issued by: r Date
JQL
t rlsmccnlConnese "Done Re-roofs
i s HALVI DOUS''MATERIALS DISCLOSURE i t r
'Will Ne appluzm in ftuRbmldingoceupatu More 6,wtalahaindoas material Type Of Roof_-
Is kiind by thCupemno Murucipal Code Chaptex 9.12.ad the Health and Wary ]l a - 7""
, '--•T -�s�i:IU(:tl.s:i• J -- _-"
Code $m en 25531a)C{til P ' z-I �I +.. I i }- s1`" I-e.l liv !.t't:il 5 ,3
ova Allsoofs shalI.be ms ected. nor_to.an roofin material bein installed.,—.-----
v,!. _,._
f( t7 No r,Ai w P. P Y g- lea
Wll the appbunt nota building boccupant y
eeia Air
nor lity deviceswhichIfaroof is installedlaith'outfirst obtaining an'inspectiori;l'agred-to remove
i cl?,d;us air comamirm- ni d'definer!by th B y'Aiaa A Quality Manegen.1
Dix Yea pN' all new materials for inspection Applicant understands and will comply with
h t r d all-non tet 'source re ulanons . .
e r _ 5 Y rW P Po g I..,. 'gt'il i np
Iosco enilof g not cumentl h e e tens t that it q m res n+tb Ino w no of the
a
I
I neve R � P
ad tb haxartlous materials mrcmcbB under Che ler 693
1', I ctions PS505255J3 and 255J41.underswnd ilial .. .-.^_.-.-,.,... ._.... .. _. __... ... _ .y. Po Y lifYjhe ... ... .; 1` 11 a i. ._..
_p n Y l man be met p b tb a,wnce of a Cc Monte of
_ P lc uv mem which 1-
Callf mi Health&Safd rile se 2 Signature of Applicant Date
Goeu e a
9,
-�. - OZ.._ _ _. _. .. .. . ._.. _._.
' Ow rm i11�. .ant ate- All roof coverings to be Class 13or better
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