02080070I
CIBUILDINGOFUOPERTONNO
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT N0,
10142 DENISON AV
02080070
C8i5F T8NG NGUYEN
APPLICATION SUB DA
OS/14�2002
PHONE:
SANITARY NO. CONTROL NO.
Z0 ARCHITECDENGINEER: a
BUILDING PERMIT INFO
BLDG ELECT PLU,'NB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that I am licensed under provisions of Chapter 9 (commencing
RE P I PE p
ed wish Section 7000) of Division 3 of the Business and Profession Code. and my license
is in full force and effect.
License Class Lie. x
Dare Contractor
h ARCHITECI"S DECLARATION
g 1 moderation my plans shell be Mail as public records
OLicensed Profeasnuml
Mex OWNER -BUILDER DECLARATION
1 hereby affimt into I ano Comp from rhe Conoactor's License Law for the
a following mann. (Section 7031.5. Business and Professions Code: Any city or county
$2500
o which requires a Permit to Construct. alter, improve, demolish, or repair any swewre
m ._prior to its issumme, also requires the applicam for such pnmitto file a signed statement -
'f 31S@21 eAc[Pr'pr..vs -Fs
ValUatlOn
- that h<9GgwitPat. tpIlk iiiision thehe
License'Inwons
Sectio 00) of
(Commencing with Section ]000 f Division l of the Buziva d Professions Cale)
Business Cor)
i t,l, i . e •t, 1.. g i,, _.
M Natio a Comby thcmfrom and the baso for the alleged excnfpdon. Any violation
of Section 7031.5 by any applicant for a Pmvt wDjttn Ne applicant ro a civil penaln
'
of no, Marc than me hundred ennars(S5001.
202AP-I`1I31QLIRRFLOOR PL
BING' Occupancy Type
❑ I. as owner or the property. or myemploy«, with wages as their salt, enmpenwrnn,
301 - ROUGH PLUMBING'
d s he Professions Code: The is not Contractor's License Law Jors not apply man
Baiine'NewerrtandthCode: TeContrmteMeeronse Low toes ale apply to an
502 - FINAL Pl�ylap�Trijg' 1-)RC3Ywill
-
er r of proper Who Weds or improves thereon, and who does such work himself
507 - F I NAL PLUMBING
or through his own employees. Provided that h' provcm t. rc of intendedyear or
__or
creel for
for sale If hu hetDuilthrig u P oanti IJ N'n one'year or
completion. Neowneobuilderwil)have the burden ofpmving thorhedidnot builder
improve for purpose of ',leer
• t 1, sus ownerrnl the proper, am eulusively conmectin6 with licensed convacmrs to
---------�----_--,_;'_:'-..' _ '." _- "'
'" r
comer (Sec. 7616, Business and PreProperty
Cade:) The ConnectorChemo
Li Law does n whom
'r License Law Vas nor apply m an owner of property who Wilds or improves thereon. .
L s .u^ ` •'
] _and,wbocemrans(oasuch.pmjeca with.a.covtrddvr(sl licevad punuant.wNe.._..._..__..-_..__.._._._._��.9
'- Conuanor's
�pp p g .-_
V�6�+Y &:71=.I�. __-_.___-.--,_------
Liccnsc Law.�,r
C)
C) f am exempt under Sec: '�' ")i `�',B &P C for his reason
n�
r.:fit �. i•.'v. �1;!(itY:
D ner GU o' C,:.' :t4� zed
ADE
AUG 2 6 2002
ORK 5 COMPEN RATIO
Thereby affirm anpenalty of perjury one of Ne. following declarations:
p l Wv2sena will maimaid a Genifi<atebf Consent to self -insure for Worker's
BUILDING
_ Compensation, as provided for by Section 3700 of the Labor Code, -for the
prformance of rhe work fur which this permit is issued. .
_ ❑ I nave and will mainiain worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is
1 issued. My Workers, CempCnarhmr Insuracamy num er a'
Insurance Line, and Wife nre:
r.. ...r.. -...
,
....-....r
Cau'II_ifh si
FlCATINOPol Policy
OXEMPTION PROMWLORK,-E,R.
_ _ -
'1 o-) "13 0 ,..
S
COMPENSATION INSURANCE .L -
" GThii'sectimi need'noilvoms lemU ifrhe
D permit is for one hundad Jolles
'.� '. " i.r'i n.•. ...' .a:L.':';.L•`.---_______. ..-_..
(EI001 MIC".)
,
I en fYln r in the performance f the we& for which N Permit is issued. 1
n t PI Y try,P a Y fm+llttAA ba -oma r i rh Wo
any,
-1t •1 `- '- '"
COP r
C. 1 jQptTJ"
APPI cam. tirf�
...... __... __.-.
N I TO APPLIC If r Makingme Cert t fE Exemption, y should
-bl
Dec ct the rk Oise . t p runs of th Later Cod you most
fon
wM comply with uch p is. o, thou Permit shall ye deemed mvolmd.
-CONSTRUCf10NLENDINGAGENCY
1 hereby aRrm that there isiter nswction lending agency for the perfortnvnce
• I,
of N work for Which N permit is issded 15ea7097,
: -Lend Nme... .. �..__- ...._�. -..... _:_ ._..
: Lender's Address
. I certify that I have read this application and state that the above information is
. crumm. I agree to comply with all city and county ordinances and state laws relating?
l
and
to Wilding cr fP nhby ace representativesof this city to trupon
the b t d papurposes
_
(We) agreei ndem fy d keep h less d City f C pert against
a.
liabilities,judgments. t d expenses which may m any y ccrugainst said
Cityiconsequence of rhe granting of t
APPLCANT UNDERSTANDS AND WILLCOMPLY WITH ALI \ON VI'
POI
s 1RCF .rv.,r• s �,_ ..
'SS
Issued by; Date
�9
\S/gnaw fAppl' oeentncmr. .' t; ... -. (Pan ".
.J4 HAZARDOUS MATERIALS DISCLOSURE .
Re roofs
.i iii Chea ream or fnmre bildingoccupant store or handle hamrdom mmcdid
Type of Roof,
as d fvrcd by the C peat Municipal Cad Ch me 9 13 dib Health d Safety
Cod Sttu n 3553 Ot t�No' i i'. -. h t
❑Y
r+, x J[i it Ctrs. ';
1
All-shallbe inspected roofing being. installed.
-Will theapplicanto prom building _eequipment devices wnch
,e it ha d om a defined by live Bay Area A Q I Management
pnor.to_any material.
If a roof is installed .4ith6ut first obtaining an inspectton;'I'ag nee to remove
ry
°iS " OY �N -
_
all new materials for inspection., Applicant understands and will cote 1 with
PY..�...
'
.._.
all'non-point sourceregulaUons..
•
- 1h a 'end 'he of the
tet alp rcq.25533muW Chapterunderstand
,
Safetyand si.I donoridthat
Cahf comingHealthosof Cud . Sect oneant,tht
iftheWilofseoesmm�stats ly itis responsibility rofica the
occupant of the requirements which moil be met pnono issuance of a C<nifica¢ of
which URtoL CIimismYssuanc
Occupancy.", A ' l�
�1"ignature of Applicant -Date
-__ -.
All roof coverings to be Class "B" or better .If
, Da
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