02030049 CI Y OFhCUnPERTTIINO CONTRACTOR INFORMAT196
PERMIT Ail
BUILDING ADDRESS: PERMIT NO.
929 FERNGROVE DR 02030049
WNFI S NAME: APPLICATION SUB DATE
?SIU FENG WANG 03/13/2002
;dUNE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
z BLDG ELECT PLUMB MECH
SZ LICENSED CONTRACTOR'S DECLARATION Job Description
O I hereby aRrm mm 1 am licensed under provisions of Chapmr 9(commencing Q"FP47RL 13
with fall Section7(g)(0)effect. 3 of tire Business and Prufesiom Code.and mylicense MASTER EL
in tap force and err"a.
z m u
is
Class Lie.tr
o Dale enmamnr
i 3 0 G ARCHITECTS DECLARATION NOV 1 0 2999
u 1 understand my laps shall he used m publ'c re 0Mx
r ax G O Licensed Pro(essio
wce h , 'RBUILDERC TIO' �'�®'��
I hereby affirm mat 1 am exempt from,he Contac r s cense Law for the
t? following mason.(Butson]011 5,Business and Professions mei$ny city mcounty $10000
E€o which q p n construct. It 'mpm e d I h p y t ,m V
n 3 poort u e 1 q thef such pe 'u file signed t t mem - �`p� pp�a p q�@� _ .._..... .. ._. .
that dpursuant theprovisionsof Ln Contractors Ln La (Ck pm
r9 r„ ,a,.35.9�J''1+.L 0�,-jU;V ry.4
Ro g, id,Section 7000) ID-.i 3ofth B as ndl f Code) ±�r'1 9 J .LO -jU:V pd y�bjvs Valuation
or Chet he is exempt m<refron and the huS.a for the alleged exemption.Any victr sup -
-°f$eninnQ031.3 by any,apPlieam far a permit subjec,v the aPPlicumcivil penuhy
or not:nare than five hundred dolHr:($500). 10etPN 'il" jjfifDATION ' ' Occupancy Type
❑Las owner°fine propenpmtar employees Latta.......their sole compensa cah, ing _
will do the work,and'tne swcmre is not intended or uttered for late(Sec.T)U, -
Business and Professions Code:The Contractor's License Law does not apply to an 103 — UFER Required Inspections ''
of Pmpcny who wile,m imp r..a,thereon,dad xen does such work hiredf 10 4 — REBAR
---a'
or through his own employees,ca [Oddi.that such improvements ici s0 arcwi not intended or
c c,le for tale.If.hbwevcr, Lai l have
ng p tit n soW with n one year of -' - '- -- - LT - - — - ----
imnpl<e°n.the nwner nu la<rwnna,em burden rnrnving mat bedid not build or 105 — ANCHOR BOLTS - ��� t- , � .. .0
mprove fprpm,m's"rsale.). 106 - SEWER & WATER
_-
El 1,as owner of the property,ant exclusively,contracting with licensed conbee toPLUMBING-
IV,
-- - —-- - - -
m,"Oult me project(sec.70aa.B"smess and Profwsmn,Cnde:)The Contramor's 2 0 2 - UNDERFLOOR'"PLUMB IMG_.._-,:.,:
License Law does not apply to an owner of property who wilds or impmvex thereon, 203 - UNDERFLOOR MECHANICAL "-';
,soil who comracts for such projcem.wi,h a examucim(s)licensed pursuem.to.me,
Coronations License Law. - -204- -._UNDERFLOOR- FRAME - --- _..--
Olamexcmp,order scc. ,B&PCfor-this option 205 - UNDERFLOOR INSULATION
*am,'
°"` 301 - ROUGH PLUMBING
WORIG SCOMPENSATIONDECLARATION 302 - TUB & OR SHOWER
Ihereby arr made,r<nahy,m' Ijuty one of'he following deelamtlonso 303 — ROUGH MECHANICAL
I nave ane ,vin mains,I Cdnm<me ar Coasen,to self-insuce far Worker'. 3 04 - ROUGH ELECTRICAL
mpensation, as provided for by section 37M of the Labor Code, for the
- perrummnce°rate work for whim this permi,is issued. 305 — FRAME
- - ❑1 hme and will maintain Worker's Compensation Insurance,as required by section
306 - HOEDOWNS
37W of he Labor Cnde;tar me performancq of the work for whim this peordt is 307 — INSULATION
Lassoed:My Worker's Compensatmm
ion lnnce carriernu
and Policy mber die: "
a_
La ,:r s 'Policy No.. 308 SHE TROCK _
$,.... ,
o CERTIFlCACOM ONCOMPENSATION
EXEMPTIONNSURANCE% RKEto J' y I' '
r'
. 309- -� EXTERIOR"LLATH�
.... :. COMPENSATION INSURANCE` .. . . ,., —__'3 1 0� •.INTERIOR 'LATH. , . .
ITh aeon he'd of be completed if the permit is for one hundred dollars ,
311 - SCRATCH COAT '
1c<nfy that in the xfLm c 7th work forwhich this pe.it is issued..) `.3.13 .- 'ROOF'NAIL--`.
shill ,e plyariyPerson in anya $oast wcomesubject tothe Workers 501 - FINAL ELECTRICAli''BNERGY
Compcnsat on Laws of C lifoma Damnne - -
"P""""'
_ 502 - FINAL--PLUMBING- ENERGY
NOTICE TO APPLICANT,If,after making this Certificate of Exemption.You should --' ---- — -- --
becomesubjecttotheWorkersCompensationprovisionsoftheLaborCade,you moist 503 - FINAL MECHANICAL' ENERGY -
Q _ p cd revoked.
ply with ro o s or th permit hall be d
504 ..FINAL .BUILDING ENERGY
r ff.'but n LENDING AGENCY - ----
on t
F v . CONSTRUCTION 505 - FINAL ELECTRICAL
he by r .tan I dnB Bcn y In the pe f riria 'e
uarF lvme-'which ta tis Lssae.,,is Saw Co,c.) 506 - GAS TEST � '
a
... . .. ..- --- `-.
:;)-z
Lendc Add � �� ..
507 - FINAL PLUMBING
�-Q 1 amify that l ha ve a ad this vpphcaiton and smm,hat III eshone information Ls 508 - FINAL MECHANICAL �;-
Q:(JE., coated agree to comply with all city and county ordinances and.tore laws mlating 509 - FINAL GRADE
mbuilding constLtiaion:aLiJ hemEy aunhurisapmunta,fives of this city to enter upon '
theabo w 510 - FINAL PLANNING
t::41.1 (N')39 i wove ndf fya dk yh° 1.s me ctr ofc peri oigainw .
rn Iiabill a,judgmusams.cnu andexpense'wn ny- anYway .,.in,,said 514 — FINA
Z City PU IC WORKS
V consequence of th g i g fm's'pc t ,
APLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N TONT"" 1 {f
REGUT 'ON"
Issued by: Date C/
3—(3^
Sig at rp,of pn m`C mor'^i,.�. .,,. . :...' - teas Re-roofs
HAZ RD 5 MATERIALS DISCLOSURE
�0 W1Is a"I an,a Ilding occupant tom oatiandl hararoo matminl
a:aernee
Is
,.pen M leme Cheats,9.1z am Health nes rets - Type of Roof
Codd Sccuo zss3z(ay'.
All roofs shall be mspec[ed poor to.any roofing material being installed. _
-Will the inc_ t°rrnmrcwildinfirsol v , .ce.Aict? r t ee an nm If a roof Is installed without firs[obtaining an inspecuon',-I agree to'remove
nit haz tlo ohm ria is .d f ed by m B y Arca A: Quality Managemrn, g
CalDisti all non- oftit source regulations. derstands and will comply with
all new materials for inspection Applicant un
1h email m,. t p .. _ 'N .. .
Dy",
'h d ions)$ q re and25 ch 6,95 fine
Tom Health Safety Codi,Sect ons 25505 t itis and 75534 d ndef tad mat
'f thebmldngdcequire eptly hnveamna Lmatnnmy rcsponxib loty to notify the
«cupam of the requirements which must be met prior m issuance of a Cenificate of0.
ry Signature of Applicant Date
°wmian
go ag - Dale AI] roof coverings to be Class `B"or better
OFFICE'