01120096 CITY UILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10626 FLORA VISTA AVE 01120096
OWNER'S NAME: APPLICATION SUB DATE
KRIS REDDY 12/27/2001
PHONE: SANITARY NO. CONTROL NO.
µOO
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
&0— BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z 5 N? Job Description
O Z`—'0 1 hereby(d IT that i and.3licensed under previsions of Chapter,and
kibm"
F=�� with Section]000)of Di " Sof the Business and Professions Code, era my b«axe HEATER & A/C
pmg ` 'son full fo cmd cfjyt.
z of¢ Licentt pI)s .�_p� _ Lie.b
°'O a L' Date A ��/ <ua-L Contractor -
O fn ARCHITECT'S DECLA A C
F— -t 1 undc'mnd my plans shall be used as pubo c records
ddar
d o O Licensed Pmfesai...I
n OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
F 3< nstruct
following reason.(Section]031.5.Business and Professions Code:Any city or county $5500
' � which requires a permit to co .al¢c w
improve,demolish,or repair any se are
u°•jR priorto its issuance.also requires the applicant for such permit to file a signed statement.
n 3= that he is licensed pursgent to the provisions of the Commerce,License Law(Chapter 9 _ _
-, c�s,.g� `Nor,j�('ea- Valuation
(commencing wuh Secentfro00)ofe basis
oof the thealeged csand Professions Code) L ,}'yY3',2'O V' u:3o .'V Vi 1} nF I `"
or that io is 31.5 t zany aeom and the bas's for the alleged the
cap
p g tpam.Any violation
of Section by eery opPlicanl for a permit subjects the applicant to a civil penalty'
of.nol mare Nan five handrel dollars ls5001. 301 Al"Nibbft PLUM13IN Occupancy Type
Cl 1,as owner of the progeny,or my employees with wages us their sole compensation,
-will do Ne work;and the structure is not intended or ofered for sal,(See:70M 303 - - ----
Business and Professions Code:The Contractor's License Law does not apply to an 304 - ROUGH ELt'E9 ke4 d9*ppetions '• ' '- '
.nor of p pony Who builds p v. the e n and who due,such weak himself
or throughh' ply provided that sn improvements am ofintended or .__ 5.05_--_F.INAL,-ELECTRICAL... _.. _
off-'df- -le If.however.thetidd' g p mentis i .-Id thin oneyarof -
q
o pl urise c owner-budder will have the burden of pmvi g N t h aid not build or 7 — FINAL PLUMBING
improve for purpose or sale.). 508 — FINAL MECHANICAL
L3 1.as pwnerof the ro n _ ._,..__. - ._ _. .__ ._.. ..___...... .... ___ _ ____ ......_.._.._
p pe y,am exclusively commdmg with licensedo Contract.,
to I^.,
_ License he present face.](is,Bas s and Professions Code)The Contractor's
and we Law does not apply man owner of property who builds seimproves thereon.
..and --
Commences
Liven.forsuch Prolene wird a commemr(s).licenud.pursuam m.Ne_ ____ __ ___ ___ __ .., _ _
Cot t e L cense Law,
❑1 ame creptm1cr5 s• B&PCfar thsrcasonOwner
)'v • /
WORKERS COMPENSATION DECLARATION
;. 1 hereby if nto under penalty of pebury one Nitro following declmauons:--
S O 1 have unit hill Cert Cenof Consent to self-intro for Worker's
Compensation-asprovided for by Section 37W of the Labor Code,-for the
Ijimformance'or Nc work farwhich this permit is issued.
01 have and will mainmim woiko's Compensation Insurance.as required by Section
- 37W of the Labor Coda for the performance of the work for which this permit is
issued.MyW k,r',C p Invu //77r and Poi y h are
t C OFECE\IPTION FIOMWO(RK� t^) ` - t- .r 'o51
"COMPENSATION INSURAM10E^'.,, .:. ...�' ._......__..._...__.,-...__._.....__ ____------_._...__._...._._._ -------
(This
is sceiion'n .... dollars
.,_
' ,.., ( end not be complaed if the tis for one hundred Aollars
Th permi
lS I W)or less.)
1ri fy that in Ne perfamiance of or
he wk for xhl h hispermits xaaw r
... .._.
shall dot employ any person in any manner so as to become object no theWorkers
Compensation Lows of Califon in Date
..Applicant
NOTICE TO APPLICANT If.after makr,gthsC nificamot Exemption,you Would
Z become kubjentthe worker's Compcnsauon pronsions of th<Wbor Code,you must
Q O forthwith comply with such provisions or this permit.shall be deemed revoked.
._ .. . __.. . .._ __-.. __, __ _ .. _
.._. ._.. .___ - -___._. . .__.- ....
:F ti -•( CONSONLENDING AGENCY - ia
a, I hereby ffm rthat there sso c .t n . ding agency for the performance t
r.
of the..,it for which this pcm issued sed(Sec.309J.Civ.C.1
L '
"Lender's Name. - __ m _. . .. ...._:
%D Z fender's Addrcu.
.Q correct.
certify that I have read this application and state that the above information is
E. rmet.I agree to comply with all city,and county ordinances and state laws relating
3q (, to building co®vuaion.and hereby achorim representatives of this city to enter upon
} (i the above-mentioned pmpeny for inspection pur,ost,
F„ d (Wc)ages,mi sole:indemnify and keep harmless the Ciiyot Cupenirio against
rn liabilities,judgmem.v.costs and expenses which may in any way acme against said
v_z Clry'nc qucnce of the gdartin,of do,p it.- - r
'AI l LIC1 NDENSTANDS WILL COMPLY WITH ALL NON=
POINT'"
so k LATIG . ,./L_ Issued b
�' �'``.'/ 2`7 .v/ Y Date -
7gnn! fApplcanvc t mr - .. - -- Date. Re-roofs •/
u HAZARDOUS MATERIALS DISCLOSURE
wore -ppuum rt ebtmng np t.treoin meha:Nxltledm' ......Type.ofRoof. -{�._,. ; .,: U, ...
as defined by th C p '
e no Municipal Cod Chapter 9.12,and Nalth e Heand Safety
.-
^
can.,Section 255320 s s ,< R r•-
All roofs shall be mspec[ed•prior to any.roofing,material being installed. __
Will theo future building p t equipment devices wit nn If a roof is Installed without first obtaining an inspection;I'agree t.o remove
em t M1 Ibbl cit l t den d by lh B,y ,e�,A Q I'ty Manag meal
Di' ae all new materials for inspection. Applicant understands and will comply with
• ❑Y ❑ - all non-point source regulations: - -- --
�-- 1 lime read the Safety
Code.Smamn t 505.2 533 a a der Ch puk 6.95 of theCAf •' -
iIfile ing dos Setty Cede have
ns tenan505t itis andmists )undersand Nat
bro does currently have at nth lit'. Yr,p eofis t aft the .. ..- .-.. - . ._. _. _... .....;.. ... .___ _ _
occupant o.the r semen¢which must be and prior m'xsuance ofd Certificate ofOccu "
- -_
.,/ ��.�->• 2"-z — - Si nature re of_Applicant _ _ .- - Date _
r anmonrdd agent I ..to All roof coverings to be Class "B"or better
:. -. . .. OFFICE. . . . . .