02060094 C BuOF C, NO
BUILDING G DIIVISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
7995 FOLKESTONE DR 02060094
OWNER'S NAME: APPLICATION SUB DATE
LAP LE & ANH DANG 06/17/2002
PHONE: SANITARY NO. CONTROL NO.
WC O O ARCHITEC MNGINEER: BUILDING PERMIT INFO
g w C BLDG ELECT PLUMB MECH
i U CUJ 1--U 1=J
H i LICENSED CONTRACTOR'S DECLARATION Job Description
O 1 nemby affirm that[am licensed under provisions of Chapter 9(commencing
1-Ht with Section 70W)of Division 3ofinesuelnwsandProfcantimCode.and mylicense REPIPE (COPPER)
:e E is in full farce andslie •"r�-s sl {-�
z re 6 License x Ld'X G�-Lb b
O a u Date Coal.ter
3 u. .{-i ARCHITECT'S DECLARATION
g 1 undecsmnd my plans shall be teed as public records
Idtl m o O Licensed Professional
c an.� OWNER-BUILDER DECLARATION
1 hereby from Nam
al I exempt from his e C.Mado License taw for me
t z a aRfollowing reason.(Section 7031.5.Business and Profeddone Code:Any city or county
$4500
I F O which requires a permit to cmasonu ,alter,improve,demolish,or repair any swentre,
u°613$ ..prior a its Issuance,also requires the applicant forsuch pemuuo file a signed statement.
Stat hq bli<en4d pursukmt nh Pv��sionsofthe Con=cars Licensetaw(Chapter9 (� [�' O��{{ w Valuation
(c eningwithSection JO011l ol'Div n}of me sh p nd Profcssioro Code) (��ql'�*' -6�ty] ICJ g, iV '14s1,9';' �)�. t
a t rhe li exam i Me f "a d the basis far the all ed PAny
P 8 nant to 1penalt
-of Stttron 70375 by any applicant form permit subject the applicant a civil penalty- -of not moa than five hundred douare(SSW). 2 0 2 ApNi 5FLOOR PL B'ING I' Occupancy Type
❑1.as owner of the Poi or my employees with wages a their sole compensation. _ ,
will do me work aid-th,supcwm'is nm intended ar affered for sale(See'704A1;
ifoadrieu and Proress o s Cad The Contractors License Law does not apply to an 502 - FINAL PL13WaddGnsfdERGY
owner or property Who bit Id matfiraves Lhemon.and who does such work himself
or through his employees.p ded that such_mp N not dd Or 507 FINAL PLUMBING 1
"-siffeOrd FbOr af,.-- If,h di building P e inis saald vvithiii orie year of- -- ""'_ _ --- ....... ._.__._..._ . ... _._.__.. .. .,.1-.... .. __ ---.---
improve on the owner bit Ider will have the huden of proving that he did not build or '
improve for purpose of sale.). i
-Ol:as owner of the property,7 am exclusively d Profiting withCodd:)The C moors m --'_'--•j;�-;j,- -----'""-'-'--"'
consvun the does
n (Sec.]to a Business and Professions Codd:)The Loather', v_l
Liceresicwh ,c d not apply for owns fp.so nywho builds o p vas Merton, - -
it
..and, he co trach forsuch-p 1 cis wtm a comracarts).1'censedp rsuant to-me. ........
CMM.dtM,License
❑1 a pi ndc S 'B&PCfonhis reason
,PENS JUN 27 2002
+ - "'
WORKER'S COMPENSATION DECLARATION
oI hereby affirm maker.pcnalsyaf perjury one of the following declarations:
O 1 hzJEund difl'mainibin-'a'Cmificmud of Conuni to self-insure for worker's BUILDING
Compensation, as provided-for e -for by Section 37W of the Labor Code.-for the
performance of the work for which his,permit is issued.)l„
❑1 have and will m IntW ke's Coarpedsatioa Insurance,as required by Section
• t 1r Con fo to pelle ce f di-work fwhich th s pe l"is
PW f the l Labor C t Inst sec - _SPolicy be am;
y i/.
is edM Wrk
Comer � / i 1 cy N N i l
+ GERTIFlCACOMPENE COMPENSATION
INSURANCE
WORKER] . .J` xrS i1t.L. i i •a,{
COMPENSATION INSURANCE s•' 1
m sscfilon neednot be corn load if he `` �---_--^-- _-- n, --
(51W) IssJ P perm's is hr are dollars L :l.t d'
1cemfy,hat in Person
parr mll c f N k f which h.Object
1.d kd 1
`dull not employ any person in a.Date ncr on as a become sublceN m Me Workers
C mpc t La f California.D t -
Applicam!NOTICETOAPP LICANT py a h Ist-
becture
Subject o Mew r Compensation np ha M m LaborCal you mustO Cfonhr ply' b itch p donsora pe t all
`
bed d rc ked
� '.r ";1",`, CONSTRUCTION f ENDING AGENCY
a > lwork foh by form ih t h ' on.( non lending agencytt
for the perfoiman
�:as of Me r which this permit is sued(Sec.3097,Civ.C.) :' -
y:o -isnder'iName•.>�.. t- --- _. ...
;D,Z Under's Address: .. .. ,
-F" d i comfy that I have read this city
and on and eum mzuhe above laws relating is
w'F to hail.isagrnsmcomplywithall esy iryudcounty antative, and stere lawscr.,.a
-:>i;V to building cunwniction,and heresy'onthnrixerepcoes,representative,of,his city minter upon
,�s W the G e - d p p ny f pal p po ,.
(W)agree•to e' d fya dkeeph I -they ty fCpee stand
V1 )iib n ox g nuc t d pensc which )-n any way me against said
t..7 ZS
APPLICANT
PCity quinceof th'grant ng of ml permit' ^ /s
- APP ICE IF,;G DERs ANDS ANDWILLCOMPLYIXI'THALL N= NI / `D
s( 1 RCE P ru n� ;', j°7 Issued by: Date
/ o
_ - Si n]wrc ipncantl onvaaor .::, : ': - I -Ti n:• '�
' HAZARDOUS MATERIALS DISCLOSURE'�'��+.`�t Re-roofs
W II Iapplicant or fMiebuilding x p N are or hanalk,hLurtions mammal T eof.Roof.
as dot d by the C pe uno My 'pal CodChaps 9.12 d theHealth d Safety - yp "' "^'--"'1 ^^- ^° ----------
Cede 5 non 2553-( ) a) ;,;
W`
C3Ye. }f ❑No' S to f t :� I f I Jr a .a
i - `l t` �' `v v i _�All roofs shall be inspected pnor-[o any roofing matenal being installed
e Wdl th air
ant f t bit fi g p t eq l 'ma -device,which If a roof is Installed Without first obtaining an inspection, I agree tO remove
emth b eoi - t as defned byte Bay ArcaA Q Iiy Management
Dinner? 1 _ all new materials for inspection Applicant understands and will comply with
I h i"he no a d 'raper l qu rementc a de cn p�r ees ,� all non-point regulations .- p
+ OY �N _ p
California Health&Safety Code.Seczicas 25505,25533 and 25534 1 understand
1'
that
'if d'upeabuildingda,fumms am which
must
be main is my rapo sibility No notify the
oe a sof theIrcm N h<h usN be etp o t ism a fo Certif to of
O
Vale
Z _ Signature of Applicant Date
9
�u�✓C—
w g N !� All roof coverings to be Class `B" orbetter "
o atmpr:ee
1.�. .. ',._1.... _ OFFICE......"... . .