02040035 (2)CITY
UILDING DmSISION"�PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20091 FOREST AV
NGUYEN
HAI T ET AL
02040035
OWNER'S NAME:
APPLICATION SUB DATE
VGUYEN HAI T ET AL
04/08/2002
HONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
'
BLDG ELECT PLUMB MECH
3
I-1 I—
LICENSED TION
I hereby affair thin lamCONTRA
licensed anlir p,oviis onnss of Chapter 9 (commencing
Job Description.
iwith Section]000)of Division 3ofth= Business and lamfe,mm,Codeandmyliver.
NEW
SUBPANEL FOR KITCHEN.
is in full force and ellen.
[ License Class Lic9
- Dole Comoro.,
ARCHITECTS DECLARATION
I undersand my plans shall he used as public records
FI BC !i A O
9�.(r�'l*• Ec
Licensed Professional
j OWNER BUILDER DECLARATION
- I hams, affirm mm I am exempt from the Contractor's License Law for,he
MAY 1 A4 9002
fallowing o acam. (Section ]0315. Businessand Professions Code: Any city or county
o which requires a permit to construct. alter. improve. demolish. or repair any structure
., L
$800
. patio its issuance, also requires the applicanl for such permit o file a signed smu men, .
o Ch peg
(xim .ms ]00) f mn3he Business and ProfessionsCede)
exempt
f:r.L
-
Valuation
m mut he s msercfrom anodic busi, irme dIIdjdAny ola on
:
of5<nion ]031.5 by tiny applicam far a armi, subjaa she applicant m a civil awlty
inlinet ... thanavehundred dollars (a5oo).
10]A'PN�DATION
Occupancy Type
as owner of,he,roomy, m my employxea with wages as m<ir role coman...jet .
'�I,
i11 dothe work. and the structure is no, intended or offered for sale'(Scc. 7(1
"tioreai and P,df<asinns Code: The Cro maor'e License Lav, does an, appy ,o an
-
103
- UFER Required Inspections
owner of proany, Who builds or improves mercon, and who das such work himself
ord gh ti: nemNr. a.v dd,hl such'mn c en,', ded or
"offs
d f
Icompletion,
the ownerbulderwll have the burden of proving that he, did not build or
105
- ANCHOR BOLTS
improv= for ,.pose of sale.).
106
- SEWER & WATER
L as owner of me - wim
p(roSepce.rt
cBxucsliusivsclaynedomProufceesosigommtra
202
UNDERFLOOR PLUMBING .'L%
]y.iaimmro
construct the proecns Colihi The ci
.. Law it. oappy0an owner cwhobuild, mproeoo
203
UNDERFLOOR MECHANICAL
..andnwho .contracts. for, h p'rs with aonmanor(s) idensiA.p man, to.me
Cam License a
204
-... _1
.u..__ .-_ .."." ."".Q .,
— _.
UNDERFLOOR FRAME—❑1
tim &P C far ,his reason
o,n., �� °o1e'�' 2'1 UL
301
- RO205 UGHPLUMBINGWOR
R S O 1PENSATIO DECLARATION
302
- TUB & OR SHOWER
nreb m.neerpgneeyor :d
y• x3 y.ne,grmeronnwsngaeelaaenna,
303
- ROUGH MECHANICAL
° 1 1 dad will mainain'a Cenif<rua'of Co.,,., to b.insom tar W.rker's
Cnmpenta,iii as provided for by Senma 37w of me Labe, Code, ma he
304
- ROUGH ELECTRICAL
parronnana onhe work far winch mit perms it ,imbl..
305
- FRAME ..
D I hive and will daimaid Worker's Compensation Insurance, as required by Section
306
- HOLDOWNS
3700 of be Labor Cade; far the performance of'he work 'for which thispegnit is
issued. My Workers Compensation Insurance carrier and Policy troadm am: '
307
- INSULATION
Comer ..
308`-'iSHEETROCK,,
ICATIOrOFEXEMPTIO WORKERS t
CERTIFIC COMPENSATION
OMPEFE TION INSURANCE
.,.. COI., N TI ON INSURANCE '
l 3 0 9 '
' EXTERIOR 'LAfTH '
_.
tThaa«t-deo tbe<nmie,ee if be ann,inro on<brmtlrea sonar.
p
- ..._...
310 t:-
...-.__.
� ''INTERIOR LATHI
aloo) rot°)
311
- SCRATCH COAT
I nfy,hn pefo b 'frac work this
x issued. l
313
- ROOF- NAIL =
shall , ti, y any f n any tic o ,o become subject to the Workers'--
pa meso
cnma ay�n rcl�rmaome'•
,t
! '
- FINAL EliECTRICAli 'ENERGY
f'501
Apple t " eG.d "`��imlir
NOTICE TOA PLICANTR f aking,h sC rM"cme ofE mlh{,you should
- -502
---FINAL "PLUMBING ENERGY--'_ _.... -
becomeiubjecuothe N'od�rs C.aptamai,on proveaonsofine Labor Code, you ad,,
503
.,
- FINAL MECHANICAL" ENERGY
forthwith comply withsuch p 9aions or thisa a
t -a c revoked,
-. .. __. ._... ._.
-.. . 504..-.--FINAL.BUILDING-
ENERGI'
' CONSTm(TION LE"DING AGENCY
by 'a coedSce d'gagency f m perf'rma<e
505
_.-..__..
- FINAL ELECTRICAL,
weak hichbigperc
of ihC kir hchmspe,m,is ssaed(5ee 3B9]Civ. C.)
-Lend
506
- GAS TEST
n paAdsde
x
507
- FINAL PLUMBING.
nfymt Ihave madm pplialn as state that the binformation s
508
n:.
- FINAL MECHANICAL [(/J
,hTribal 1 Agree to comply with all cityand county d e t le l nibbling
.I i'n dhe bya'utIh p r, set oftti 1y In char upon
509
- FINAL GRADE
eabuilding<
m<bove noemi.red reetosppnde indemnify and plereeld,,
(we) agree tssave, anekhihamayinthe Cityofcrom
510
- FINAL PLANNING
and
liabilities, judgments, cost and enanxs which may in any way accrue against said
aainst said
514
- F INA PU I C WORKS
City in consequence NITU R me ginning mit permit. L
S'Ap'Dw WTTH N 'r
.L COMPLY AL N -PO NT
SOURCE u1:pTlD J}
SOURCAM-UNDE to '
Issued by:
V
Date
S &nam APPhcan✓C ,uc r. —T1 -1 a�Iw`
-'-
Reproofs
„! HAZARDOUS MATERIALS DISCLOSURE :
a, 6a al
WIl m appl cam o f , <nu. ,. p n, s, re ha die ha' sou m e'al
„Type Of ROOF.
an defined by C <pal Coe Chaper 9 ¢, and the Hrdm and Safety.
.. ....... ..::::.. ... .::
.,,
Cade Sec, on 25A2(p)
❑Y t °"
?
All roofs shall_be
inspected prior to any roofing, material being installed.
N Il theappbt ntoraft W ld occupantmecympm , tEev, which
doth undo contain t aid fnetlb ,he Ba p p
I— mm
3y
If a roof is installed without first obtained an'ins echon;l agree.to'remove
g P
D sma
°Y °N
all new materials
for inspection. Applicant under
P understands and WII1 comply Wllh
P..Y
'
_....,
all bus oro[ source re ulanons
g Pp.
e
I h e J lh e d mal 'alt of the
dents undo Cl�p,cr b'95e
5 .1 t
Cal fo a H ahh d'S f, C d Sections 25505 25533 d 25534 1 u d rs
y t
alrel Idngaw at
G"
notcu curly have , ant that t. yresp responsibility nafy
c m f h
-
i'�
equ r t ch- tis, be mn p , issua ce" f C<ni ate of
u
Occupant
Octup n ,.
- .
Z
Signature of Applicant
Date _
All roof coverings to be Class "B" or. better' '
"a'° '" "==Qae=' , aO
_.. ... ..... .. ,... .I ... "-OFFICE _. ... ...