02090096 c]BUOF G DIVISION
I PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20730 GREENLEAF DR J C DE ACHA 02090096
WN 5 E: APPLICATION SUB D9 TE
°J 5 ACHA 20730 GREENLEAF DR 09/16/ 2002
II PHONE: SANITARY NO. CONTROL NO.
O a4 Oz ARCHITECT/ENGINEER: a BUILDING PERMIT INTO
kL" BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z 5 y Job Description
O z�+ I hereby affirm mm I am licensed under pang Pions orchapmr 9(commencing ADD 2 CAR GARAGE (4 6 2 SQ. FT. )
FyFw with Seniav Md'e Division Jof the Businessland Prof=uions cock,and my license
m f< is in fall fame and a@n. �B
IC
D i u License Class Li,,.tr /� Fl E
Dere Contractor d�Bw
63 a.t;; ARCHITECT'S DECLARATION
SC g I understand my plans shall be used ax public records FEB O 5 Z 003
adx p O Licensed Profeamnal
OWNER-BUILDER DECLARATION
ax+'Q--'to I hereby affirm that 1 am exempt from the Contractor's License Law for the
of?Q following reason.(Secman 70315.Business and professions Code:Any city or county / '�D'p'�
$40000
E CF G which req permn t c .t i hen improve,demolish. p someone,r anysomeone, BU BUILDING
Y
a 3
2.
poor t is ii.munce,al 9 thii,phemit fim,uch perrut to Msigned statement.
that bei is licamsed punttan td the pmvtinm of the C..mar's License Law Charlie,93.2�g. o neat Valuation
o cngwiths do 7")ofDvtsion3ofthe Businc ndProns
fewmCade) 1'fAly t � d h,il�A'�t'?(�',.
or that he is exempt tncmf oto and the bass for the alleged exionpluh.Any violation " '-
of Section 7031:5 by any applicam for a pemat subjects the applicant to a civil penalty
of hotmarernanfivehundreaaagat(s5w). 101 APNgtDLli'gJATION I'iarl:Tl.) Occupancy Type
❑I,as ownetuf the property,or my employees with wages as their sole compensation, 102 PIERS
'-will do the'wark;and!(he st wrc'is not intended or offeredfor'sale'(Sec:7043;' -'
rB nes and Pr pea' C Th C t t License e raw does not apply to an 10 3 - UFER Required Inspections" , ••• ' f
owner of property Who bui or improvesthereon, J who does h work himself 104 - REBAR
or through n' pl. s Provided th t himprovements tie a mended or _ - -.
offs d forsale,IC- the bu ldi Id th ono f - - - -- -
gor rderolmen yearn 1-05-'-_--ANCHOR`BOLTS'-� 'i:;
co pl i nth w W de will have the burden of prov ng that he J J not bu Id or j'' "'
imvrow=ror puryo,c oYs =). 106 - SEWER & WATER �
pl a of "'am exclu itcontracting ithlicensed«nimctors toconstru _ 202 UNDERFLOOR"PLUMBING _.
License awdoc a IYW.Ba, and Prof=,aian.coae)Tneeantmemr•a 203 - UNDERFLOOR MECHANICAL fuc- ." .�.M 11,.il
License Low d« no ppl to an own r o property who builds or improves rhcreoa,
and.who.comm wit o,contmctoos)licensed.purso ut w the. 2.04- UNDER-FLOOR-FRAME--
'- 'r "
Contractor'saso Lic s a •
C7lameaempw oy' `B�Pc•far tniartaaan 205 UNDERFLOOR-INSULATION
o = ' ` 301 - ROUGH PLUMBING
"WORKERS COIF ENS ION DECLARATION 302 - TUB fie OR SHOWER r
• In by rant a First,hy,tpcj y eprth`followingd=alarfimo -- 303 - ROUGH MECHANICAL
�. ❑ 1 nose con will maintain as cemficne at Cnnxnt'to self-matte for Worker, 304 - ROUGH ELECTRICAL
Compensation, as provided-far by Section 3700 of the Latin, Code, for the
- - perfomratic'uftheworkfor which this permit Lizrs...J.-t, 305 - FRAME
-- ❑1 have and will maintain Worker'.sC8Wfichadion In.mmuce,ei icquiree byprior
Section 3 06 - HOLDOWNS
- = 370()oTmdLal.ir Code,q„ iex
the femance of the,wo'rk-for which his prio is 3 07 - INSULATION
is ta d My W, k's mpc!aui o Inpu and Pol cy a be
°r1"430� SHEETROCK -
.,_.__.
_...-_.
'Carte 1 .j }I tP1 rN A i..t .y
i I 'CERTI CANON OF EXEMPTION FROM WORKERS',—•' + + .309.'. 1•.$XTERI�'OR;LATH ,s Il
COMPENSATIONINSURANCEa _ - - 310 -1-, 1NTBRZ"OR LATH------
311
ATH
- __
:r (Tn ;i. d-dd bn=ntnplmee'nn=varttar,rrone nunaxa as"'rs 311 - SCRATCH COAT
alwly nr t ,
31.3. -•= ROOF FNAIL'.,..:,>
' "i the perfmm�tie f �pe'it si, J 1' _ .. ••.._.`. '::::'
wn cn 501 FINAL ELECTRICAL"ENERGY" �'I`
shut? t - o any - ct to th W rkcrs
ca x tt _5.02__-_..FINAL_PLUMBING, ENERGY. __.__.
_Apel cant "..
NOTI' TGAPPLICANTII nr k ghtcrtfgt "Eempt 'you should 503 — FINAL MECHANICAL`ENERGY
z c e subject the k Compensation p nsofth tabor Cod you must
O rd thotnplywan np ionaom.p t.halt deems coked 504_ - FINAL BUILDING ENERGY
O
'F'4 ^t' -I') �c't CONSTRUCTION LENDINGAGENCY - 505 - FINAL ELECTRICAL'
�- .` I M1e for Ilirm thatperconstructionlending dg cY f tM1e perf'vnunce
W nn work n nen Pe is issued 3097 Co,cl 506 - GAS TEST '
Q -..Ce la ,Name .- ..• - -t - u.3ra s._r .. _. _
507- = FINAL;- PLUMBING —"Z Wmler Add s � - I -
v-C508 FINAL MECHANICAL 0°
'fy at I base read this application and stare that the bo irtuma t on is
0 E. co ct I g e= opo Ply with a1 ly and county ordinances ord out laws relating 50 - NAL G DE
t,1 }o buJJ o m o anah y mh <p r t e nrtbty tyt to upon
pp5t P rq .. - - 510 - NAL P N G
d l "I e e 'r snake i hara anywy fc x� i g aid 51 - NAL B RKS
W Iiob t ) m ¢,costs ova which m y any y again t said
U z City co de fill g Till per t
APDL CA ¢ ST s' D WILL COMPLY`Wr"H AUN PG' r' Issued by; Dale
'O[IF E EC f J
sig m IAp n co t : -� at Re-roofs
;II, HAZA US MATERIALS DISCLOSIIR
Will N applicant or future bu'Id'ng avcupam some or h rndic h1l"tis material
❑YJt TYPe of Roof.asdefined b h cupenn M y Cod Chapt9 12,a dthe H ,had Safety'
ty.
eu 25533()Coo S
;1 j; •••-,-••- --,_...
t Iktla h .. ..
it-
..
\ r J'.ins
ti ko'a' M:
.,. , All roofsshall be inspected poor to.any roofing material being.mstalled _ _
µJt it co t r t ren Id g« pat ee9 a to a , nm If a roof Is installed withbut firs[obtaining an inspection I agree to remove
mill to na_s dcned by the ByAreaA QualityManagement
-
,• Dt t�<tall new materials for inspection _Applicant understands and will comply with
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all non-point source regulations -
h rc &area hate" nomon req m=nts.0 a Cho 6.95 the '
Cale nil oh s Sofcty C«k S'dons 25505,25533 and 5513 1undcrnand thin;
t' es note neatl h ee¢ LNnt t y �1' t -buy -... .._ _ _. . . .. ____ _. —_ __ _ __
8
tie I d
< t to req t t,
Dec a
Signature of Applicant Date
muse tot us C ti f f
'. '0-he,.1 archon ea agentr Date•iiiiii rr All roof coverings to be Class B" or'better
-OFFICE - . __.._.. . .. .".. .. .. _ - ..... _. ........_....- --
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