02090071CITY
nrnSIOND
SINPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS:
_2192ti RYANr
OWNER'S NAME:
WANG JAMES
PHONE:
ARCHITECDENGINEER: A
z9 LICENSED CONTRACTOR'S DECLARATION
in C 1 hemhy affirm shat I em licensed ander provisions of Chapter 9 (commencing
M C with Section )of Division 3 of the BWiAes and Profession Cade And my license
C y is in full fn Ane e(feee,,,��st. ✓/v 'y-3�]. !
y o Q License C ss LiIn co s i I
s LL KKKO U� tf� at
ARCHITECT Cont ARATION
I understand my plans shall be used as public records
7 p O Licensed Prufeuioual
R met I am exempt r DECLARATION
I hereby a(Gml on I a1. exempt from the Contractors ssions e: Any c Law for the
C Z a following reason. exit t 7031.5.Business and P:e, aions Code: Any city or county
A o which requires a permit to construct. alteri improve, for su demolish, ore a sig any structure
pdono its issuancA. also lcquims the applicem fur such permiuo Ele a signd statement
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8)234-8134
BLDG ELECT PLUMB MECH
Job Description
WATER MAIN SERVICE
�-r;'g f s
or that he is exempt theiefrorn And the hasis fur the alleged exemption. Any violation 3
-of Section 70314 by any applicant fora permit subjects the applicant to a civil pewlty'
of not more than five hundred dollars IS500).
❑ 1, as owner Of the progeny, or my employees with wages m their sole compensation,
-will do the wod,'and the stratum is not intended or offered for sale (Sec: 7061, -
'Badhers uml,Professions Code: The Carrel nr's License Law docs not apply to An
owner of property Who builds or improves thereon, and who does such work hlmaelf
or through his own employeesprovided that such improvements arc notmendedor
offered- f - If h thebuilding p ent i Id within one year of
completion, the owner builder will have the burden Of proving that he did not Wild or
improve for purpose of sole.).
Ot Omu Irvnecpr the progeny, 4. eusiniss a coarmaing ns C de:) Thconwnots to
_ - - icewm the project (Sec, )IMO, Business and ery star,
b ilde:i The rs. tomer'.
License Low docs . f apply m nn owner th progeny who builds or improves Nercon,
% - .end. who rommns. forsuch profects.wnh.v.rommctotlal licensed.punuant.to the.
Commmors License La ..-... „' , I'' (I s6 .
❑ 1 an <aempt under Sec . Bi& P C for this reason
Ownerr' L•'.., .:: y.,. " ' Aly ....., d. L::r
SA '
"'WORKER'S COMPENSATION DECLARATION
1 hereby affina under Penalty of pe fury one of the following declinations:
(� ❑ 1 have iud will m to n u Cen fc i f Consent to self<nsum for Worker's
\
Comfientation. u provided for by Section 37M of the labor Code. for the
perfnmmnc<of the work for which this permit Is Issued. „
0 have and will i,iAiniain Worker, Comp6minn1laiurelme,'ai A, An. by Section
J700 of the'Laho Cod f Ih pedsrm c f the ark f r h¢h this perm Y's
�/�tl MyW rkernComppenaallon lnsumn end Pnitey nbe
' )✓L�-1}i1LGil/e-�It'5i Pol cy ... I.
J;`.II„l try ICERTIPICATION OF E%EMPI'ION FROM.WORKERSy�'
"COMPENSATION INSURANCE'".";'' '"-
v�(Thii actin,,nerd not tie compleiN if the real is for one hundred dollars
IW)or less.)
,` 1 cenlfy Chet in Ne perfnrinunce'of theork f' -filch ih s pcmiii ii issued�l
shall notamplay^.42'1 peiun m any`mAnller is ai m become Sub)en to the Worker,
fnnhwlth comply with such provisions ar this permit sholl be deemed revoked.
AIII3 l n ."!'CONSTRUCTION LENDINGIAGENCY
I heresy affirm that th is k consuucl o' Itiding agency for the performance
of she work'for which this panni, ii Isiud (Sec. 309), Civ. CJ ..
Lender's Name' •..°c='•'+ "v ` ,..i�..�....
7 777
Lender's Addrlsz'-`'•"': ':-
yl I a n:fy ih of 1 mvicomd,hi,ii,plicruiciamIdiula duaffirribole inhormainan,
Cotner I agree to comply with All city and county ordinances and stare laws Mining
to building cons,riletion, and hereby authorize representatives of this city to enter upon
1,:7 ,'y'
:'lir), hi C
106 - SEWER & WATER
3 01 - ROUGH PLU�f G'spec`ttins • r
-302-..__..TUB.-&. OR -„-SHOWER -
502 - FINAL PLUMBING ENERGY
_506,,,. -..-GAS -TEST------..�--- - - - ----- - -
507 - FINAL PLUMBING ”"tl1iO"""aI
)uh i_c_ pit :n
FaNA_LS0
SEP 1 % 2002
�a �yel f4 1 A) SZ 1 .l ,, 1%:.
a� .
lie Yl ties,' dgments, costs a: expcnui huh they in any ay accrue egeinsi said
Cit n c cote ofihe g in s n
/
I
su
A ti NDERST fS'A I COMMLY P'ITHA N 'POINT"
so
Issued by; Date
B' , c�Torrq_p
Si arure,of ApplicanVCo tmltbr'4;. ;: ::"'""'""':',^„}y.% 'Date�'•�,”
•' ':
Re -COOT$
FUIURDOUS MATE r�LS DISCLOSURE -. �' I
'. I NIll is, licanI or ful:uabuddin, ujAm more or hvldl harnrdwsllulerul
'ud
-
Type Of ROOF -.. .—-
-
finetl by the Cupcnm M it PO a Ch pt r912 ad the Healthand Safety
COE S c,❑Yes532feJ
t fy It's' v t {I •ih r s hi':1 t y
iii 1 �i: Ek
ni nsC, l� IrrR s 1f'J71
ai . 4 t r:.
r
. All roofs shall.be mspected.prior.to.any roofing. material.being installed._ _.
Wdlih s eWilling pm,.,Acqup t a itch.
If a roof is ins[alfed Without first obtainingan•ins ection;'I agree to'renlove
P
,.an',
t hamAo s air tomo is u defined by she Bay Area Air Quality Management
air
Dia et
/p
all new materials for inspection Applicant understands and will comply with_.
f�'fq
❑Yes, .!_,,n ! ,. SI ,,, I.. ;., ,,,
-,,
all non -point source regal ations_:,,� ,
�1j'' f 1 ha a reed the hazardous maienal :rtgmremelns under Chapter 6.95 of the
t: ,. I ,•„1f;
to fomite Health &. SaII cule(Sc,ions 25505.25533 and 25534.9 understand that
the builof docsnnt cmrenti h ntenanirihai
8. Y Y u flan
or m issuance Of. .nitlfy,Ne
oecupam of N' egdirememi x mutt ' bf a Ceriifdau of
'
Oce pansy ,f11 I : ,. .
Signature of Applicant Date
_ ----- -
All roof coverings to be Class i or better
h
'-OFFICE'.
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