02060101 CI
BUILDING my SiONNTRACTOR INFORMATIONt-'
PERMIT CO
BUILDING ADDRESS: PERMIT NO,
10075 IMPERIAL AV CITYWIDE ELECTRIC 02060101
OWNER'S NAME: APPLICATION SUB DATE
PIRIACH MARIANNE 4686 MERCURY ST. #A 06/17/2002
PHONE: SANITARY NO. CONTROL NO.
(800) 797-8677
q 8 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
reBLDG ELECT PLUMB MECH
i f---1
s. LICENSED CONTRACTOR'S DECLARATION
00 z�'q 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section7")Of Division 3ofmc Business and Professions Code.admy license 100 AMP SWAP OUT
rue s is m fall fore Bea etl 7
Q License Lic.tr
W9 Date 2 Contra
nar
ARCHITECT'S DECLARAON -
I understand my plans shot l be mad as public records
as
It:p O Licensed Professional
OWNER-BUILDER DECLARATION
'^ 1 hereby all,.thin 1 am asap,from the Cismommr's License law for the
t?< following reason.(Section 703 IS.Business And Professions Cade:Any city or county $3000
F,S O which"equines a Permit to construct,alter,improve,demolish,or repair any structure.
prior..its issaattcq also requires the applicant for such Permit o file a signed stmcmcm.
that pa 14 licensd pu(suent to o Th Activations of the Contractors License Law(Chapter 9 �'r�, ( &' r Valuation
(commend1egg wap ScetiomY ) f0rvisionJofihe qusl(lesyenctiii, Anyvi Code) Js."•.� ��' !Sh�J,.q�Lq 1f,� t( (j R���,h jk's"e, 1
or that he li 31:5 b any
applicant
and the hears for the subjects
the
c matt Any violation
--of Section9 than five
a undredicaa Tar$50(j.tsubjecu the uppllcnnunacivilpenahy
- p yTYp
of not more than Eve.naaerm dollars uslxB. 304 APNI�5�4 ELECTRICAL""R. Occu enc e
°1,As owner of the propeny.or my employees with wages as their sole compensation,
-
will do'the work:'and me'structure is'not'intended-or offered for'sale'See:7044;- - -- - -- --- --- ---
iBasineis'eddPrdfeasions Code:The Cormcror'sLicense Law duesnot Apply toen 505 - FINAL EIJDQUU 8CDAftctions)< >:aa-"'
Owner of property Who builds or improves thcremn,and who does such work himself
or through his awn employees.provided mm such improvement as no,intended or �,.,__i_-_.,-____-_-_-___-__,._--..
-completion sale:If.however. will
have the urden of entProv is that within one year of - [ Pl • „q,
'improve for the owner-builder will have,he burden of proving that he did eat build or
imp forpurpose
ofsale)
- 171 a ReP44,exdui ly t t
2
g with trcmrsm •
It ` SF'
iSec.7 'on Code:)Th,Com
Li nla does notapply m anownerofproperty who builds or improveItherron, I
turs
.-❑andI mh`o xceomnptrt asecn.sat.e:f:o Sl such
cht licensed
As.PdCpfor utist rteamm
C t ! LtttncLe Bu'L®,'I JNi"G+ - T_
.,Daeowner .
..._
\
-"
-, ��. .. . ...
WORKER'S COMPENSATION DECLARATION
'•''c -1 hertb Rim undo
yes pcnel,y�Fperjtiry,one of the following deelare,ions:--
t ° 1 haveadd will"Inaintain'd Certificate of Conserv to self-insure for Worker's
-. i. Compensation, as provided for by Section 37M of the Labor-Code:-forthe
perf rmonce'of the'work for which this permit is issued.
��1„h And ill moto
Armin Worker'a Compensation Insurance. s required by Secdon
!'"�of;he Labor Cod for'llre ferformance of me work for which this permit is
ss W My W rkcrx C mpen ret an I u carrier and Policy number arc:-
- • 447K
y�rrss .a-._. r _,_-.....t_",._....�s.�p._�---t_�_ _ .._..,.__......_,.-...�._,
Cern
P! ATO %Ecy No.:VF'ROMW ROpy Z../ _ ` Isal I�.....�\i`.� [\•t!\SI•ttat.''i. `r. IIJ _. .1 ..__..-.-_.._.....,...
COMPENSATION INSURANCE•;s,:vI
O*(Thii cilo"n reactant n<completed if the permit is for one hundred dollars
(SIM)orlas.)
....r .... .. _
I
rem fy'that th per mtana fil k f r h h tn' perm t is d 1- - - ...r. _..- -
sh II Out employ any parson!it any m as to become thject m,he Wcrkcrs I A ,"1.
Compensation Laws at California.Data
manner s
NOTICE TO APPLICANT If,after'making this CrtiOcme of Eaempi.a.you should ••'.I _ . +
hes me subject to the Workers Compensationp inions of theLabor Code,you must
ZO forthwith comply with such provisions or this Deans shall be deemed invoked
E'4 1 +r+CONSTRUCTION LENDING AGENCYCd"'• ,t•p.
-� '' 1 hertby 11him that there a isconstruction lending agency for(b performance' v t:i' \t
W nee of thew k f r hich,lire perms s s u d(Sec 709] Civ.C 1
�.Q -Leders Name
land Addre t -
o'U ,,, I I gcmthinlh arcdebapplication and ruin, thathso is einformationeterts (/l••I�J
Fr me.
t 1 green.comply with all city and county ordinances and state 1 relating
V m ambling
u .ng c t ct n and hereby far i mho p entef c Tilt any t enter upon
m b mi red ptnpend f ppatke
f^ L
(Wel aim ndemn fy and keep harm)s.qhs C ty f C Datum igainm
fn liabilities,judgments.cot and a pe se which may n any ay acs gaima said
U.Z Ctyy n seq - fth pruning of permit
PPpLIg'TUNpERSTA. - MLCOMPL WRH ALL NOYP L !
_ sb RCE REcuLAnov>. O Issued by: Date
Stg t ofApplica UCbm no m Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
..-;•
''Will"he pal can future building occupant store r handle Wee N m cat I ,Type Of Roof.
as defirred by he Ca,ssira Mpolci,stl Code Chapter 9.12.ard InHealth and Safe,, - 3 •.."'•"•_••. " `-• ...••.•.... "...•'
C dt,Section,' fil f t e 3 q , , S I r'E T r. t t
LlY �. 1 JII { te a - f ' . V / - t + r. i.\.ti '..FIs ti,I yLI" .tl•
II roofs sfial] be inspected pnor,to_any roofing-material being installed _-
WB'dua_Dalt ,o fiat build' g paortim couipmentor device.watch If a roof is insialled'withoutfirst obtaining an'inspectioll,-I,agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District,. all new materials for inspection_Applicant understands and will comply with ._--..
w all non-point source'regulanons. c
1 have read the haxoNous
human.I requirements under Chapter 6.95 of the
Calif imia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have atenant,[hI it is my responsibility to notifytheof r,
0 cu runs f the regdtrcme a ht h mu t be ,pnor�to;iss ante of o Ce fiesta '
p
p y G Signature of Applicant Date
Ouncruragmor;aed ge D,te. All roof coverings to be Class rB'•or better g
•� r•. i ...... - -`OFFICE--- -- ._._. . . --------.. ..---- - --
t