01040143 CITY
OIVSION o
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10381 JOHNSON AVENUE 01040143
OWNER'S NAME APPLICATION SUB DATE
SAM TANUAME 04/26/2001
PHONE. SANRLARY NO. CON'IRUL NO.
,20=76 ARCHITP.CT/ENGINEER: BUILDING PERMIT(NPO
BLDG CLI[m' PLUMB MIiCN
y i
N LICENSED CON]RACfOR S Df CLARAIION
SeIhembdnuflaold,lilaraedrrdapro.namarchapta9¢anmerco, Job Description
o
t-at
0 1oli S.nfon70Nllof lot tlhe Blanc.,and Prlcas'ma Corfu ndny lisenc
Y � L[rrNOfbreeandelect. DEMOLITION OF CARPORT
_oda 13tca c Cla.. Lie..
Dam Cronmaar
ARCH I I ECFS DECLARATION
O 5 I understand my plan.,shall IN uttJ as public records '
Liansal Y am"inwl
OWNER-BUILDER DECLARA'I'[ON
='at, I hereby affirm mal In pt frothe Cnmmctnr',Liceam law for the
C 3 lullowing reason.(Section 7031. anm
5Basin. ..and Prnfevion.GO,Any city nr county
5 O which arifum,.pa it Iom,..It p nor.de ilikh,or m,airy lit,oure
ae
pror loo,svacur,v,Ilio y Ihara,,l wool fiu, I 'g I:mtenen
(hal by Ip o:nttI,Ilot p t.iou,of lh�Courri( Law(Chapter] Sq. Ft. Floor Area Valuation
I commenting with Seetion 701 Xh of nivivion 3 of the Ilusmons and Professions Code)
or that he is e.anm therdrion and the basis for the at Irked estantil on.Any vinmdon
of Section 7031 by any applicant Its a pmrnit subject,me applicant 10 a civil pcnahy
of act room than File hundred dollars($500), APN Number Occupancy Type
❑1.as awner of the pr,pi ar my employees with wages as their sole compensation. :3791 AL-471 00
will do the work.and the rrucore is not intended or o11Jrtd for sale(Sec.7044,
Online,and Prafesaans Ctrdc:'The Carurau is License law does not apply 10 an Required Inspections
r of prnpeny Wha builds ar improvers thereon.and was dons such wore himself
owner NO ASSIGNED INSPECTIONS
or arongh It,own howls es, houldon that-web ban amW are not intended or
,Iteral for.the IL hit p the hnlave o mpm roam.NOW withindid one yard nt
n,nmlertan,me owner-n�nyder will have he nrrdrn ar praelne ntat he me nm Haan or
t prow rRy nnmm,e ar.ale.l,
t►1/Js owner of me prapcn emlaeiedy commeling with licensed caccwtor,m -
mktt161 the loot(Sa a.Bu,iness undo Pmtsssions Coi The Contmcmr's
License Law dces not tip Y t u caner of propery wAr IwI'd,or improve,Ontario.
and who contracts for s ch rmjats wish a n,mmaods)I rarwcd pursuant to the
Catnreelola Liecarwii
Q,
um cxcnrpl tier sec _ .B&P C for this reason
Go:cx Jit — Date.
SCOM1'IiNSA'f10N I31iCLANA'I'ION
I hemby ulFir r der penalty of perjury one(If the l iylowing dcehirmione
• ❑ 1 have and will taintain a Cerilicros of Comm m self-inmrc for Worker's ..
Compensation, as ovidcsl for by Section 3700 111 the Labor Code, for the
performance of I nd.for which this permit is issued. _
O 1 have and will maintain%Aaker's Cnmpvirrou n Insurance,as required by Section '
3700 of the Ia Cr e,tot Ike pafnmramc nt the work lin which this permit is
Issue I ,tion Insurance carrier and lsricy numner arc:
Cara: Pahey Na: ��3 , o oc�6 ) f 3
CERT'I pil]ATTDN UP IiX13Ml'TIUN PROM W(IKKERS'
COM PENSA PION INSURANC Ii
(This section had not Its completed it the permit is for one hundred dollars
(SIO)nr lr_aJ
1 cenify that in the performance of the work for which this permit is i...ad.I
shall not anploy any person in any enamor so as to become subject a)the Workers'
can iter.atiao Law.of Cali ..frit.Date
Apoc:tat
NOI'ICH 10 APPLICANT':II,alter inaking this Cenilicam of Exemption,you ehu.Id
bavnrc snhj...u.the Wader's C...ulwnwtittn pro.isin put ho Lubar Caro,you tarot
Q O lIschwlth comply wlh vrdr pit oars,or mil permit.hull he darned revoked
z
F V1
CONSTRUCT a LUN LENDING AGENCY
1 hereby a ich this that is s issued Ever.
lending agency for the perfomrana
nl a e work for which this pennn i.issued(Sec.JlN].Civ.C.1
L Q Lender',
O Z Leader',Adds,
U O 1 cenify that I have ont l this application and ram that the above information is
Lzs [r correct.L agree to comply with all city and coOny orlittanm and>late law,relating
Q (� Inintildingcnn.ar¢ nodhant
er horim represnnativea nl lltis city In enmr upon
y aha aMr.o-tnemn,net °61,emy liar 6r.petin'n puma,,.
r6s tWevagrec to uw.i nAeannlfyund kap harndcas the City of Capernno against
Z) city ales,juJgttnts , >ts and cspcnses which tarry in any way xctmo ugainq said ,
U Z
city
in cu .efri v of the gruntiag ol'thi.permit
APPLIC .'TUN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �C3
Q$(�URCE ' ATIONS. Y'
Ititlirapare,-A pFica vcamtmaur Dale Re-roofs
1 I A7/ARDOUS MATERIALS DISCLOSURE
\YI re applicant orliaumhildingrweupant.womorhandlehazardous material Type of Roof
mcle Om C.,trino Municipal Code,Charm,9.12,and the I bath and Safely
Calc Scotia 25532W1' -
ove, 0 N All roofs shall be inspected prior to Buy roofing material being installed.
Will he at,plbm or mtnm nnwhalinciatianl use cwbuwcaur dc,twr,which If a roof is installed without first obtaining an inspection, 1 agree to remove
mil Notorious contanmfam,usdefred bythe If.y Arca Air Quality Management
L•buu,,'I all new materials for inspection. Applicant understands and will comply with
°Yeti °N" all non-point source regulations.
I[rave mad t hamrdou,materials requirements under Chapter 6.95 of the
California Health&. defy Core,Sections 25505.25533 and 25534.1 understand that
if the oilding Joe, enlly have.mutual.that it is my or"ro'bi icy to notify the
(ItLnm of the re imoscros which tn4.1 he mc1 prior lo issuance of a Canifiea:m m
U.
Signature of Applicant Date
ar ars art en,seta - Date All roof coverings to be Class "B"or better
OFFICE