01110045 CITYBUILDING DIIVF'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10731 JOHNSON AVENUE
OWNER'S NAME: APPLICATION SUB DATE
LARRY FU
PHONE: SANITARY NO, CONTROL NO.
. 4082556723
ARCHITECTIENGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
<O LIVING SPACE 2 486 SQ E4 U
t;a
O H Z LICENSED CONTRACTOR'S DECLARATION Job Description
ZO Z 4 I hemb,.M m that l am licensed under provisions of Chapter 9(commencing
ay with Section 7001 Division 3uf the Business and Professions Cale,and my license m 2 ce� is in fall forand ellen.
m s z< Licenu Class Lic.g
e'O E.U 3a Date Combacmr
.:-i ARCHITECT'S DECLARATION
F L`Oy I understand my plans shall be used as public recONs
�te
ip O Licensed Professional
OatNEm BUILDER DECLARATION
vas"4— 1 ma.(firm that 11. exempt from the Cocoons Cna License Law for the
C?< following vires a Panni to
]11315,Business and improve.
de Professions Cnde:Any city or county
tF O which sequins issuance,permit re vires t ca alma improve,demolish,or rcpzu any swcmm
a3 that heor to iuensed alsutto the thic ovisios of for such Coatimmouofile aicense ned Low(Chapter
that he I.licensedSmiann7" of
of the he Business
License fawons Covr9 ,Sq. Ft. Floor ACea;. tt qa Valuation
(commencing with Sanofi]1X10)of Division 3 of the Besidesexam Prnfuny vi Code) 7's• o! r' • _ ! 1./f:.L 4:"..t k 7 r '
or that he is exempt imy appli iandi the basis for the cis the applicant to Any violation I
of not mom than
v anyapplicantfor epermit subjects the applicant toacivil penalty+
of not moreNan Rve hundred dollars(S500). APN Number secs Occupancy Type
01,as owner of the pmpcny,or my employees with wages as their sole compenution.
will do the'wmi and the'swcture is not intended or offered for .Is(Sec.7614,
-9uioness and Professions Code:The Currencies License Law does not apply m an Required Inspections' '
.we.of property Who Wilds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or _ _
. . .. __.secs. secs._. _ _ _......__._s __.. ---J_.
offeredtion,the'If,hbwrcvcr,the Wilding or urden of moving tat within one Wild
of - •r r...
completion,the owner-builder will have the burden of proving that he did not Wild or
improve for purpose of sale.). t
-_ _ _. secs ___ _.._secs. ._secs .. .. ._ secs- _._ ._ _ _ __ ___. secs___ _.._secs. _
�I.as mer of the property.am exclusively contrxting with licensed conuac[ors m
construct the pmjen(S..7641,Business and Professions Cod.)The Contractor's .•. •t.,'.
License Law does not apply to an owner of property who Wilds or improv.thereon,
and who comencu.fos such projects whil,a.comenctor(s)licensed pursuant in tW_ 'EXP'
_ _ ----- ----- --
Conuacmr ice law.
Olama pt under Sec. ,B&PC for this season RE
rt Dam I I1DoL
r WOR 'S COMPENSATION D LARATION
• Ihertby aRrm under pewlry of perjury os of the following d.lam[ions
❑ 1 have and will rnh main a cmiBcme'of Conus m self-insure for Worker's
Compapaptipo, u provided for by Section 3700 of the labor Code, far It.
performance of Ne work for which this pcmlit is issued.
01h,
'
Ibband will maintain Worketc Compensation Insurance,not strained by Section
3700 of di Labor Code,for the performance of the'work for which Nis permit is
issued:My Workars Compensation Insurance carrier and Policy number art:
.. - 'Ca`mien i ,secs.. •s'k:t_•. +Policy No.: - - :sae's %1 'i'gi%.,I„q_'\,!.. .,_1.,,•�' secs.. ,,.I.
CERTIFICATION OF EXEMPTION FROMWORKERS” t s-. :1. a
` •. COMPENSATION INSURANCE"
r1bis'.ciuon need not be completed if the permit is for one hundred dollen
IS Had or less,)
..._ — _..�. secs secs .. . .
ird.
1 Cenpl that m the n i nmmn[e nn the work for W me subject
ct to the
y Workers'I
shall not employ any person m any mdnnes so as m become subject to Ne Worker'
Compenss Laws ad California..Dare"
OTI_E TO APPLICANT:If,after making,this - -_- - _ secs secs. _. _.. ._secs ..__ _ .__.___secs secs._.. _.
—Applicant
Certificate of Exemption e.you midst
tincome'su mop to the Worker'sor,ims or his Provisions of the Labor Cade,you sun
Q
Z.
fortnwiN comply with such pmvisions or this permit shall be deemed rooked
z
tt .y,;."'CONSTRUCTION LENDING AGENCY' "r
"PI hereby afimfthat there is a commandant lending agency for the performance
T W `�.r of the work for which this permit is issued(Sac.7097.Civ.CA __. --- .._ ._,-
Q -;Under',,Name ' ._. r � ._ :. _'_. ' secs .. _ secs . ._ secs .._secs ._. _..._. . . _ .
7 �• LendersAddress t _ {)t:'_'
.U I cam y Nat l have mad this application and state that above information is
kL E. cbrrect.l agree to comply with all city and county ordinances and state laws miming
U to building construction,and hereby authorize representatives of this city to enter upon
(a� the above mentioned p-pe ry for inspection p rpo
q (We)'gmen,save indemnify and keep hrr is the City of Cupmino against
VI liabilities,jdgmems costs and expenseshich may in any ay accrue against said '
V y Cry n consequence of[h g i ng of tht petmn n
SPPLI: TQ,14IDERSTANDSAND WILLCOxLPLYWITH ALL N ^JP INT Issued by: ! Date
T1_ ilha
mumof Applicant/ .411 Data Re-roofs
IAL
.:HA'LA OUS MATERS DISCLOSURE
WIIIN 'ppbc m t Wddng rocaparimmen handlataiamdmamaterial, .._Type of Roof . . _ .m. secs...._ _--- ----
a _. ._
defined by the Corona.nMuni pal Code.Chapter 9 12 d theHealth and Safety
. Code Scoriae
eT12(a) -�NO s''� (, sn l 7t{
All roofs shall be inspected.prior.to any roofing materia]being installed ,.,,.
Will the,appl a t r[ _b'1a g c_ p n�n.e eq p t ee.�c men If a roof is installed without first obtaining an inspection;lagree to remove
cm n htantrumsairc t t.as defin d by the Bay Arc Air Quality Management
District? all new materials for inspection. Applicant understand_s and will comply with
❑Y drvn all non-point source'regulations,`
-. I hove rend the Safety
Code, materials gmremcma under Chapter Est of the
California Health&Sofas anyhaeeami SSO&255U yrespo34.1undemmnd Not
ifthe building does not curzemlyhaveatenant.that it is my responsibility to notify the
occupant n he seclaii na which most be met prior to Issuance of a Certificate of
p ( ( rr'' Signature of Applicant Date
Owner or nm� r� _ Data secs ._ . All roof coverings to be Class t,B„ or better
. _.. ,. ,.,..:. .,.. . .. . . ., ..- _ " OFFICE. .