01060103 CITY OF c DON
PERTNO
UIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19675 LA MAR DR A PERFECT CLIMATE 01060103
OWNER'S NAME: APPLICATION SUB DATE
KAREN POON 10570 5 DEANZA BLVD 06/18/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHRECT/ENGINEER: BUILDING PERMR INFO
O
�— BLDG ELECT PLUMB MECH
8,ae
yi LICENSED CONTRACTOR'S DECLARATION Job Description
OZ—O I M1ercby off roe that 1 am licensed under provisions of Chapter 9(wmmencing
p yLw wan sention7lrxll nr Divi.ann3onM1e eaamesx arta pmressmm Bale,arta my license CHANGE FURNACE
a �; iainfuh Cl... serf —, & ADD A/e. FIf�BALED
a,ae uenna ore � u<.a
O Dae Contra;
LLO�2it A CHITECT'S DECLARA ION
J 1 understand my plum shall M used as puhlic records
=LL;
ce
a S o c Licensed Professional JUL 3 1 2001
OWNER-BUILDER DECLARATION
u�=LL I hereby affirm that 1 am exempt from the Contractor's License Law for the
c-i< following reason.section 7031.5,Business d I or:' Code:Any city or county
I x p
which requires a permit to construct.after, p demolish.or repairY smactumG. ....
so 3 a prior to its 1so mquircrithe applicant for cuchpe t so filetti,igniall soneraterst.
mane
listrilaolp int 1.flivip f0 Cmmiarim,License La,ch.,pmrIf S Ft. Floor Area - duction
(enmmurs
in wlh Section7u00)otUvisum 3ol the Busne.and Pericss'oas Cole) s_' \ ',IG _•..AS a \t\ .
Lir that he is exempt therefrom and the basis for the alleged aemption.Any violation
-of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty
-
.ofnotmomthanr hundreddollars(S500). SV� umber ,• " Occupancy Type
❑1.as owner of the property,or my employees with wages as their see compensation, —
will do the work:and the structure 1, of intended m offered for sale(Ser:70,14, -
Business and Professions Cede:The Commcmrs License Law does not apply to an 304 - ROUGH ELXQ9iR110TFCetions l " 1
r of property Who Wilds or improves thereon,and win does such work himself
ow rintendedor 505 - FINAL ELECTRICAL
or through his own employees. builcied that men improvements are no ... - _ .. ._._. ..
.ofrueafnr'sale.If.howevu:wibuave tnataidhat he did not .. .f .. .. . . . .. . . . .. ...... ._ _..-.. _.
compluion.the owmr Wilder will love�e MWcn of proving that he tliJ not Wild or 508 - FINAL MECHANICAL `ll'" ••'/ '
improve for Patti of salc.l.
'o I,as owner of me pmpeny,am But 'i,Z a contractingsoo with licensed)The Concmn m
License
me project(S.c.ppl 7(411 Business pro Professions CodeO The Contractor's
Licence Law does not apply m an owner of property who builds or improves menton.
`
ami commitsuch Prajecn with.a.contracmrts).licensed pursuant to the
Comaz
rtoi z LicensecenseLaw.
❑1 am exempt under Sec: _ ,B&P C for this mason •��-
- Owme Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of PcUm,one of the following Jeclmmimn:
J' ❑ 1 have and will maintain'a Cenifcate of Conant to elf-inzme list Worker's
Compensation, ea-pmvidrd for by Section 3700 of the Labor Cale, for the
�,.. performance of the work for which this permit is issued.,
and will maintain Worker's Compenimion Insurance,as required by Section
700rof the Labor Cole,for the performurte a of the work for which this Permit is
' iszuen:My ort rs Compcnsaiion lnsumnc2 ISM
�an-dr P�uliry number arc: '_:
Cnviee' t I' Policy Nu.: y9-p Tit,
CERTIFICATION OI'EXEMPTION FROM WORKERS', - '
COMPENSATION INSURANCE ", - .. _.
' trfhirv',.uo i need not be completed if the permit is for one hundred dollars
(51811 or lase.) ..
I certify mai in the pn in an,nma marine,
cs rink roecame'Lhic e,to
Cmm not employ any person in any manner so Liz to became mbjcn m the Workeri
Cmlicant ionLaws of California.Date,
App
NOTICE TO APPLICANT If.after making this Certificate M Eacarpoon.you should - '-
became vub)eu to the Workcls Compensation Prov s ons of the Labor Cone,yo'most
O forthwith comply with such provisions or this pearnit shall be deemed revoked.
_ . ... . ... . . ... .
!tn ' CONSTRUCTION LENDINGAGENCY
�'> - 1 hereby which this there is
csued(S on lending agency ipr Mme performance
W of n e cork for which this permit is issued fSec.3097,Civ.CJ
CL, me . _ ._
Lenders Na
._ ZLender's Address
U C) I ecnlfY that 1 have mad this application and s,am but the above infi mcotion is
is.'[s smareco I sma,to comply with all city aral county ora n< nd state laws refining p�
V mWId' ycn.wt dh by moenmta fttik city to enter upon
F 0. 4he n c t cJp- r 'pcoprm
t p po. .,
y 1W 1 g m c.mdmnifY and keep h rales C ty f c Pen inst%aid
'Z nebilitics,ludgmmes,costs and expensei which may y n any way deems against hid
U�Z City' aqucnice of DERSTegnnting at this Permit.
A VI'U DERSTAN'DS AND WELL COMPLYK'}TFI ALL/TON-/Pf N'f Issued by:
Date
s) En LATIONS: 1I ,. :.. .:.. - �/ 0
a ofAp IicanUContractor , , rc Re-roofs
- '.HAZARDOUS MATERIALS DISCLOSURE
Will gine al3iicam or.future building o<cunaot store Lir.handle haiadous material; Type of Roofit,defined thyme Copcninn Municipal Cale,Chapter 9,12,and the Health and safety ,
Code,Swion 255316)'1
.'ors. ON.,
-. •''a•!�} __.All.roofsshall.be,inspected.prior.to.anyroofingmaterial_being.installed.
lithe applicant future building oo p- t use equipment or d L<. which If a roof is installed without first obtaining an inspectifni I agree to remove
tiouh Wild n< llt,mdefinedbytn B.,AmaAi,Qrdi1yM ag t'
D t t all new materials for inspection. Applicant understands and will comply with
0 Ye, ElN all -point source regulations.
I huuv rexJ the hirJns mamital,no,
uincrocorl,under Chapter 695 of he
California Health&Safety.Code.Sections 25505.25533 and 25534,l understand that.:
if me building does am<ummly have a motors that it is my responsibility to notify the '
am of the requirements which must be met prior to of a C ficate of
pan<y i.-nature of Applicant Date
soohmiren agent- (Date All roof coverings to be Class"B" or better
L-J. -
,_ ,.. .., �.. ' ..,.. , .. . OFFICE .. ...