02030211 CI saOF CtNO
BUILDING NG DIIVISSIONPERMIT , CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21045 LAURETTA DR. 02030211
�NER'W
S NAME': APPLICATION SUB DATE
SURENDRA NAZK 03/28/2002
,PHONE: SANITARY NO. CONTROL NO.
Qs
m µt O O ARCHITECGENGINEER: BUILDING PERMIT INFO
8 ,1�-• BLDG ELECT PLUMB MECH
E - � LJ I._7 L.7
n Z LICENSED CONTRACTOR'S DECLARATION Job Description
i z- 1 hereby affirm that I am licensed under provisions of Chapter 9lcomaneramis
,yC with Section 7000)of Division 3ofthe Busincs and Prof nsiauCode,endmylicense ADD 168 SQ. FT. & REMODELING
j is in fall fis
ndc
: � Lrmu l' (ao� u .. 09 �d KITCHEN & DINING.
0 o rip Contin r �pl�mr(�
3 3 u.In l'( ARCHITECT'S DEC ATION t'•'ts•I3
u.O g I undersand my plans shall W used as public records `en
1 p O I.icemed Professional OCT 2 9 2002
Oe,I am exempt
from
DECLARATION
u� m 1 hereby ffnn thin I 1 xempt from the ConuanC s :Anse Lew for the
(:�_a following (Section 7031 3,Dui nets end Professions Code:Any my or county
F❑ which requires a Permitto consumer allar.improve,demolish,or repair my swcmm ,{jf; a
° 3c� -Tinto t ' Iso requerthempl'emt for such permit to File.signed'...... _
thut he islscanned pursuant tothepovi ns of the ConuuctntsLicameLaw(Chapter 9 S FtFlOOrAreas� •r- - Valuation
mom ring with Sectin7")ofDivision 3 of the Bupness Ppd prof os Coda) l'.l'1i s.l.kS%,q'�.Ls.at a_aa•vti kl�T'�,rLF l.4:
mr that he rs exempt ibarefr�m and the bas s for sena alllgeU nemprmn Any vtolaum
-mf
mrme norm In m five hundred
.atemnors a Iznniuubjaa ilia applimm to n civil penalty
(asooj. 2 umber Occupancy Type
❑I,as owner of rhe property,or my employees with wages as their sole compensation,
-.ill'dm'the wdrkl-mdthe structurC ii not intended or offered for sale(Sec.76141" - - - - -
$ sio
beincieand Profens Code:Thr Contractor's License nLaw does not apply 1.m 102 - P I ERS Required Inspections
owner of p opcny Who builds or improves thereon,and who does such work himself
or, h h' o mployces provided thath improvements arc not intended r _ 103 UFER
offered for side If however,the haldmg pr ve em ii cold within one Yen of ""-""'_ ._ -_.., .. ._....._...... .... ._. _... .. ........ ....__ -
completion, 104 - REBAR - <'%
P pmvingNathed,dnotbuildor 10.5_ - ANCHOR BOLTS _�
improve for purpose of ale.). ,
c...._.__.. contractors to _ _
❑Los owner of the tort_. .._.....tort_.
property,am Business and nvamisionsC licensed co Contractor's
ncmtnr° O6' - SEWER .& 'TAIA'1']!]R"' f
- _ Dreamed the proses (apply to a Business and Professions Cade:)The improves to thereon,
LicenseLawdoes not apply Nanownerof a contrwodid,Udsorrsuainho 2 0 - UNDERFLOOR PLUM&ING
..rod wuchre, kens.Laue.ah pmjects.wiuh a comncmr(x),IicetvM punuenr.N-the.
' contmentsuanseLaw„ ... . - -•---- --203--=-UNDERFLOOR MECHAN'I'CA'L - -- ---- - - _
---' ❑late exempt under Sec."' 't '-' ,B&P C for his rcewn 204 - UNDERFLOOR -FRAME'S
Ownr
Data 205 - UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby affirm ander prosily orprrjuryone of following declarations: 302 - TUB & OR SHOWER
-. -
❑ 1 neve and will ro.iutaii f Cenificen"or 37006nsof the Labor
for workers 3 03 ROUGH MECHANICAL
Compensation, on ark rod for by Section 3]00 of the Labor Code, for the
_ s'per� emanaatmewaI ls*, I .rmuisi see. 304 - ROUGH ELECTRICAL
I ha e antl ilr.;'m6 n Wo k 5 Cum'peniut n I s ranee required by sectmn 3 05 - FRAME
3700 of the Labor'Code for'dic perf hhm c of the work for which this permit is
t mea My Workers Compere t t l arm5a came end Policy n robe ore 3 06 HOLDOWNS
..r ., t �� ,( _�..._. . .. _ _
.., f
�unerl.�,C7 TIFICA.Ubfs of}p1lgi No JYO/51x0/ -. 307;I. 1. zNSUJa11TTONI•�-
CERTIFICATION01 ;1vtP1'ION FROMWORKER.S't ". ii'1it 16Z.3,08v it GS'HEETROC'K
r'.. 1'I'hts union neW no0i bemm COMPENSATION INSURANCE,° r "
_,, ..._.---- 3'09;x. 'EXTER`lOR"liATH
(_ h„ -
p ted if the permit is for one hundred dollarsJ<
s�00j or leu,) f _ „ ., 310 - INTERIOR LATH
" '311 SCRATCH-COAT
Co I em(y that in the pe o ma t of th workY' which NI perm t ti Issued 1Istria, '"-
Fll not empl y.ny K any manner am is i become subject to the Worker'
313 - ROOF NAIL' " '
mpd'ub laws of Caldm Otc" `
Appl ---501--. _FINAL.-.ELECTRICAL,-_ENERGY--- -
NOTICETOAPPLICANTI(after making this Cemficate of Exemption.you should
z beejegnorho WoP of the Code,you 502 - FINAL PLUMBING ENERGY
OO forth with oit ply with suchprovt, orNispamitshahedomdrevked.
s .
::✓ a.
503.._..-.-.FINAL..MECHANICAL -ENERGY-,..-,.-,
K 1'^CONSTRUCTION LENDfNG AGENCY '•^ '•C� - t.
t-' v3 - Ihre elfmiNatNeu a ostiut nlenai 504 - FINAL BUILDING ENERGY"-
by gg g cy f r Ne performmce
a' of rh rk for wMkh th a r, fetl(sec J09] Cv C)
50 '
,W-p sena Nay. ' t • . ,.,; 1.. .• ..� , _ ._.,.._. _. .5,,,-. FINAL ELEC_TRICAL. _ .
_..
z sneer 'Aeeea 506 GAS TEST",
U'O lseriiyNatunavete.dNuepplinnonmdsateNetNeabovem(onnnionis 507 - FINAL PLUMBING'
OLaac[r coired•1 agme to comply wiN all city;enE coumy�ominenas end sten lawn relating 508 - FINAL MECHANI CAL
sp upbuilding conswaion,end hemny authorize rcpreienativrs of inti cirymemerupon /
,W the aWvemem mncd pmpenyf ,' P<lionp rpo s_ ,', ,. 509 - FINAL GRADE
G. 1We)Sgreem ave and m ify dkeep hanNeas'Ne City (Cupenmo egatmt
h Habil t es,judgmaa,costs end xpmso wNch may n ny w y accme instant
nst osis 510 - FI NA P I NG
V City m consequc ce rot Ne grnnung (Nit pemdt ' ' - 2 Ay
SPPLI �UNDER. AND WR.L COMPLYWITHIAt,L NONjpOMT '' ISSUCd 1151 IN C WORKS
�LiYi-7?�',l� y' Date
3t ipmwml&`Appllamde ntrwmr - - One-.'::' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
W1i11Ne appl ter orf N pudd'n nc
g ha tnoreoi ad
hazaldir amental Type of RGolf-.. .. . ... ..
as deb ed io Ne Cupen n : "Municipal Code.Chaptec9 12 end I- He IN.d Safety -
cnaes�eaYnzss3ua)nr 1 e; tr � " t dj�. f1'F s1
r` t All roofs shall be inspected-poor,to any roofing material being installed.
„wnm appica f tuubulding occupant useequipment o devioeawnch If a roof is installed without first obtainin ins ';ectfon;I'a res to'remove
mithznN air tamamis.1dfinedbythBeyAreAir QaltyMnagment g P g
DRme6 all new materials for inspection. Applicant understands and owith
- P nwill cmply
_ _
t,L ¢ all nor-point source regulations
1 have read'Nehe{udous mamd.1,tegmrements under Chapter 6.95 of Ne
Celifom,a Health&Safety Code,Serious 25505t25533 and 25534.1 m demand that
frhc1!bdddh.,does not mrtently haee tenter Nett my responsibility to notify the
-
pan
oa pent rcqu arttenn which drubs et pit eto tnumo f e.Cemficste of r
Signature of Applicant Date
..1 bwne .N nuJ agate .1 ate, All roof coverings to be Class "B"or better '
stoatt - ._ . ... ._. .. ._ . . _._. _._. .__.. _. ..
OFFICE , . _..
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