00030003 CITYUI DING mvisRiONNOPERMIT -CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7505 LEEDS AV 00030003
OWNER'S NAME: APPLICATION SUB DATE
DE LA CRUZ BRUCE N AND DELACR 03/01/2000
PHONE: SANITARY NO. CONTROL NO.
s
re0 ZO ARCHITECTIENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
afi« 1-7 CJ I'-'U CJ
Z 5 h= LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_ 1 thereby aRrm tham
t 1 am licensed under provisions of Chapter 9lcomencing
F,4 t with Section]000)of Division 3 of the Business and Professions CMG,and my licenu 19 5 S Q. FT. ADDITION
is in full force and e0eet.
3 U Date class Conti FIN q LE®
Date Lic.0 car r ,m�r�
F O fn ARCHITGCI"S DECLARATION
g 1 odemand my plans shall M used a,public records
E. o o LicensM Professional JUN 0 6 2002
OWNER-BUILDER DECLARATION
or I heuby air.that 1 am exempt fmm the Comm�or's License Law for the
?a g reason.(Section 7031.5.Business and Professions Code:Any city or county
HO which nq ' apamt m construct alter.improse,demolish,or repair my strunurc BUILDING $18486
Q _.pn rto itsiWmnce.olsu felam,thepplicm fa such permit to fleastgnWsasement.
(h^hq I,licensed puhuudd,provisions th Comment's ants License Law(Chapter 9 sp a�6� a- Valuation
g with Se It 7000)of Division 3 of the Business and frpfSu ons Code)
or that be s exempt rherefroid and rhe basis for the alk ed aunnpnn Any violas on
-of Sectio 7031.5 by any applicant for.pemrit,ahj«ta me appEcnnt m a civil penniry
mf not more than Eve Warned notars Ui5fa/. 101 APN} AT I ON '- " Occupancy Type
01,as owner of the property,her my employees with wages as their sole compensation,
or offered for not apply to an' --- - --- --- --
-wdf du'the'walk.and he umcwrc-isnot intended - Required IUSpeChOUS l"
'owner ss,.,,,y Who
CMe:The Conbncmrs License Law Joss not apply m an 103 - UFER "
canerofprogeny employees,
mbuildsmimprovesat such andimprovements
hodoes
am
kndedor i
o through his can<mpl ye .provided that such mprov s r intended or 104 - REBAR__, . _ _• _ _ ___
off rcd'fdr saleIf. the'building onmpmvemmt Id ohm one year a, 105 - ANCHOR BOLTS
completion, owner-builder
r budder will hove the burden of proving thin he did not build or '
impro.emrparpnaanfame.). 106 - SEWER & WATER
- — -- -._..... .. _ _. _._. . -- - . .--
❑has owner of the (Sec.
7 em Business and
with Carlo)
The Contractor's m
2 02 - -UNDERFLOOR:-PLUMBING-'-—`...--�
construct the does
(Sec ID4a.Business and Professions CMe:)The Improves
trecmr's
License Law aneanot apply tnanowner nfprnpenrwho baudanrimpmuamerenn, 203 - UNDERFLOOR MECHANICAL;(" '
Co-.ho cs License Law P 1 os).lietrod!pursuant m.the. ..._..._..._._.,___...__.......-..-..:_...
and who eommds for such. ,oats.wIlh a -'� '----' 2 04""=""UNDERFLOOR"'FRAME
eon rano
❑lamcxempt under Sm.
,B&PC for this.... 205 - UNDERFLOORf' INSULATION
,Owner Dau 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under pcnalry of perjury 6.of the following declarations:
303 - ROUGH MECHANICAL
❑ 1 have and will maintain'a CaniReau or consent to aell'.insom for workers 3 04 - ROUGH ELECTRICAL
Compensation.-itsprovided for by Snion 3]00 of the Labor Cnde, fm the 305 - FRAME
_ 'perfonnan eof at Ne ork for which this peromit is icwM.
❑1 have and will maimain,Worker's Cosmic'nurion Insummal.as required by Station 306 - HOLDOWNS
3100 of the Labor Code.for the Performance of the work for which this permit is
issumd'My Walker,Comm tion lnsumnce carrier and Policy number arc: 307 - INSULATION -
a. ..,r I l .;Pduc,Nr,: 306,..__ SHEETROCK ..._.... _ . ..._._
i CERTIFICATION OF EXEMPTION FROM WORKERS' - g .5 w�3t09.. �(!E}CTE-•'RIORs-L'ATH�• '
COMPENSATION INSURANCE
4. - ... .. ._... _..� ...... .....
_31'0`;--., INTERIOR 'liATH . -
(Thu saiiori naJ not be compineJ'f the permdollars
it is for one hundred dol
lelao) n«
or less 311 - SCRATCH COAT
_. _. .._ ..-' - 313' - ROOF NAIL——
I unify thin n the pctf tat nee of the work for which thn perm t u rssued I " -
shall'ms employ any person in any manner so os m become aub3ect m the Workcrt 3 15 - EXT .S'HEAR
Compo set L I Cal m e D te po man - FINALsubject
.: ..FINAL. MECHANICALNERGY--ENERGY ... . ._... .....,
'NOTICE f0 APPLICANT If after maks g th C rtnc�au of fxempo n you should
z N 0AtotheA kisof mrin tmnpr vso y NERGY•
0 D forthwith
orth th c ply nh h p pe
z . _ _ . - -
'-' LENDINGAGENCY.' - 504 - FINAL BUILDING ENERGY '
I herehy o1Rrm that there is a amilmoniun lending agency for the perfomm�ee I'r
ofthe w.,it far whichthis permhisissued(S..3091.Ch,C.) - 505 - FINAL ELECTRICAL '
W7Q�
Lender's Na .. _ _. . _ _ _. . _- .... - __ _-.__ ._. ..._ __.. _.... __-. _.
nndraAdd 506 GAS TEST
U'Q ,Icertify that ihave mad this application and state that the above information's 507 - FINAL PLUMBING
PLUMBING
comet:I agree to comply with all city and county ordinances anti state laws relating
508 - FINAL MECHANICAL
building construction.and hereby authorize representatives of this city to enrerupon 509 - FINAL GRADE
rg) the aMm
ve- entioned o
property for ,penion purposes.
�., Q. (W) gee,to a indemnify and keep hand ithe City fCpahmm agains
VJ limit t 3 dgments c t nd earame h h may any y accrue egvmn said 510 - FINAL L ING
U„7W. city consequence of the gm tng of this permit. 14 Fi F A WORKS
APPLICANT UNDERSr\NDSAND RILL COMPLY'WITH ALI NON-POINT' DatO
SOURCE RFOULATIONS ”^l ISSlled n
-1 Signorina of ApplieanJContmaor;`L "' Date ' Re-Co�'92" - ROOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE .
3 W II
that applicant or fiat a bu lding occupant to.car handle haiatdous menial Type o Roof.
as lar 65 dr (Tonsil Municipal CM Chapter 9.12.and the Health and Safety !' I_- '� •' ,: ' '- -�-
CMCSaf n25532(a) , . ° x s' "s jY�' it }}`f"s t' "?,tfa:" ' '
t, All roofs shall be.mspected pnor_to_any.roofing material being,lnstalled _
",: r Willtheill amoral bola g < pante eequii,Qu dMaa, ni If a roof Is installed without first obtaining an'ins ection; I a rde to'remove
'a r t h� d n r mm t.as dcfineJ by the B. A,[a�k Quality hlundgcmem g P g
District? _ all-new materials for inspection. Applicant understands and will comply with, .
" " ' all non-point source regulations, ._„•_ t ,
I have read the huardous materiels requirements under Chapter 6.95 of the
Cithfomia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that
. . _ .....__ ......
I 'he buildit does hot eno,amment, yhave
'mou be t,ta,prior
ismyaymnotify the
Oc up5m of the requircmenta which,mu.st be met prior to issumma of n Certificate of ”
• papanry., - Signature of Applicant Date
r.:..,
ownerorauthonamageatDare All roof coverings to be Class "B" or better '
OFFICE .. ..