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CIBUILDIING DPERTONNO
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
21821 MC CLELLAN RD
02080135
UB DATE
APPLICA08/23/2002
k3yg�r'�S9"XUNG & PHILIP YEN
PHONE:
SANITARY NO. CONTROL NO.
ARCHInC`DENGINEER: «
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LI U L_I L_I
LICENSED CONTRACT'OR'S DECLARATION
Job Desc ton
loony klirmIhm1am (commencing
DEMO 10e1VALE®
m3li1B,mastProvisions,i esC.d9(commencing
with Scaion9W(11 of Division J ofine Business and Pronasions Cuec, Brener
is in full force and cffcn.
License Class Lir. x
Date EC
SEP 1 0
ARCHITECT'S S DDECLALA RATION
2002
1 undemand my plans shall be axil . public rtcoNa
Licensed Professional
OWNER-BUILDERr.amp,DECLARATION
BUILDING
I hereby .(item Inm 11. exempt from Ins Contractor Lkrnx Taw for the
o
following reason. (Section 90]1.5, Business mpr Rvfasims Code: Any may or roomy
$16000
whim requires a pilar, improve, demolish, or repair any uncture
core.
-- -
da, for such pemuuolike
poo t is suadlano eort9 - tae
e, Mus, re
,,���. ae
.l's•. ?3 YHi ,,Tr, VT3 s _•`.'f
�'}, t } r„ .. „ !Is..I IA tn. isl;
Valuation
Law (Chapter
that he is licensed ySectiot lithe ofprovisionson the Contractors License lawim, Casr9
f
(cpm c g,with S¢ton]11001 ofDivision l of Ne eusirmsa and PcNessions Code)
or that he is exempt therefrom and the basis for the alleged exemption. Any violation
-of Section 7031.5 by any applicant for a pemdFsubjects the applicant o a civil Penalty
r of not mom than five hundred dollars(5500).
NO AMNsNlov INSPECTONS"
' Occupancy Type
❑ [,;is owner of the property, or my employees with wages as their sole compensation.
Required inspections
will do the n k'and the structure is not intended or offered for sale (Scc-7046,"
Bds d Professions Cody The Contraan s License Law does not apply Io an
owner of property Who builds or improves thereon. and who does such work himself
or Through his own employers, provided tart such impro, nm intended or
�
.. .. ---_. _.. ._ ... ...... . . ....._ ... _ _. . .
�-���- �� -
is sol within ar
'IoRcicd for oak. If. hmwcv<r, the building`--� wtis sold within one year of
Y
lmproof
r. t
e
will have the buNen of proving that he did not build or
ownemh pro
oprove
for ander
improve for p,rry:x,r arae.).
pa
t2rh asowner progeny, a usin vi sly contracting with licensede m
'
haractx
Character's
consumer the project and Code:) The Contra
no (gee. ]loan
reach.
an owner of Properly who builds or improves msmam,
does owner o erry who
naw d«s not apply
Licensewho
.mdwhorontmens for inch.Prul11.1.iNa.cmntrecsortst harped.pursmnt.Io.toe._
,
Contractor's License law.
Olam exemp under Sec. � �'�' .,. s�'r( 'BBsPCfonhism
er ate
,
WO K COMP TION DECLARATION
v
' 1 herchy affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a CenlEcete of Consent to .self -insure for Worker's
Compensation, as provided for by Section 37110 -of the Labor Cole, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain Worker's Compcnr tion Insurance, as required by Section
37M of the Lahr Cole, Bir the performance of the work for which this permit is
issued. My Worker'd Compensation Inzmanec carrier and Policy number me:
t;g:. Policy No.: -
..] .7 s. ,. m'•a,bY 1' ,'r L;,,l..�.
1 l�'1' t'•'pl I.i y'• 1 : Y } :� i (7.11
1 •' . CERTIFICA'T'ION OF EXEMPTION FROM WORKERS{
:S r x'•.;S s .
' COMPENSATION INSURANCE" } ,-
..
l" 'mrii union need nm h completed if the permit is for one hundred dollrrs
(SIM)or less.)
.•..'-i aeriey'inel in the peefonnimie or me w,ri m. wnkn iris permit .e i aged, I
.'hall
- . r .: ,i .. '
s ,
res. `` ,'
r '
n t e PI y any pc a Y e be u bI t I Ih Workers'
aa55
Csmpe s u La ofC I'f i D'! ✓ 02
Aliph
' f0 PLICA II f k g th C n Iia t t E gti y should
bernme subject to Oe Workcri umpcnsm on pnvsons of lM1<Lanur CnJs, you moa
,Co
Itrnhwith comply w'nM1 turn provisions or this amtit shall be deems] rtvokcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is u construction lending agency for the pe,fico a t<e
r
of the work for which This perorit is issued (See: 3097, C'w. C.)
..........__. __ ......_ .._ . .. _.. .. .... .._.._ _ .. .... ..
ame— _. .: .._.. ...:. ...-. ........_ . .. ... ....
..Lender's Name-
. ...... .. .. .. ... ..... ..
Leader
Lender's Address
1 an tom 1 have read this ion ane state information is
ey all ciry irk county oNinonces and state laws miming
m 1 city mad anc s a d So
to soon.
Wes.
and h
Wilding construction, and hertby ambodu posemativo of this city to enter upon
risebuilding
property for inspection purposes.
u
Ne ahWO
irgiuncd
(W'dxgme the against
smsi rund keep hamay
in way a cone.,.t
liabilities, judgments, rose rad eapanxs which may in any way uccrve egainm said
ts. costs scat v
of the gmming of this permit..
City in CANT
Ulcre
APPLICANT UNUERSTAND54' WILL'COMPLY WITH ALLNON-POINT
Issued by' Date
G . ATI
SOURCE REONS .63102
�• _ 102
y'
Re -roofs
i,rature pplicmmf" at
HAZAR$ 5 MATERIALS DISCLOSURE
' Will thppLr I or future balding occupant since or handle hentardmis houracriad
Type of Roof. .. ..._...`. •. .'•
_ as E Tried by the Cu,acmno Municipal Ced Chapt 9.12, and the Health and Safety
Code Section 25532(a) -i
,. '. f ,, ... i I I tr ° 3 7 Y' f •, ( ti
a
°Y' N 1 Y' I (`
.. ,
All.roofs shalt be inspected prior.to.any- roofing .material being installed.. _
Will the ppl c t urfunum building I use,niprout ordevices which
If a roof is installed without first obtaining an inspection,' I agree to remove
rim, Winumm,rrco rano m rscWmcdby the B.yAm.Ai,Qmni1y Management
'Dislrla7�/
all new materials for inspection. Applicant understands and will comply with
iter,• keN, -
all�non-poinf source regulations.,
,1 have mad the hanallous materials requirements under Chapter 6.95 of the
Califomia Health k Safely Code. Sections 25505, 8533 and 25534. 1 understand that
if the building does nm cumen0y have a Iewnt, thin it ix my respureibility to notify the
-
oecupam of the requirtmena whir ust be met prig m issuance of o Ceniftcme of
Drr"panry
!%,..
Signature of Applicant Date
1310.2..
All roof coverings to be Class "B" or betteriff'
Owner mr thri<ed rgm ': DaI
.. .. _ .. ..OFFICE
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