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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
21821 MC CLELLAN RD
"M11W: YEN & ERENE KUNG
PHONE:
ARCHITECTYENGINEER: I
LICENSED CONTRACf0 'S DECLARATION
1 hereby affirm Ihm l am licensed ir ` pmvisiom of Chapter 9lcommeming
wilt Secuon 000)of Division3of the s and Professions Cade. and my license
Licenis in se f and cB0 Lz Lic. x t:> 1 t t00
DoIC � Cdiraa
ARCHITECT'S ARATION
I understand my plans shall be used as public rtcoNa
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Comment's License Law for the
following mown. (Section 7031.5, Business and Professions Code: Any city or counry
which requires a permit to consumer. alter, improve, demolish, or repair any slsucwre
prior an its Izwance, also requiras Uie applicant for on permit to file o signed summenl
be is efiempt therefrom'aad the
lion 703 L5 by any applicant for
more than five hundred dogars I
owner of the monenv. or my cm
Owner of propeny Who holds or i
m through his own employees. pct
offered to, sale If, however.he k
completion, the owner -builder will
as Their to compensation,
offered for sale (See. 7DN;
se Law does not apply to an
who does such work himself
wamems art not intended or
at is .sold within one year of
twin, than he did not build or
_ ,lJ Cas mvnpr m the progeny, nm exclusivelyeomracnng with licensed contractorsto
_ -construct the project Sec. 70W6. Business and Professions Code:) The Contractor's
License Law does not apply,, an owner of progeny who builds ser improves thereon,
and who contracts for, wch.projects with a mntractuds). licensd pursuant. to. dm..
Contractor's License La -
I mescmptunder; Sc it I'• ;B& P C, for this reason
Dave'
WORKER'S COMPENSATION DECLARATION
�Ihereby Uffirm moto.penalty ofpcje Of the fll gd I' I' -
( ❑ I li a and will7mainoto ro'CofficateI Camcut to . If' re for Workdc
Compensation as provided dor by Section 3701) of the Labor Code, far the
performance of the work for which this permit is issued.i .
❑ 1 have and'will normain Work'er's Cd'mpcnlmion Insurance. ai rcquircE by Section
'37M of the Lahne Code
as;u d: My W rlo's Con
G.... Tom.,
.1 COMPEI
^fn, (This sktion need not be dt
($HXd or is".)
1.. iii. . e,
CONTRACTOR INFORMATION:
PERMIT NO.
ACME & SONS SANITATION/ELE TRI02090089
3408 HILLCAP AVE
(408)295-2263
)uB1UAh
6 2002
NO. CONTROL NO.
BLDG ELECT PLUMB MECH
L:1 L3
Job Description
TEMP
2pk1EAILED
PP�IIllS99ElNPI! 17 2002
BUILDING $300
103
Required Inspections'------------
LARf van r;� r7",".
OI.ILP."w l•Ii1:\tl, ICP.
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I ! t Ss. i laR t�i Ll. lvi�i lax. .
N INSURATCE` u a I __...
I if the Permit is for one hundred dollars j"PN 'il ., l): L'. �'%'.'1 71 �I
m,,wndt rnr wrote mikpernh is atoll. : i' itf.; ,,,; •rci Irst'ertl79::":.' �11 C.'L
.r so as no become kohoo to the Workers .
Z become subIcel to the waacrSCompenwtion pmvinnnzot the l UUT Uwe. You mus,
Qfonhwilh comply with much provisions or this permit shall be deemed mvoked.
_..._._.___.._,.,._.._..,___.____._..._-___... _.—._....._ _ _._—.__...._.._..___._._
y'„•'a.","cn•s'.b:.3CONSTRUCTIONLENDINGAGfiYCY,'ine
"' 1 hetebY ofrtn that the is., onswnion IelMing agency for the peHtismantt
'of thd'work for which this .if is mooed (Sec. 3197. Civ. C.)
❑ Leader s Name
_V O
Lender IAddroll- -
I nfy that Ili dtgl, application d.t.thatI above fommuon is
'3a Fw correct. I agree to comply with all CIY am county onlimance, and .l l , train,
w Wilding congmeiio. and herebyamhonze represenml yes r this city to enter upon
:the abovciricmihncd progeny for inspeown Purynus._,,,, . .
' a
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-- �ICi. It.'ni Tlf\U'll
C.liabilities.judgment, 1. C .1 d tense which y any aY _ against Bald
Cityconsequence'of the gruntingof this,runt.
`APPLTCA\T UNpER$Td\DSA\DWI COMPLY WITHAL{{-LON-P/dlls7'`
SOVRCF ULATIO 1' •• - 600274
/,,?Date
Issued by; Date
Re -roofs
�S,(/aturc aP t t „.,
DISCLOSURE
HAZARDOUS MATERIALS
so u U applicant r in building w 1 1 re rn nd1 ha;did mmenW
.Type
as defined by the Cupertno Mimici,iA Coda. Chapter 9,12, middle N Illi and Safety
F-. ..1. 'i •,r :.)i 4 st:
Cliae, Section 355321a)ss 3 f IIfD ..x
❑Y „ JQN ?
,y,.
to.ang roofing.matenal being installed._.-
All roofs.shall be inspected,pnor_
ell@ f<ntl tI rch ldi ruse In dcvicee which
pr v g then n P
_. ,. ,.
If a roof is installed without firs[ obtaining an' ilispecuon-'Iagree•toremove
onnii haiardo, air contaminants .defined by lh Bay Area Air Quality Management
District'
all new materials for igspgc[ton Applicant understands and will comply, with_
a11`non-poin[s'oui'ce regulations...,:�u
1 have zreadIM1e h rd i mdlenul equ remcnu under Charter6.95 of the
Cal 1 is Health &.Safety C'deseclions 25505 25533 and 25534. 1 undersmnd Ihat
--- - - -
Ath'e jniilding dues nm currently ho ver, heCthIt
" �,.... ...:dtremcmy which'iiit he l'et it is my rcsPonsibilitYmnoffy the`
�•����_• "nor l'o'isamncc of u Ccnific m of
-"" -_" -- v)
r
,m q . Signature of Applicant.. _ , - ... _ _ ., _ - -,_.. - -Date.
"dale ; All roof coverings to be Class B" or better '