02090021 OF
c►BUILDING DIIVL�ISIONN0 PERMAD CONTRACTOR INFORMA N:
BUILDING ADDRESS: PERMIT NO.
22790 MERCEDES RD WM H FRY CONSTRUCTION COMPANY 02090021
OWNER'S AME: APPLICATION UB DA
DAV & MELISSA RUSSELL 10351 SAN FERNANDO AVE 09/04/ 2002
�� PHONE: SANITARY NO. CONTROL NO.
(408) 996-8173
P o O ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Fy i LICENSED CONTRACTOR'S DECLARATION
Z O a+'q I hereby affirm that 1 am limered under provisions of Chapter 9(commencing Job Description
rfO MCgq.I with Section 7000)mDivision 3uf the Business and Professions Code,and my license DEMO & REMOVE JACUZZE SHED
a 7 is in rail froca nde t. �It �a. g
m,2
License cogs Lic.g S'ZO 75f FI H X11 i� LE
%3 u O Data 5�-9—oZ coal. .r M H 1.1 10 oa-G
W ARCIi1TECfSDECLARATION
u JUL 2 2 2003
s. O I understand my plans shell be mud as public records
6 E¢p p Licenud Professional
S•s�, OWNam ER-exempt R m the Contractor's
W I hereby oRrm that 11. .Burin from the Comment's License city
a for the
BUILDING �S'4 5 0 0
following reason.(Section]031.5.Business and Professions Cade:Any city a county
E Z O
which mi,ims a Permit to construct.alter,improve,demolish or repair any swclum
c.tics 3 -Poo b m ssuam el req,res Ne ePPlnam far such permumo fileaugned soununt-
_._
(c the i. ng with Se ColtgNe ofDjsonsof o ComnnohLnenuLaw(Chager9 n r a, Valuation
(cm ecngwlh Smmo ]000)of DivmsmonJofthe BultpesaaMPryryfmaoms case) f;�). I;3` A', @� Y��r,\�.i. ?'E9,;'
or that he mi exempt lhererrom'mnd the basis for the alliged chimptiod.Any vola ion
-of Smile.7031.5 by any applicant for apermit subjects he¢,,kaon m a civil penal �af.a,..Ia�,
.ofnot'more in..five hundred dollars(S500). ry 1OJAeN f"I311* DATION Q.'. �tl Occupancy Type
" 01.as owner or the fmpcny,w my employees with..$a,as than one compensation• 102 PIERS
-will do the work.and the structure If not intended or offered for saIrfSm:7Bf4, 103 - UFER Required Inspections 0'
+Basinae vii&Pldfesrines Code:The Canmam
ntcmr's License law docs t apply mo
owner property Who builds or improves thereon•and who does such work himself 104 - REBAR
or through h employees provided that such improvements rent intended or _ — _
"i cot redirsalerohr-bolt then Iver nmnen of proving that
he
one year of 10 5- ANCHOR- BOLTS-- �,s'• r
completion, m,me of
will have the buNen of proving Nat he tlid nm build or
improve for parpou of wle.l. 106 - SEWER & WATER
.plum-mwner`ol the Property.am exclusively contracting witii iicensd con i,n�o —._._..._.....202--= UNDERFLOOR—PLUMBING______,__.,
,nswct the project(Sm.7044,Business and Professions CoeeO The Comrumr's
203 - UNDERFLOOR MECHANI CAL'1' l i:mr< V,.,:It
License Law does not apply to an owner or property who builds or improves mh rco
and who.commit,for such,projects with o caricaturist licensed pursuma.w.the _,............. .._204'-----UNDERFLOOR--FRAME-= ._.. .._____..
Cmdracmfs Licenu L,aw.,,.,, „
—
Ola
meumpmunderSec; ..,,P ','B&PCforNisrcamn 205 - UNDERFLOOR'='INSUliA!PION
o r tie. 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION
_ 302 - TUB & OR SHOWER
'�"' Ihcrcby affirm under pcnelty,o�perjury one of the fnllowin dcclenmions:-
303 _ ROUGH MECHANICAL
0 1 have'end will maintain'a Cehificnie'or Consent to self-inure for worker's 304 - ROUGH ELECTRICAL
Compensation:-as provided for by Section 3700 of the Labor Codr.for the
_—
performance of the work for which this permit is Issued.,. 305 — FRAME
yn na eand'w01'ma ta' w kit Compesai Is;(nmce,ai rrydmci by&¢tion 306 - HOEDOWNS
3700 f Nc'Cubur Cod far h performance of work wich Nn permit is 307 - INSULATION
issued My Wok C mpen auon l. r c d PoI cy ti mbe a e
308 SHE TROCK ,_ _..
_.
Ae+rtrtiSl ' it " ,4'polry �l9/f 2 L'S2' p 1
ls� I!1,CERTIFCATION OF HXEM FROM WOVKBRSI ' "•?s 30.���t �Y'EXT'ERI'OR!!'LATF'I s: +'•1i�11: 2n
COMPENSATION INSURANCE __--31-0--IN,P�;-,RIOR_—LA,I•H-_ '
'f• DfOhis uctioo nmd not be compg:od if the permit is for one hundred dollars 311`=— I SCRATCH COAT
(SIW) rless) :
313¢.,-._:.ROOF.,.NA3L.....,... __..._...--_� _ .,:_,.,.• __._.._..._, ._
I c o fY',that i o, omKnolls,,t f the work for this permit a is. ed l q„+• D ^l:
'.hot]not employ my persbn r any m n as t become b3 t to he W rken 501 - FINAL ELECTRICAL ' ENERGY
cbmpenpatmo Laws urc urprm,.a'Dam: „ - :: --- --_502 ..-_.FINAL...PLUMBING_.ENERGY--------'-'--_-..__
INOTICEM APPLICANT Writer mking this Certificate
of Exempno y should 503 - FINAL MECHANICAL ENERGY
O Cbac m s bjmt to the Wo kK C pc tin pm ,n of mh lobo Cod you must
mon itb! nply N such ;., n.or permit h Bbea medrroked 504 - FINAL BUILDING ENERGY
',',•CONSTRUCTIONLENDINGAGENCv ” 505 - FINAL ELECTRICAL
.r 1 hereby at mo Nauh s m t n lending alt ncy f mh,perfovn nee 5 0 6 - GAS TEST t i':.l „ rI`. ')n
of Ne work for which this perm t, lorded(Sec.309];Civ.c) - I '
_._. ....— _---------
="z
. -_
E.4; -LmdYrName - 507--'- _FINAL_..PLUMBING
p Z 1< e Aaa _ - - 50 - FINAL MECHANICAL'`'
C.7 .,� I can fy mhm 1 have read Nis application and some that Ne above information is
w L core cel agree mo comply wiN,ell city and cqunmyiorJinances and xwu laws:elating 5 9 - INAL GRADE
D2V tib Id ng .t do and herchy au0m" p olives of this city m enter upon 5 0 - INAL ANN NG
i it'd pr penyfor s pen; p tp, ; -
[•aCL' lWel agree to'rae emnlfy and kephatmIaIiide Ctyorcupcninoaganst 5 - INAL RKS
rq load' 3udgmeat"costs d e genu which may n any y¢cert it inti and
U ZCity c uqu nce of Ne gnmi g f mhi perm t J
TPFI ,AM1TU\'U STA�DSAYDs4ILLCONPLYWtTHAil POLYT' Issuedb Date UL/
SO cC t .TIO, .=/ "'• '1l ya
sg awreofApplicumC.roidmo, 1; .Ij; 1 `hDme�• I`4+G Re-roofs
. ;K HAZARDOUSMATERIALS DISCLOSURE
willyt epCur or future ip c hapt mad�anal , Type 0f ROof
az deft Vi by e a Cupert no Mute buil a Chapter 9.12.ane the Healtn a, Safety a
Code aYea )335J2()1 , orf, - J i, EAs .t is 4>n .I�tilgs ;.'y7+1: y+411 t.: l�;"ti: t s •t
_Allroofs shall be.inspected prior_to.any_roofing.material being installed.—.. -
W;II the applicant or future Deco am use '
I PP 8 P eq ;pmemorAeviceswhich If a roof is insialledwithout first obtaining ariins inspection,Pa tee.to remove
` Dismict - fined bythe ByAm.A;r(bmityMmwgemem g P g
Dion aarq '. it cnm t.ora
[3 Y. y�R,''' , - __ all new materials-for inspection Applicant understands and will corn lyXith -
all non- ort t so source re illations=
(�.,: P g k iDbm, rti.
I have reed the haiardoux mate6aH requirements under Ch pter'6.93 of Ne _
Coliform Health'&Safety Cole,Sections 25505,25533 and 25534.1 underaond Nu -
'-( eta m docsnot currently havea¢omni that Bit myicspon of. nsnonotifyone
Oce poan of
the
quircmi most he m m,p t iss....e of Ccdauof
--- Signature.of Applicant ..__ .. ._- .... ._. _ -- - Date,- _-
r, `O t
r
Npdpm agD All roof coverings to be Class "B" or better
_ _ .. ..----OFFICE
# 1
/ STTAL
EP- 0 4 2002
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