02080159- _ OFFICE _..._ ..._._.....
CI BUILDINGUDPERTONNO
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
11221 MONTEREY CT
DON WADE ELECTRIC CO
02080159
OWNER'S NAME:
APPLICATION SUB DATE
TSUI FRANKLIN R AND MOSS ELLE
16320 HARWOOD RD
08/28/2002
PHONE:
(408)377-2323
SANITARY NO. CONTROL NO.
0
ARCHITECTIENGWEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby a?nn ltit lam licensed under pmvisiom of Chapter 9(commencing
Code. license
200 AMP MAIN SERVICE/SPA OUTLET
to
with Sec on9C�lW01 of Division 3 of Ne Business jld Professions and
' in full �rr�J/�e1 1.
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sc
Dale C nl etas
teLicense� -FSE
ARC CTS DE 'I t
/.ask, gym
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h used a records
SEP 0 4 2002
LireneedPas
ca DECLARATION
m1
OWNER -BUILDER
hereby affirm that I am emmW from the Contractor's License Law for the
a
following reason. (Section 9031.5, Business and Professions Castle: Any city or county
$3000
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which requires a permit to construct, alter, impmvc. demolish, or repair any structure
priocto t'' aalso 4 e. Nc pplua tf hpe tiuo (lens coed dxtensno.
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Valuation
tion
- that he s1a sNp—intotleproYeons fN C va t rsL¢cnseLnwlChapler9
9lpgls (D'nsi J fin Busmcsagd Pm&ss ons Codd
IcomrtrnS gs MSecu
or that he it emmpt lhertfrbtn aM Ne naris for the altcged eacmptioh. Any violation
-nf Seetium9031.5 by., upplicnm fm o permit subjeax the applicant m a civil penalry-
lidnotmmethrie.enundreddniwr.(s5an
304APN VM_fNR ELECTRIAli"
Occupancy Type
0 h as owner of the pmp<ny, or no, employees with wages a their sole mon, sation.
S01 -
505 - FINAL EIlRg1 YR,d.I10fkctionsK1N `l B B'dt
--will Jo the 'wadr-and- flu swcmrc is -nor intendedor offered for sale (See.-TBM,.
'Buiine'ss`ainn Profesions GWe: The Contractor's License Law dwas not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided Nm such im or
arc not ore
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er. i, old
c r
;bRetWfor clef lf.'hbwao: On dsRtling or impios4ment is soldwiNin one ycv of.
milder will have the buNcn o(prvving that he did not buil) or
copmsefar
purpose pose
improve for purµhtt Of sole.).
blsm rofdm p(Sm.7 mexdusv tan t fsoms be<nad contmcmtsm
t fLa :`. I'I
Licenses the project (Sec. 9000, Business and Professions Codea The Contractorthereon,
1.
„.t s 1 .. pl'-+':',
License Law does not apply an owner of pmpe who builds or improves thereon,
..And
such.pmJert wiN.a.comractogs).liceved pursuant to the_
who.rommnse , tr
_.._. _.__. _._.... _._. _____.....___...___..._....
7,
L
C ntrvcwrs License Low.,•,
OlamecemptuOder Seci•PC for this,rcason
I 7 i. ,Ct ll';ilpil
-
WORKER'S COMPENSATION DECLARATION
' -I hereby aNrm under penally of perjury one of the following declarations: -
0 I hale"arid 'wily-mairuon'a'Ccnificate of Consent to self -insure for Worker's
Compensation, as, provided -for by Section 3900 of the Lahnr Cade, for the
'
'prdooderm of the work for which his pepnil is issued.;
01 have anti will maintain Worker's Compenotion lawou ce, a< rcyu ocal by Section
-
137M of lhc' Labor Cole, for the pisf,mmuce of he wort fur whicM1 this permit is
'
C. 'li}'C.�✓t Iii Y4�Pdl
rpt t 1, fs♦ +crit
eY ./'VWI.O�/OI�Ir
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/- / i`. : t fw it sy
1 }CERTIFICATION OEEXE ION ROM WOkKERS
" h T - -COMPENSATION INSURANCE- -'•' •
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jpbj�'smrW n" J 1 be campetcJ"f thepe ren is for one hundred dollars
ajar 1..-I u,.,,,.,.• n:.. ..,,:.,. ..:..-
.. _..._.,� _ :_
lcntufytom finer pc dl
in any mannerwto&111.4 becomsubject tot}W
t}hall not employ as n any manner so as to become subject tot. Wo kers
that
'
.t C.on
Cn al nW .nlC f Date
. APPI cam �:, f - .,
is
.. ._._..
�.NOTICL';TOAPYLICANTIf rens making the Certificate ofLemplon. you should
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becove hlettothe o,k,,, Ccompiciotakno pro sions of the Labore c,youmusr
.�
forth lhcmupjseittli ch ante rc
'.: f''s uts'9'CONSTRUCTION LENDINGAGENCY\
lending agency for e perforti -ric
nnetion th
1 hembY bfNm thm there is a com
ti
'of N' work for which this Permit issued (Sec 3097Civ. C.)
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LindeNNm
Lc d AJJ est' H
.IJP' I�r^• :'t)::
nd t t Ili W < information is
I n fy lh el h e ith N aty
F.
and ty N d relating
sconrct Iegrc my, Ply with 11c and r. es
tit
rob IJng wamnndhmby authorize p ft' fin achy to enter upon
r�
tlhepbgve-menuoorJ progeny for inspection p "o,'., -
-City
6i
'(we).'reemsav<:mdemAify and keep harmless the of Cupenindagmnst
cZlliabilities,
judgments, costs and expo ses, which may in any way accrue against said
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City in consequence of the ppranting� fthispci l.,
10N:POI,VP"'
/APPLICANT UNrOERSTANDS ASID WILL COMPLY WITHA
' •-:
Issned b'Asu Date
y
Yc ULATIONS,,,ts�r..l,. I .�.,...,..., -0
Re -roofs
Si r. Appll nUContm m "' -W¢�-
�.a I-AiKARDOUS MATEJUA1S DISCLOSURE WnNe"pplra t«f t rewtmngo w l tore or nawlewz;rda mare al
Type of Roof._ ._
as d f ed by the C pertq Municipal Code, Chapter 9 Q. an the H linand 5 f ry
., ; „, i, ,; l';-11
.spected prior.to.any roofing.matenal being installed. .._._._
,All roofs shall bem
Wnmea��uy mast mwrc wading o<rapant ace equ 'too' which
If a roof is installed'without first obtaining an inspection;'I agree' to renove
airi haudusv col nacos as defndny Ne Bay ArcaA Q It anagement
D. tot ,,;
all new materials for inspection Applicant understands, and will co_ mply with_
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-`all -point
T
non source regulations -,'-,' ...
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e toad the baavdem, mmenet requirement under Chapter 6,95 of the
ealth & Safety Code: Sections 8505,25533 and 25534. bood<tstaud thatgdoes
not currently hate a tenant, that it is my responsibility t0 noliN'ha-
unclBansswhich mtiitbenielpnortoissuanceofaCentficiteof-
L
Da erSignature of Applicant
t1
All roof coverings to be Class "B" or betier .
onrc
- _ OFFICE _..._ ..._._.....