01050159 TY
CI
BUILDING DIIVIISIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
23505 OAK VALLEY RD 01050159
OWNER'S NAME: APPLICATION SUB DATE
MINH LE 05/21/2001
I PHONE: SANITARY NO. CONTROL NO.
❑ce Z ARCHITECTIENGINEER: BUILDING PERMIT INTO
w "' LDG LIB PLUMB M[CH
L L J LU
v=yi z LICENSED CONTRACTOR'S DECLARATION Job Description /
I hereby affirm that 1 am licensed miler provisions of Chapter 9(commencing
F_t=w wthSmlon7000)aroisssion3ofrbaBusiness and PmresdonsCode,and mylicense 2ND LIVING UNIT-GUEST HOUSE.
¢m 8 j ism fall force and effect.
z z tee¢ License Class Lic.p
X 0'at;O Data Contractor
ARCHITECT'S DECLARATION
I-`='O g
Y 1 undersrand my plans shall be used as public records
�
ies O Licenmd Pmfeainnal
es. o OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
t_z< following reason.(Section 70315,Business and Profbssions Code:Any city or county $63000
S x o which requires a permit to construct,alter,improve.demolish,or repair any structuregecj3= prior to its osumpec.alsoWapplicantl Pe a file"signa,d staxinert - ---- - --
thathc n dl ittl p -(,fel C imtosi e 1 (Chpmr9 ,j ( l` p 1 Valuation
(coal ng willli Seuot]0 ))ol'Dvisonl sflhc Bumcs undProf..on,coda) �;+; , 1 !34 /'CF� .I�V':L,,."
or that he is eAempt Neofrom'and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant In a civil pauhy
sofa.,mere Nan five henired dollars S50r 303APN KtTklI MECHANI AL'• Occupancy Type
❑I.as owner ofthe property.or my employees with wages as men.sule compensation, _
will do the work,and the structhre is no,intended or abated for sale(Sec.900.
'Businesd and I Professions Cache:The Contractor's License Law does not apply to an 501 - FINAL EI�3V'R(MWtF MRGY
owner of property Who builds or improves thereon,and wno does such work himself
serfnroagn his man employees.pr.... ed thin such improvencns are not intended or __. ._ 505. .; FINAL -ELECTRICAL - ... .._ _..- ..
offs d f ;abF,If however.the building or improveramit ii-.iold'within we year of _
mampl I' ,the owner.n lel will have theburden or proving that head not build or l•
prove for purpose of sale.).
_ L act the
propertp am Business and noammg ns Code:)
Contractor's ro •
nswn the does
no(apply to a Business and Proproperty
who
CWe:)The Contractor's I n it
License ci does nm apply w an owner of property wno builds,v d pupate Norton,
:. rand who comrac'ts(a sash projects wird a.comramgsl_li¢nsed pursuant w one _. . . __ ... .... .. - .._—. .. ... .. __ .._.__ . ._ ..
Contractor's License Law.
_ plata cxemm un, r, c ("/O�' 'YOB&PCronhis recon
of WORKER'S COMPEDateDateNSATION DEC�A AATION �����m�®
:. •.• Iherehy affirm under Penalty of perjury one of the fallowing Jedarnrions' JUL 2 2 2002
❑ 1 have mal will maintain a Cerificao of Consent to self-m ure for Worlds
Compensation:as provided for by Section 3700 of the Labor CWe, for the p
performance of the work for which this permit is bmW. BUILDING
0 nave and will'maimain Worker's Comperoadon Insurance,as meatball by Section —
37W of the Luton Code,for the performance of the work for which this permit is
'-' issued.My Wohcls Compensation Insurance come,and Policy number are:
Carrier. '.Policy No.: t !t c'1 t ,
CERTIFICATION OF EXEMPTION FROM WORKERS'
.'. _,. . ... COMPENSATION.INSURANCE".'. . ......_....___..._. ..... .._..__ ..__. _ ..- .__
. .__ ..-...._. .. _._._._-,_
• (This action need not be cnmplemd if the Permit is for one hundred dollars -
($100)or less.)
' I cenifY aha in th<pcRomunce'r(dte sort fw which Nis permit is ism W.1 - - � � � _. ,, t i � - r•� -
shall not employ any person in any manner so as to became subject to the Workers'
Compensation laws or California Date
Applicant-- . ' .. ..._.__ .. . __ '"_.. _ ._
NOTICETO APPLICANT.It.after making Nis Certificate of Exemption,you should "
become subject to the Workers Compensation provisions of the Labor Code.you must
hwith
Q Q fortcanary,with such provisions or his permit shall be deemed mvoked.
r .. . . ._, ._ _ _ _. .. .. _ . . .- _
J: I -i .y "CONSTRUCTION LENDING AGENCY
a > 1 hereby affirm that there is a construction Icuding agency for Elie performance
of the work for which this permit is issued(Set.YI97.Civ.C.)„
Lender's Namc.. .... ... ... .. ._: _. _ ..
.7 Z Lender's Address
t..l 1 certify that 1 have read this application and stag that[be above infornmtion is
Ls�[.. softest.1 agree to comply with all city and county ordinancex and state laws reltiong
�D U to building construction,and hereby authorize representatives of this city to coronation
`>,.W the above-memioned revive,for i nspection purposes.
E„I CL. (We).,me means.indemnify and keep harmless the Cim of Cupettmo against
Va
Rabaul,ped,ound,costs and nspensex which ,,ay in any way acctoe against said
U .ZiCity in eonsequence'of Ne'gmming or this person:
'APPI, %NDUNDERSTANDS ND WILI COMPLY WITH ALL NON-POINT Issued b Date
SO SCE RF Y'
�� Z
tgms c ppltamadon Date MATERIALS DISCLOSURE ' Re-roofs
HAZARDOUS
Will the applicant or fud building resonant slam or handle haoodoes material Type of Roof - ... .._ ._,..._ .. _.. - .. _ ..
as defined by the Cunrrino Municipal Cale.Chapter 9,l_',and the Health and Safety
Cole. c25532(x)7
'❑Yn :.O Nn
All roofs.shall.be.inspected prior to.any.roofing material being.instaUed. _ -
.
Will the applicant or future building occupant nor equipment ordevce%which If a roof is installed without first obtaining an'inspection,'I•agree to'remove
emit havmdouc air contaminants as defined by the Bay Am Air Quality Management
DBtamo Yes ❑Nn all new materials,for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read Nc h:tor dour materials requirements under Chapter 6.95 of the
California Health&Safely Code.Secllon525503,25533 and 23534.1 understand that
-'if the builJing docs not cuncn0y haveatenbnt,flim it is my responsibilitymnmifythe ,
dciilpnt of the requirementswhy mast to.met prior to Issuance of a Ceriliene of
0c p `y Signature of Applicant Date
4 . . _...
D umori J ascot Date All roof coverings to be Class "B"or better
.. . OFFICE _ ._