02020081 CI BUOF DIVISION PERMIT
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10-�'7n PAID IIISTA Rn GRErngTog PLUMBING 02020021
OWNER'S NAME: APPLICATION SUB DALE
HSING MARGRET KUNG 292 BARNARO AVE 02/22Z2002
PHONE: SANITARY NO. CONTROL NO.
(408) 286-1103
ARCHITEC tENGINEER: BUILDING PERMIT INFO
00
u F BLDG ELECT PLUMB MECH
z V b LICENSED CONTRACTOR'S DECLARATION Job Description
z._C 1 hereby affmm that I am licensed under provisions of Chapter 9(commencing p
w with Section 0000)of Pit isom 3 ofthc iness and Professions Code.and my license
xxE
ism fell andeBeei REPLACE SEWER LINE .
oma LicenseC C Lica (Gla`(al
i o O _
y
am IT 2/Za /an Commc or er nL
3 i l —� AT RCHITECT'I DEG ATION r M�
understand my plans shall he used as public records
ve nt25 i p O LlcemeJ Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
N
s-S C following moon.(Section 7031.5.Business and Professions Code:Any city or county
�a which mgni.a a pemdt re cnathu,peer,improve,demolish,ri repair mmna. $3000
a3$—poor oth is also q the vomm applicant for such Ticsigned.mmmnt.
hot sl ap ,-,707070 p, m.am<cn mnmraL w (Channel $ .;Ft. F1oor.A[ea t •a'- Valuation
(commencing with Semi -Taal) foist 3f the BusinessadProfessionsCom) `'e1yi•J is ' qq V """'J�\c:7,7h1.
or that he .exempt tnc,efrom and the basis for the alligce=.emixfon Any violation 3 5'7 0 2 0'51. 0�0
—of Section 7031.5 by any applicant for a permit subjects the applicant b a c...-malty .
ter nm Tore ten five nnna.a amuars(sspo). APN Number Occupancy Type
01.as owner ofthe prtemy.or my employees with wages as their sole compensation, 106 — SEWER & WATER
-
will do the work.and the structnrc is not intended or offered for sale(Sec.7mil,- -
BuSinesz and Professions Code:The Common's License Law does not apply to n spe Ions' -
owner of property Who builds or improves thereon,and who docs such work himself 301 - ROUGH P
or through his own employees.Provided that such impnev=mems am not intended or -_5 0 7 - FINAL- -PLUMBING.
-offered forIf h w th b Id g inp email .old th yc (
cruippleti.e.the ms ner-Infilde,will have h huNe f looming tht he did n ,build or '
improve for P rp e l ),
01 to,owner of the P pent' exclusively l �contractors
construct theproject(S ](4sandP so ca )ThCo actors
J
License Law does not apply to an owner of property"no Wilds p s thereon "
mora.¢for s ch pojccts with,a contortions)1 d p rsuant.to the _._ .. .- ...._.-.. _
t '
- f
Contractor's License Law.
0 l am exempt under S _ .B&P C(r this seas on ."sC:
Owner' °'Date"
WORKER'S COMPENSATION DECLARATION '
I hereby if,.under,pcm illy of perjury one of the following deelmmimim
0 1 have and will maintain a Cenificam of Consent to self-insum for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work;of which this permit is issued.
01 have and will maintain WorkWs Compensation Insurance,as required by Section
3100 of the labor C6di,for the performance of the work for which this permit is
rswu J My W k rs Cm npc14m ten Insurance ca J Pub y -he re;
art �WuaL4StAkt:ANJ:PnhcY ��� I I /S�' I11• 'Tel' 1 r! C1 ^Y9 r 1, t
s.CERTIFICATION OF EXEMPTION FROM.WORKERS
' 3� - COMPENSATION INSURANCE)�- a
'(This senors need not W completed tithe permit is for one hundred dollars
151 W)or IessJ
1 C<nif ihm'in thc"� ,.. ' ,w - . . . .
t., - - � pc n anuncc of the work for which this ct to
issued,1' � t :,.ts,. --_(v,
employ any f California.n any manner so res to become subject to the WorAcrs"
Cmdpenxation lows of CalifoDao'
NOTICE TO APPLICANT:eWork 1L after makingCompensation
this vision o of e,Awl Exemption.Code,o u ould
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z become iuomply thesuch 'scoier,cotiom permit hall dewed m,.kroumutt'
O O fon- -comply with such provisions or this permit shell W deemed invoked.
F4 '"+ l " CONSTRUCTION LENDING AGENCY - ,
- I hereby affirm tem them s a eonstmct on lending ngevmy f the performanceof th�,orlk i'
CL Lender's Name or which this permit is issued(See.3397
,Civ.C.)
.7 z Lender's Address
V 0 1 center that I have mad this application and state that above information is
W.U toren.I agree on comply with all city and county rolonnces and stem laws relating
O, .0Wilding conswnion:and hereby authorize'repm natives ofthis city o enter upon
W 1M1e ebm�egmcm,. nn pmpeny for inspection purposes,
(We)ag.etoesave,indemnify and lamp hemnleas it Cay'br Cupcnino'against
-V1 liabilities,judgments,costs and expenses which may in any way accrue against said
Q z City in consequence of the granting of this permit. - `
APPLICANT UNDER$TANDS•AND WILL COMPLY WITH ALL NON-POIM"' • (/
V U;;L I�•vt �2/LUe Issued by: ate
c
Signature° ppllcannUmorraceri TT Re-roofs
/ HAZARDOUS MA' LS DISCLOSURE 1' "
t Wn'tlictt,h t far.Wilding stop t m rc or handle restaurants mm al _ ..Type of.Roof
as defned by tb C pen o M p I Cod Ch pt 9.12 end Ne H Ito nn0 Sof ry -
G,deSection 25fR( ) t- 1 + ', 31 Ja !A -9 s., -f, s S-t!11,• '
_All roofs-shall_be,mspecfed_prtor,to any roofing material being installed.
Will the,applicant or future building uccupam use equipment or devices which If a roof is installed without first obtaining arrinspec[ion,d'agree to remove
emit he d lair amt t defined by the Be,Area A i Qumity Management
Daniel? all new materials for inspection.. Applicant understands and will comply with
ores all non-pomf source regulations. .
I haLc'rcad the hazoolmo n o trials requirements under Chapter 6,95 of fie
California Health&Safety Code,Sections 25505.25533 and 25534.1 understand that
-ifthc Whim,due,notcurncnd have a moan,that it is my responsibility to notify the
pant of Ji req eine tiwhich'm.,I be i prior to i'vio c of C<nificme of
a
pope
c
Signature of Applicant. Date _
�h� LZf" v 7>b�Z tlo All roof coverings to be Class "B"or better
e,m:m dge,t ata_ g
a:
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-OFFICE . .. . .. ... - _. ._ . .. ..